The U.S. Institute of Medicine [IOM] identifies six connected pillars of quality healthcare: efficiency, effectiveness, safety, timeliness, patient-centeredness, and equity . The inclusion of equity is based on strong evidence showing that inequities reduce health-care quality.
Healthcare research on the link between equity and quality shows that:
- Equity is embedded in all components of quality healthcare
- Equity is a necessary condition for a “Culture of Quality” in hospitals
- Unchecked inequity leads to increased pressure on hospital services, avoidable future costs, and reduced productivity
- Inequities in health care have an impact on quality, cost, safety and risk management
Health Equity in Canada
- Health equity research in Canada tells us that: “Equity-relevant variables such as income and race matter more than health behaviour in determining Canadians’ health outcomes.1
- Children from low-income families require more hospital stays and show increased vulnerability to various illnesses, accidental injuries, and mental health problems.2
- Living conditions, age, income, immigrant status, and race significantly affect diabetes, cardiovascular disease, mental health, and self-reported health.3
- Economic and social conditions such as income, education, race, and housing significantly affect Canadians’ physical and mental health beyond their lifestyle choices and available medical treatments.4
- Inequity is expensive. A Public Health Agency of Canada report states “inequities are health system cost drivers” with approximately 20% of total health care spending being attributed to income inequality.5
Demographic Data and Health Equity
Identifying and addressing inequities requires long-term strategic planning and a multi-step approach.
Planning for equitable and quality healthcare
- Collect patient-level demographic data: This step will give hospitals a comprehensive picture of the community they serve and the characteristics of patients in their care. When done properly, demographic data will serve as “a fundamental building block” for identifying health inequities and gaps in quality of care .
- Identify and Report inequities in care: The second step is to examine differences in health outcomes based on demographic variables such as race, language, and income.
- Implement solutions to reduce inequities: Hospitals can address special patient needs based on language, disability, religion, and so forth, and develop programs to target populations disproportionately suffering from adverse health outcomes.
Ultimately, demographic data can be used to develop “identify and report” graphs:
Age-standardized prevalence of diabetes among urban-dwelling immigrants*, by sex and world region of birth, and among urban-dwelling long-term residents^ in Ontario (2005)
* Granted residency status in Canada between 1985-2000
^ Canadian-born residents and people granted permanent residence prior to 1985
(Source: Bierman, A. S. et al. (2012). Social determinants of health and populations at risk. Ontario Women’s Health Equity Report: Improving Health & Promoting Health Equity in Ontario)
Additional examples of how demographic data can help us understand plan for health equity:
Hospitals in the US and the UK who have been collecting demographic data for a while have started using it to identify, address, and reduce inequities, as illustrated in ‘Best Practice’ case below.
Why standardize data collection?
The variation in research tools and data collection methodologies across Canadian hospitals makes it difficult to compare findings and build on existing knowledge.
Dr. Paula Braverman, a pioneer in health equity, points out that inconsistencies in methodologies and questions make it difficult to measure the impact of interventions 6
A standardized method of collecting data in hospitals reaches as many patients as possible, ensures greater control of data quality, and facilitates data sharing and hospital comparisons
Assign Project Lead
Project Lead Responsibilities
The Project Lead will oversee the planning and implementation of demographic data collection across the hospital. This individual will:
- Act as main liaison with Toronto Central LHIN
- Lead Steering Committee meetings
- Maintain timely, effective communication between hospital staff and senior leadership
- Act as an internal champion for advancing equity through data collection
- Oversee the development of a work plan, including goals, deliverables, and timelines
- Monitor the project’s progress in accordance with work plan
- When necessary, troubleshoot problem areas and devise a contingency plan with Steering Committee
Project Lead Qualifications
The most important quality is the ability to encourage cooperation from management, staff, and patients. The ideal Project Lead will also have:
- Knowledge of equity issues, including inequities in healthcare and existing access barriers
- Experience working with the planning for and/or delivery of quality care
- Strong familiarity with the hospital’s structure and culture
- Ability to be persuasive, encouraging, and motivating
The Project Lead will be supported by the Health Equity Project Coordinator who will provide resources, information, and assistance with developing strategies to meet project goals.
- Canadian Institute on Children’s Health. (2000). The Health of Canada’s Children: A CICH Profile 3rd Edition. Ottawa, Canada: Canadian Institute on Children’s Health. ↩
- Institute of Medicine, Committee on Quality of Health Care in America, IOM (2002). Crossing the Quality Chasm. Washington, DC: National Academy Press. ↩
- Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto. York University School of Health Policy and Management. ↩
- Bierman, A. S. et al. (2012). Social determinants of health and populations at risk. Ontario Women’s Health Equity Report: Improving Health & Promoting Health Equity in Ontario. ↩
- Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security, Health Disparities Task Group (2004). Reducing Health Disparities – Roles of the Health Sector: Discussion Paper. ↩
- Braverman. P. A. (2003). Monitoring equity in health and healthcare: A conceptual framework. Journal of Health Population and Nutrition, 21, 181-192. ↩