Targeting within universalism has been identified as a promising practice to reduce inequities in health. This practice focuses more intensely on improving the health of more disadvantaged groups through targeted programs, while at the same time offering universal services to improve the health of the entire population. This approach is often used in conjunction with the promising practice of supporting early child development. Public health programs are designed to support the healthy development of all children with a special emphasis on children living in disadvantaged circumstances.
A good example of this combination of promising practices can be found in the Manitoba public health strategy of contacting all new mothers within 24 hours of discharge from hospital with an offer of nursing services. This universal service includes an assessment of the need for more intensive supports, which are provided through a targeted Families First program.
Eligibility for Families First is based on the results of a universal screening tool that is completed by public health nurses. Families who screen positive on three or more risk factors are further assessed using a second Families First Parent Survey screening tool. The Parent Survey screens for 38 different risk factors and identifies families that would benefit from intensive public health support. These families are offered Families First services and they can choose to enroll or not.
Families First is an example of an equalizing program as it invests in the development of the most deprived young children. Home visitors work with families in their own homes for up to three years. The home visitors are paraprofessionals trained to administer the Growing Great Kids curriculum and are supported by public health nurses through weekly reflective practice supervision.
An evaluation of this program shows families that participated in the program developed stronger positive parenting skills, experienced a decrease in negative or hostile parenting practices, increased their social supports and felt a stronger connection to their community. The evaluation data showed increased social support and neighbourhood cohesion, which also helped protect families against other stress factors.
However, the evaluation also showed that some mothers enrolled in the program continued to struggle with depression and/or other mental health issues. In response to these findings, the provincial government worked closely with the WRHA to strengthen mental health training available to home visitors and public health nurses.
Please visit the NCCDH Resource Library for related materials, including:
- Building a business case for preventive home visiting for pregnant women and mothers of young children: A review of the literature, NCCDH 2010
- Learning from practice: Targeting within universalism, NCCDH 2014
- Let's talk… Universal and targeted approaches to health equity, NCCDH 2013
- VIDEO: Public Health Speaks: Advancing health equity through targeted universality, NCCDH 2013
We would like to hear from you! What have your successes been in using targeting within universalism and early child development as practices to improve health equity? What resources do you find helpful? Please send your ideas and examples to Lesley Dyck, Knowledge Translation Specialist.
With thanks to Helena Wall and Darlene Girard for their help in preparing this story. For more information on the work of Manitoba Health and the Winnipeg Regional Health Authority, please visit our database of health equity champions.