Blending targeted and universal approaches to advance health equity

CPHA Conference 2014Hannah Moffatt, Miranda Elliott & Dianne KinnonNational Collaborating Centre for Determinants

of Health

Objectives• Increase understanding and clarify the

concepts of targeted, universal and targeting within universal approaches to health equity in public health practice

• Discuss key factors that support - and challenge - using a targeting with universal approaches in public health practice, and their impact on improving the health of all

The National Collaborating Centre for Determinants of Health

One of six National Collaborating Centres for Public Health in Canada

Our audience:• Practitioners, decision

makers, and researchers working in public health

• Organizations in Canada’s public health sector

Our work:• Translate and share

evidence to influence interrelated determinants and advance health equity

Our focus:• Social determinants of

health & health equity

National Collaborating Centre for Determinants of Health

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Let’s Talk… Universal and targeted approaches to health equity

A discussion guide about when and

why to use a universal, targeted,

targeting within universal, or proportionate

universal approach

NCCDH. Let’s Talk seies. Available at: http://nccdh.ca/blog/entry/Two-new-releases-in-the-Lets-Talk-series

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Universal Approach Targeted Approach• Applies to an entire

population• Each member of

society has access• Universal in principle

may not be universal in practice

• Applies to a priority sub-group

• Interventions are designed to support populations experiencing disadvantage

• Can address the consequences of inequities, rather than the causesLet’s Talk: Targeted & universal approaches to

health equity. http://nccdh.ca/resources/entry/lets-talk-universal-and-targeted-

approaches 6

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Targeting within universalism –approaches define goals for all and tailor strategies to reduce barriers faced by specific groups

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“Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage” – Marmot

Marmot M. Fair society, healthy lives. Strategic review of health inequalities in England post-2010. The Marmot Review. 2010. Available from: http://www. instituteofhealthequity.org/projects/fair- society-healthy-lives-the-marmot-review 9

Learning from Practice: Targeting within Universalism• How does the theory apply to practice?

• Three case examples describe their process and lessons learned

• Available onlinehttp://nccdh.ca/resources/entry/lets-talk-universal-and-targeted-approaches

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Sudbury and District Health Unit’s School Health Promotion

• Universal program with extra resources for CORE schools

• Comprehensive school health approach, multi-year strategy

• Partnership and relationship building

Learning from practice: Targeting wtihin universaliismhttp

://nccdh.ca/resources/entry/lets-talk-universal-and-targeted-

approaches 11

Capital Health’s Healthy Beginnings Program• Universal program pre-natal

education and post-natal support with identification of families that require more intensive, long-term support

• Partnership with school boards, primary care practitioners, family resource centres

• Gathering feedback from clients and service providers Learning from practice: Targeting wtihin

universaliismhttp://nccdh.ca/resources/entry/lets-talk-universal-and-targeted-

approaches 12

Vancouver Coastal Health’s tobacco reduction program• Universal programs to limit tobacco use and

second-hand smoke exposure

• Targeted tobacco reduction for priority groups

• Shift to increase emphasize populations with the highest rates of tobacco dependency and known barriers to universal program participation

Coming soon!13

Overall Lessons• Various reasons and approaches to applying

the concept

• Strong partnerships, evaluation, and flexibility emphasized in the public health programs

• Efforts continue to seek balance to achieve best health outcomes for all

Visit our website - Contact us

National Collaborating Centre for Determinants of HealthSt. Francis Xavier UniversityPO Box 5000, Antigonish, NS B2G 2W5Email: NCCDH@stfx.ca and CCNDS@stfx.ca Phone: (902) 867-5406 Fax: (902) 867-6130www.nccdh.ca and www.ccnds.ca

@NCCDH_CCNDS

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