What is the Health Equity Impact Assessment (HEIA)?

Module B

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How do we Improve Equity in the Health System?

• Ensure equitable provision of high quality healthcare regardless of circumstances and make sure that all individuals and communities get the care they need

• We can do this by:1. Building health equity into all health planning and delivery

doesn’t mean all programs are all about equity but all take equity into account in planning their services and

outreach2. Targeting some resources or programs specifically to addressing

disadvantaged populations or key access barriers looking for investments and interventions that will have the highest

impact on reducing health disparities or enhancing the opportunities for good health of the most vulnerable

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HEIA is a structured method to include equity in health planning and decision making

• HEIA is a practical tool for assessment and decision support

• It helps to address and anticipate any unintended health impacts that a plan, policy or program might have on vulnerable or marginalized groups within the general population.

• It builds on existing work and creates greater consistency and transparency in the way that equity is being considered across the health system.

• The end goal of HEIA is to achieve health equity and eliminate disparities in health.

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The HEIA tool includes a template and a workbook, which provides step-by-step instructions on how to complete the HEIA template.

Template & Workbook – core components of HEIA

HEIA tools have been adopted in a number of jurisdictions

• Including Australia, New Zealand, the United Kingdom.

• HEIA is also used and advocated by the WHO.

• The Ontario HEIA tool was developed by MOHLTC in collaboration with the province’s Local Health Integration Networks (LHINs) and a second edition was recently launched with Public Health Ontario. It incorporates international evidence as well as input gathered during regional pilots and conversations with health service providers.

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Video Clip

Dr. Kwame McKenzie, Director of the Canada Institutes of Health Research Social Aetiology of Mental Illness Training Centre, Senior Scientist of Social Equity and Health Research, Deputy Director of the Schizophrenia Program at the Centre for Addiction and Mental Health. He is a Professor of Psychiatry at the University of Toronto and sits on the Service System Advisory Committee of the Mental Health Commission of Canada

3.15.34 - 3.24.25 - Kwame MacKenzie on CAMH being an early adopter of HEIA and why, the use of HIA in the UK and how he got support of CAMH to apply HEIA and where it was applied

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Health Equity Impact Assessment (HEIA) helps users to align services/policies/programs with need—enabling better health outcomes

Source: Health Equity Audit: A Guide for the NHS, UK Department of Health

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In this simplified example, there is a match between need and high services/programs: a desirable situation

Source: Health Equity Audit: A Guide for the NHS, UK Department of Health

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In this simplified example, those with the most need experience the wrong type of service/policy: the undesirable “inverse care law”

Source: Health Equity Audit: A Guide for the NHS, UK Department of Health

Group Discussion

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Can you think of an example that you are aware of where the inverse care law exists in Ontario?

Please discuss as a group and choose one example to share with the larger group.

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In the UK HEIA has driven value and results

Source: Health Equity Audit: A Guide for the NHS, UK Department of Health