An important challenge for public health organizations is building and maintaining the knowledge, skill and experience required to work effectively on social inequities.  This challenge has led to a variety of capacity building strategies for public health recruitment, job orientation and training, and ongoing professional development. 

A practice that shows promise for supporting these health equity-related capacity-building strategies is the development of competencies and organizational standards that explicitly reference social justice.  Recognizing the effectiveness of organizational standards and competencies, the Canadian Nurses Association (CNA) developed the Social Justice Gauge to help put their commitment to social justice into practice.

Social justice is a public health core value and is described as being central to ethical nursing practice by the CNA. They define social justice as the fair distribution of society’s benefits, responsibilities and their consequences with a focus on the relative position of one social group in relation to others in society as well as on the root causes of disparities and what can be done to eliminate them.

The Social Justice Gauge was initially developed to evaluate the CNA's own organizational standards, policies, programs and products.  In 2007, they started working with external partners to revise and simplify the Gauge.  The revised tool—along with a policy document called Social Justice… a means to an end, an end in itself (2nd Edition)—was released in 2010.  

The Social Justice Gauge asks the developers of any intervention or policy statement to answer three basic questions:

1. Does it acknowledge that individuals or groups occupy positions of differing social advantage in society?
2. Does it acknowledge that unfair differences (inequities) exist in the opportunities and available to different individuals or groups, and therefore their health outcomes?
3. Does it acknowledge root causes of inequities?

According to Joyce Douglas (Nurse Advisor, CNA), the Gauge has been used widely:

• The CNA used it to initiate conversations with the Canadian Institute of Public Health Inspectors (CIPHI) about environmental health and environmental justice.
• The Community Health Nurses of Canada (CHNC) used it to evaluate their practice standards, which resulted in standards that better reflect the values and attributes of social justice.
• The Public Health Agency of Canada used it to critique its Core Competencies for Public Health , and recommended integrating social justice principles into all competency domains instead of creating a separate social justice domain that could be viewed as optional.  

The CNA Social Justice Gauge encourages people to integrate social justice in their programs, products, practice standards, and competency statements, and to take action to reduce inequities in health.

Please visit the NCCDH Resource Library for related materials, including:

• Public Health Speaks: Organizational standards as a promising practice for health equity, NCCDH 2013
• VIDEO:  Public Health Speaks: Advancing health equity through public health competencies, NCCDH 2013

We would like to hear from you!  What have your successes been in using competencies and organizational standards 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 Joyce Douglas for their help in preparing this story.  For more information on the work of the Canadian Nurses Association, please visit our database of health equity champions.