{"id":14390,"date":"2013-10-29T09:00:20","date_gmt":"2013-10-29T09:00:20","guid":{"rendered":"https:\/\/nccdh-dev.media-doc.ca\/the-power-of-people-and-systems-1-2\/"},"modified":"2025-10-01T19:25:50","modified_gmt":"2025-10-01T19:25:50","slug":"the-power-of-people-and-systems-1-2","status":"publish","type":"post","link":"https:\/\/nccdh-dev.media-doc.ca\/fr\/the-power-of-people-and-systems-1-2\/","title":{"rendered":"The power of people and systems – An interview with Dr. Bernie Pauly"},"content":{"rendered":"

\n\tOn December 3rd, we will be hosting an interactive webinar<\/a> about the people and systems that support equity-oriented approaches in public health practice.  <\/p>\n

\n\tHelp us create the content for this celebrity-interview-style webinar.<\/p>\n

    \n
  1. \n\t\tConsider the question posed each week by Hannah Moffatt while reading an excerpt interview from Public Health Speaks: Organizational standards as a promising practice to advance health equity<\/a><\/li>\n
  2. \n\t\tJoin us in an online conversation held from November 26th to December 3rd in our Health Equity Clicks community<\/a><\/li>\n<\/ol>\n

    \n\tConsider this question when reading the below excerpt:<\/p>\n

    \n\t                     How does understanding the social determinants of health and health equity influence public health system renewal in Canada?<\/strong><\/em><\/p>\n

    \n\tPublic Health Speaks: Comparing the Ontario and British Columbia Renewal of Public Health Systems. A conversation with Dr. Bernie Pauly, RN, PhD, Associate Professor, School of Nursing, University of Victoria, and Scientist, Centre for Addictions Research of British Columbia<\/strong><\/p>\n

    \n\tConnie Clement, the Scientific Director of the National Collaborating Centre for the Determinants of Health (NCCDH) sat down with Dr. Bernie Pauly from the School of Nursing at the University of Victoria and co-principle investigator of the Renewal of Public Health Systems (RePHS) research program on December 5, 2012. They discussed organizational standards as a promising practice to address social inequities in health as well as Dr. Pauly’s experience working on the RePHS team.<\/em><\/span><\/p>\n

    \n\tRePHS is a study to advance our renewal of public health systems knowledge. The project is co-led by Drs. Marjorie MacDonald and Trevor Hancock. The research involves examining public health renewal processes in Ontario (ON) and British Columbia (BC) that experienced investments and sought to strengthen the public health sector of the health system.<\/em><\/span><\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement:<\/strong> Could you tell us a little bit about the renewal of public health systems (rephs) research initiative?<\/p>\n

    \n\tDr. Bernie Pauly:<\/strong> The Renewal of Public Health Systems project is a program of research comparing British Columbia and Ontario in terms of implementation of public health renewal. In Ontario specifically this was the introduction and renewal of the public health standards and in British Columbia the initial impetus was the introduction of the British Columbia core functions framework. This research arose out of the calls for public health renewal that were related to a series of crises, including SARS (Severe Acute Respiratory Syndrome) and calls to strengthen the public health system in our country. Part of the research involves looking at how health equity is being incorporated as part of public health standards in public health organizations in British Columbia and Ontario. The document review involved taking the standards in Ontario and the core functions documents in British Columbia and doing an analysis to try to understand how equity was being talked about and what kind of strategies were recommended or being implemented.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement:<\/strong> What were your key research findings about how health equity was conceptualized and incorporated into these two provincial sets of documents?<\/p>\n

    \n\tDr. Bernie Pauly: <\/strong>In the British Columbia core functions framework, there was a clear direction to incorporate a health equity lens into the delivery of public health programs. There was the overal lintent to improve the health of the population and also to ensure that health equity was specifically addressed to avoid unintended consequences. This spawned a lot of activity and engaged people in asking the question, ‘how do I integrate or implement a health equity lens in my work?’. Each of the regional health authorities in British Columbia interpreted and took that up a bit differently, and we are learning more about this in the Renewal of Public Health Systems project.<\/p>\n

