Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review.

OBJECTIVE: The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective was to identify implementation strategies and indicators being used to integrate and measure health equity. INTRODUCTION: To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. INCLUSION CRITERIA: This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). METHODS: This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were screened for eligibility followed by a full-text review to determine inclusion. The information extracted from the included studies consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data were quantitatively tabulated and presented according to 5 secondary review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings were visually presented in charts and diagrams or presented in tabular format. RESULTS: Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (108 scholarly and 14 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity, and we found that both indicators and strategies lacked adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. CONCLUSIONS: Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems, and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. REVIEW REGISTRATION: DalSpace dalspace.library.dal.ca/handle/10222/80835.

Physical Activity Trajectories in Early Childhood: Investigating Personal, Environmental, and Participation Factors.

INTRODUCTION/PURPOSE: To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years. METHODS: Two hundred seventy-nine children (4.5 ± 0.9 yr, 52% boys) were included in this study. Physical activity was collected via accelerometry at six different timepoints over 6.3 ± 0.6 yr. Time-stable variables were collected at baseline and included child's sex and ethnicity. Time-dependent variables were collected at six timepoints (age, years) and included household income (CAD), parental total PA, parental influence on PA, and parent-reported child's quality of life, child's sleep, and child's amount of weekend outdoor PA. Group-based trajectory modeling was applied to identify trajectories of moderate-to-vigorous PA (MVPA) and total PA (TPA). Multivariable regression analysis identified personal, environmental, and participation factors associated with trajectory membership. RESULTS: Three trajectories were identified for each of MVPA and TPA. Group 3 in MVPA and TPA expressed the most PA over time, with increased activity from timepoints 1 to 3, and then declining from timepoints 4 to 6. For the group 3 MVPA trajectory, male sex (ß estimate, 3.437; P = 0.001) and quality of life (ß estimate, 0.513; P < 0.001) were the only significant correlates for group membership. For the group 3 TPA trajectory, male sex (ß estimate, 1.970; P = 0.035), greater household income (ß estimate, 94.615; P < 0.001), and greater parental total PA (ß estimate, 0.574; P = 0.023) increased the probability of belonging to this trajectory group. CONCLUSIONS: These findings suggest a need for interventions and public health campaigns to increase opportunities for PA engagement in girls starting in the early years. Policies and programs to address financial inequities, positive parental modeling, and improving quality of life are also warranted.

Strategies and indicators to address health equity in health service and delivery systems: a scoping review protocol.

OBJECTIVE: The purpose of this review is to describe how health service and delivery systems support health equity, and to identify strategies and indicators being used to measure health equity. INTRODUCTION: It is widely acknowledged that a population health and equity approach is needed to improve the overall health of the population. The health service and delivery system plays an important role in this approach. Despite this, system transformation to address health inequities has been slow. This is due, in part, to the lack of evidence-based guidance on how health service and delivery systems can address and measure health equity integration. Most studies focus on health equity integration in the public health sector at a provincial or national level, but less is known about integration within the health service and delivery system. More information is needed to understand how that transformation is occurring, or could occur, to make a meaningful contribution toward improving population health outcomes. INCLUSION CRITERIA: This scoping review will identify studies that describe the strategies and indicators that health service and delivery systems are using to integrate health equity and how progress is measured. Evidence from qualitative, quantitative, mixed method studies, and gray literature will be included. METHODS: This review will be conducted in accordance with JBI methodology for scoping reviews. A comprehensive search strategy, developed with a librarian scientist, will be used to identify relevant sources. Titles, abstracts, and full texts will be evaluated against inclusion criteria. Information will be extracted by two independent reviewers. Data will be synthesized and presented narratively, with tables and figures where appropriate.

Fare well to Nova Scotia? Public health investments remain chronically underfunded.

Inspired by Fiset-Laniel et al.'s (2020) article entitled "Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada", we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015-2016 to 2019-2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5-6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015-2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.

RéSUMé: Inspirés par l'article de Fiset-Laniel et coll. (2020) intitulé « Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada ¼, nous avons évalué les investissements en santé publique depuis la fondation de l'autorité sanitaire provinciale de la Nouvelle-Écosse en 2015. Nous avons analysé les budgets du ministère de la Santé et du Mieux-Être de la Nouvelle-Écosse de 2015−2016 à 2019−2020 et nous avons observé que moins de 1 % du financement était prévu pour la santé publique annuellement, un montant bien inférieur à la recommandation que 5−6 % du financement pour les soins de santé soit dépensé sur la santé publique. Les dépenses de santé ont augmenté annuellement depuis 2015−2016, mais les proportions du financement consacrés à différents programmes et services ont demeuré statiques. Spécifiquement, nous n'avons pas observé de changement dans l'investissement en santé publique au fil du temps, indiquant que tandis que le gouvernement ne dépense pas nécessairement trop ou trop peu sur les soins de santé, il dépense bien trop peu sur la santé publique. Ce sous-financement chronique est problématique étant donné les hauts taux de maladies non transmissibles en Nouvelle-Écosse et les inégalités en matière de santé qui existent au sein de la population. La pandémie de la COVID-19 de 2020 a souligné l'importance du travail lié à la santé publique, ainsi que la nécessité d'un plan de rétablissement suite à une pandémie qui priorise l'investissement dans tous les domaines de santé publique en Nouvelle-Écosse.

Development of the Physical Literacy Environmental Assessment (PLEA) tool.

Physical literacy is becoming increasingly popular in sport, recreation, physical education and physical activity settings and programming. We developed an environmental assessment tool to evaluate the extent child and youth activity programs implement physical literacy across four domains: environment, programming, leaders and staff, and values and goals. The Physical Literacy Environmental Assessment (PLEA) tool was developed in 3 phases. First, the PLEA tool was created, content validity established, and physical literacy leaders were consulted. In the second phase, the PLEA tool was completed and tested by 83 child and youth programs and it was validated with individual physical literacy assessments completed on children in programs that scored in the top 10% and bottom 10% on the PLEA tool. Third, a National consultation was conducted, and program leaders provided feedback on the PLEA tool. In Phase 1, the PLEA tool was modified and shortened from 41 to 29 indicators, based on feedback from physical literacy content leaders. In Phase 2, participants in programs that scored in the top 10% had significantly higher scores on the upper body object control domain of PLAYfun (p = 0.018), and significantly higher PLAYself scores (p = 0.04) than participants in programs that scored in the bottom 10%. In Phase 3, over 80% of program leaders identified the PLEA tool was useful, and relevant to their areas of practice. The completed PLEA tool is a 20-item environmental assessment tool to evaluate to what degree child and youth programming implement physical literacy across four domains: environment, programming, leaders and staff, and values and goals. The application and validity of the PLEA tool beyond child and youth physical education, sport, dance and recreation sectors, such as in early years programs, should be investigated.