'It doesn't happen any other way': relationship-building and reflexivity for equity-focused intersectoral practice (EquIP).

Intersectoral processes that bring together public institutions, civil society organizations and affected community members are essential to tackling complex health equity challenges. While conventional wisdom points to the importance of human relationships in fostering collaboration, there is a lack of practical guidance on how to do intersectoral work in ways that support authentic relationship-building and mitigate power differentials among people with diverse experiences and roles. This article presents the results of RentSafe EquIP, a community-based participatory research initiative conducted in Owen Sound, Canada, in the midst of a housing crisis. The research explored the potential utility of equity-focused intersectoral practice (EquIP), a novel approach that invests in human relationships and knowledge co-creation among professionals and affected members of the community. The three-phase EquIP methodology centred the grounded expertise of community members with lived/living experience of housing inadequacy to catalyze reflexive thinking by people in professional roles about the institutional gaps and barriers that prevent effective intersectoral response to housing-related inequities. The research demonstrated that EquIP can support agency professionals and community members to (i) engage in (re)problematization to redefine the problem statement to better include upstream drivers of inequity, (ii) support reflexivity among those in professional roles to identify institutional practices, policies and norms that perpetuate stigma and impede effective intersectoral response and (iii) spark individual and collective agency and commitment towards a more equity-focused intersectoral system. We conclude that the EquIP methodology is a promising approach for communities seeking to address persistent health equity and social justice challenges.

Glossary of health equity in the context of environmental public health practice.

Health equity is increasingly present as an overarching goal in public health policy frameworks across the globe. Public health actions to support health equity are challenging because solutions to the root causes of health inequities often lie outside of the health sector, and a specific role for environmental public health practitioners has not been clearly articulated. The regulatory nature of the environmental public health profession means that their role is particularly ambiguous. Still, environmental public health practitioners are well situated to identify and respond to factors that contribute to health inequities because of their role as front-line professionals who interact with a wide cross-sector of the population. This Glossary, rooted primarily in the Canadian context but drawing on lessons from elsewhere, describes environmental public health regulatory practice in relation to health equity, including approaches that practitioners can use to contribute to addressing the social determinants of health.

Glossary of health equity concepts for public health action in the Canadian context.

Despite increased interest in addressing health equity through public health initiatives, practitioner and decision maker comprehension of core concepts is limited and inconsistent. Absence of a shared understanding of equity and related terminology contributes to lack of coordinated solutions as practitioners focus on individual level issues, unrelated to social justice. Taking action to decrease population health inequities requires a comprehension of where inequities are rooted, who is affected and interventions that consider the complexity of inequities being addressed. Public health decision making would be strengthened with greater common understanding of health equity concepts and terminology as an initial step to collaborative action. This glossary defines key concepts related to health equity in public health practice as well as broad-level approaches for taking action on health inequities at a population health level. Exploring terminology in this way supports going beyond individual practitioner responsibility and shifts towards organisational accountability for action.

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity.

BACKGROUND: Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. METHODS: A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. RESULTS: Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. CONCLUSIONS: This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.