    \n\tIn the British Columbia documents, there was a clear commitment around the importance of reducing health inequities. Health inequities were defined very much as Whitehead and Dahlgren (2006) have described them, in terms of being differences that are unfair and avoidable. There was also a focus on ‘vulnerable populations’ and identifying those people who because of their socio-cultural status, lack of economic resources, age or gender should be a focus. The actions to reduce health inequity included a focus on: measuring or quantifying the degree of health inequities; making the social determinants of health a priority; and identification of the need for specific action, particularly advocacy, to reduce health inequities. There was a fair bit of focus on the need for a political commitment to health equity and also the importance of working directly with communities and across sectors. In a subsequent project, the Equity Lens in Public Health (ELPH) project, we are more specific at answering the questions around ‘how do we make health equity a priority?,’ ‘how do we work intersectorally?,’ ‘what are some of the tools that can support this?’ and ‘what are some of the ethical issues that public health practitioners face in promotion of health equity?’.<\/p>\n

    \n\tComparatively, in the Ontario Public Health Standards there was an emphasis on the differences between health inequalities and health inequities but not an explicit equity lens. Ontario, like British Columbia, embraced the fact that they wanted to focus not just on differences but those differences that were unfair, unjust, and avoidable. So the way health inequities were defined was actually quite similar in Ontario and British Columbia and the term ‘health inequities’ is visible as you read through each of the documents. However health equity as a key pillar to improving population health may come out a bit more strongly in British Columbia because of the equity lens in the original British Columbia core functions framework.<\/p>\n

    \n\tA key difference between the two provinces was the choice of language used to talk about equity. In Ontario, ‘priority populations’ was used to identify those at risk, as opposed to the language of ‘vulnerable populations’ used in British Columbia. In British Columbia, there was a specific emphasis on Aboriginal people compared to Ontario. Another point of difference is that in British Columbia, the core functions framework was a means of informing public health planning processes as British Columbia does not have legislated standards. Whereas in Ontario, the standards were legislated, this made it more difficult to incorporate equity in the same way. However, implementation is a bit clearer in Ontario because the standards are mandated. In Ontario the activities to reduce health inequities focused on surveillance and measurement; removing barriers to access to public health programs; and developing partnerships and collaborations. There is a stronger focus on action and advocacy for health equity in the British Columbia documents. Both sets of documents do highlight that reducing health inequities is a responsibility that is shared by many sectors not just health.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement: <\/strong>What do you think are the implications for practice between taking a vulnerable approach or a priority approach to defining populations? I think for many practitioners, they have seen a language shift about every five years.<\/p>\n

    \n\tDr. Bernie Pauly:<\/strong> That is an excellent question. I think what we’re starting to see is that the language of vulnerable or priority populations tends to lead people to say well ‘who are the groups?’ or ‘who are the people that are experiencing health inequities?’ The focus tends to be placed on the groups rather than the broader conditions that create inequities. For example, “the homeless” may be viewed as a group of people without housing in need of individual-level intervention, as opposed to recognizing the effect of structural conditions that affect homelessness such as an inadequate supply of affordable housing or the history of colonization. We need to think about ‘what are the structural conditions in which vulnerabilities are created?,’ instead of only the groups we see being affected and at risk. I think it can be a bit of a trap to start labelling.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement:<\/strong> Were you able to discern key elements that supported the integration of health equity into the standards or functions in each province?<\/p>\n

    \n\tDr. Bernie Pauly:<\/strong> I think one of the things that have supported the integration of health equity has been the 2008 World Health Organization Commission on the Social Determinants of Health Closing the Gap in a Generation report. It’s fairly easy to see how that document had a tremendous influence on the provincial documents we reviewed, and the way in which people took that report up to try to say ‘this is important for us, so how are we going to operationalize this?’ In British Columbia, we’ve had a lot of activity around the equity lens and I think people in public health have been asking the questions -‘what is an equity lens?,’ and ‘how do we analyze data from an equity perspective?.’ Also in British Columbia, the Public Health Services Authority has started developing a specific set of health equity indicators which will be available to all health authorities. I think some of the documents in Ontario that were developed around health equity have also been influential, such as the First Steps to Health Equity concept paper. Further, Sudbury & District Health Unit’s review of the literature on promising practices, and the increased availability of related resources such as their video focusing on the social determinants of healthhave improved our understand.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement<\/strong>: What do you think some of the barriers were to getting health equity strongly integrated in public health, and what can be done to address those barriers?<\/p>\n

