Thirteen Public Interventions in Canada That Have Contributed to a Reduction in Health Inequalities
The following summary report details policies and programs in Canada that have had some measure of success in reducing health inequalities.
The National Collaborating Centre for Healthy Public Policy asked researchers at a research centre on health inequalities, Centre Léa-Roback, to report on programs and policies in Canada whose results have been evaluated using current medical evidence-based standards, including an evaluation of the quality of published evidence used in clinical guidelines.
Public health actors interested in promoting healthy public policies are concerned that these policies be based on a rigorous application of sound methodologies. Policies and broad government programs, in other words, are ideally based on what has been proven to work. Working with actual populations in social contexts, however, is not the same as working in a laboratory where the researcher has far more control over the experiment. Working with health inequalities and the social determinants of health may make the application of evidence-based standards even more difficult. Notably, in the recently completed report of the Commission on the Social Determinants of Health, the World Health Organization concluded, “had the commission made a decision to rely on evidence solely from well-controlled experiments, this would be a short report with only biomedical evidence-based recommendations and the conclusion that more research is needed” (WHO, 2008, p.42). This abridged report attempts to highlight the publications which have relied on biomedical evidence-based approaches to evaluating the effectiveness of past and current policies and programs that seek to address health inequalities.
The report summarizes the findings from 13 cases. Interestingly, when comparing these results with a report published by the Canadian Institute for Health Information (Ross, 2003), we found that some six years later, very few additional cases had been evaluated. The fact that many of these programs were discussed in the 2003 report emphasizes the fact that few policies/programs are subject to this kind of evaluation. In other words, there are only a few policy/program initiatives that have been systematically studied, particularly over a long period, for which we have results. Although perhaps frustrating from a research point of view, this is not surprising given the nature of health inequalities, referred to above, and the difficulty of isolating the policy or program variables that might be directly measured. This situation underlines the need for a variety of methodological tools for carrying out this type of evaluation.
The following is a summary of a longer document produced by the Centre Léa-Roback on the 13 policies/programs examined, including the basis for their selection and the criteria used to evaluate their success. We hope that this will be useful to public health actors working in the area of the social determinants of health.