Increasing Organizational Capacity for Health Equity Work: A Literature Review for Health Nexus

By Chase Simms, Practicum Student

In January 2017 I began my MPH practicum at Health Nexus. The focus of my practicum was to conduct a literature review on health equity, to support the health equity capacity that Health Nexus developed in 2016.

At first I was overwhelmed with the huge amount of information related to health equity available, which is why I wanted input from the health promoters who would be using and applying this research into their everyday work. Informal conversations with health promoters ensued, and their concerns boiled down to the following question, ‘what can I do to promote health equity?’ Voilà! I knew I had to produce recommendations for tangible health equity actions for practitioners and their organizations. Thus, I began my literature review on health equity organizational capacity.

Although there were thousands of articles about health equity, there was a limited amount that was specific to organizational capacity in Canadian organizations. Following thorough appraisal and synthesis steps, 46 articles were included in the literature review. The majority of these articles were found within the grey literature through organizations such as National Collaborating Centre for Determinants of Health (NCCDH) and the Wellesley Institute. Table 1 illustrates the framework developed based on the literature review findings to improve health equity organizational capacity.

Table 1: Framework: Health Equity Organizational Capacity

Evidence Base, Knowledge Translation and Exchange

Collaborate

Competencies

Embed Equity

Core Foundation: Strong and Effective Leadership

Although this framework was developed specifically for health promotion organizations, it could be adopted by non-health related organizations and staff who have a desire to increase their health equity capacity. Specific implications, barriers and actions for each of the framework themes are outlined in Table 2. In addition, there were distinct best practices applicable for all five themes. In particular, integrating evaluation and reporting to increase overall accountability. These best practices could include establishing and utilizing performance measurements and health equity indicators.

Table 2: Theme implications, barriers, and actions for health equity work

Theme

Implications

Barriers

Actions

Strong and Effective Leadership

Key factor to address social determinants of health (SDOH)

Supports equity work, both operationally and philosophically

Passion, conviction and resources

Wicked’ problems

Resources (budgets, organizational supports)

Lack of momentum and support

Clear mandate

Organizational commitment and readiness

Performance measurements, evaluation and health equity indicators

Continuously Expand the Evidence Base to Support Best Practices and Foster Knowledge Translation and Exchange

Necessity of equity data collection

“Build knowledge we can act on”

Role of researchers

Knowledge Translation Models

The existing evidence base and limitations

Insufficient systems

Lack of coordinating systems

Staff capacity

Project management

Create and use a strong knowledge base

Theoretical and methodological innovations

Collaborate and Partner with Intersectoral Stakeholders and Communities

Better comprehension of the problem under investigation

Capacity to address future issues through partnerships and confidence-building

Time, relationship building, evaluation, common language and capacity building

Competing agendas, communications and engagement, imbalance of power, managing and diverse expectations

Borrow resources and tools, provide mutual support, network

Working groups

Community engagement

Comprehensive strategies and strategic directions

Demonstrate and Increase Competencies

Provide the building blocks for effective public health practice

Resources needed to update current competencies

Ongoing training, supportive learning environment and updated competencies

Embed Equity into the Organization’s Mandate, Policies and Procedures

Apply a health equity lens Clear duties and expectations

Lack of resources and understanding

Clear mandate and enabling infrastructure

After reading the literature review, practitioners may feel slightly anxious about the sheer amount of recommended actions. Practitioners may think ‘how am I supposed to do all these things while my current workload is already chaotic?’ Fortunately, these actions do not have to take place in one fell swoop: health equity work takes time to be fully implemented and integrated within an organization.

If organizations are able to establish a phased implementation approach, staff members and the organization as a whole will not feel overwhelmed completing this work all at once. The evidence has clearly articulated that effective health equity work begins with strong and effective leadership. Beginning with this core foundation of the literature framework would serve as an ideal first step for organizations to adopt in their pursuit to increase their capacity to increase meaningful health equity work.

Read the full literature review.