    \n\tDr. Bernie Pauly:<\/strong> I think one of the barriers is that public health is a fairly small part of any health care system. Getting health equity as a priority in that bigger system has been a specific challenge and I think that is a huge undertaking. Public health is a small, but powerful force to even say, we’re going to not only look at how we address health equity in public health but ‘how are we going to further that concept in the broader healthcare system?.’ One example is Vancouver Coastal Health Authority and its incorporation of health equity indicators into its regional health report. I think people have viewed that as a tremendous success. I also think that public health has taken leadership and championing equity by doing things like raising awareness of the social determinants of health among all health system staff. It’s about getting people to understand the importance first, and then being able to introduce actions, for example, incorporating health equity indicators into reporting. Another facilitator is that public health has a really key role in reviewing and analyzing population health data and being able to ask specific questions about health inequities– ‘what if we looked at this data by gender or housing status or ethnic identity?’ ‘How would this data look different when asking those critical questions?,’ those are just a couple examples.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement:<\/strong> Would you say from what you’ve learned and your research that organizational standards are an effective strategy to advance health equity in public health practice and settings?<\/p>\n

    \n\tDr. Bernie Pauly:<\/strong> I think they are an important strategy because they explicitly make health equity a priority. But it is not just about the legislated public health standards, such as those in Ontario, but also the extent to which organizational missions, visions, values and system-wide policies and the programs make health equity explicit. I would say what is important is how the Ontario standards or in British Columbia the core functions, are taken up and operationalized at the organizational and front-line level. The outcome may become that practitioners who are already thinking and addressing health inequities in their practice are explicitly supported by such documents and the documents may promote thinking and action.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement:<\/strong> What do you think some of the lessons learned are from looking at British Columbia and Ontario when we start to think about other provinces and where they might go with similar initiatives?<\/p>\n

    \n\tDr. Bernie Pauly:<\/strong> I think one lesson learned is about how health equity is kind of that thorny problem that requires action across multiple sectors. I think public health people are very brave, but I sometimes feel that it is overwhelming to think about, for example, how do I work with the people that are doing housing policy or income policy?. I think we need to push ourselves to think through how that collaboration is actually going to happen.<\/p>\n

    \n\tThere’s one more that I want to mention, and its been a bit implicit in our discussion, is our understanding of the social determinants of health. It gets taken up around things like housing or food or social support or empowerment which is great, but I think the one place that it in some ways is going to require a bigger shift are those processes and structures that create marginalization, such as racism or discrimination, and how we in public health are part of the system. I think that’s going to be one of our challenges to deal with at the systemic level.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement: <\/strong>Did you see different implications arising from the fact that British Columbia was more of a guidance document and Ontario was a legislative document? British Columbia was at a period where they were willing to invest some resources and Ontario was trying a resource neutral initiative. Did you see any implications if we think about lessons or things to think about going forward?<\/p>\n

    \n\tDr. Bernie Pauly: <\/strong>I think there are two issues that are tied together: (1) accountability, and (2) funding. In guidance documents, the accountability piece is often not as clear. The Ontario legislative standards were to be resource neutral so there wasn’t the addition of funding, but there was that accountability in place. Those two factors influence how people are going to respond [to the documents].<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement: <\/strong>Do you have advice for practitioners, managers or decision makers who are considering a move towards organizational standards either at their own organization or at a larger jurisdictional\/ regional level?<\/p>\n

    \n\tDr. Bernie Pauly:<\/strong> When I start to think about standards, I think of them as the ‘musts’ and then how to implement those ‘musts’. I am always a bit cautious to think that everything must be clearly laid out in the standards, but rather that the standards provide the overall direction and then within that we have policies and practices that allow us to operationalize the standards. I think they [organizational standards] are important, and have a clear role in establishing the overall framework that is in turn complemented by a series of policies, practices and even programs that are aligned.<\/p>\n

    \n\t <\/p>\n

    \n\tConnie Clement: <\/strong>Bernie, I’ve really enjoyed the conversation and thank you for sharing your thoughts and experiences. Good luck with the continuing research. I look forward to the outcomes.<\/p>\n

    \n\tNext week read the interview with Janet Braunstein-Moody. <\/strong><\/span><\/p>\n

    \n\tEach of these interviews can be found in <\/strong><\/span>Public Health Speaks: Organizational standards as a promising practice to advance health equity.<\/span><\/a><\/strong><\/p>\n

    \n\t <\/p>\n","protected":false},"excerpt":{"rendered":"

    Follow us each Tuesday until November 26th to read an excerpt from Public Health Speaks: Organizational standards as a promising practice to advance health equity to help co-create the December 3rd webinar. 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