CLAIRE BETKER, RN, MN, PHD(C), SUME NDUMBE-EYOH, MHSCNATIONAL COLLABORATING CENTRE FOR DETERMINANTS OF HEALTH

PURPOSE

To explore the facilitators of public health leadership at an individual, organizational and systems level using an appreciative inquiry approach.

BUILDING PUBLIC HEALTH LEADERSHIP FOR HEALTH EQUITY: WHAT CONTRIBUTES?

WHAT WE KNOW ABOUT LEADERSHIP AND HEALTH EQUITY

• Leadership is an enabling factor to address social determinants of health and to advance health equity.

• Leadership is essential to public health capacity to improve the social determinants of health and health equity.

• Public health leaders and organizations play a vital role in advancing health equity.2

• Leadership is consistently identified as a key factor that supports action on the social determinants of health (75% of survey respondents).2

• “High-level leadership in all sectors – health and otherwise – is crucial to reducing health inequalities.”3

• There is little consensus about effective leadership practices and supporting or limiting factors – and leadership needs are very divergent.

• Leadership is key to ensuring that the core concepts of human rights and social justice are central to improving health equity and focus on those at the margins of society.4

• Domain of the Core Competencies for Public Health in Canada.5

METHOD

Semi-structured interviews were conducted with 14 public health leaders from across Canada using an appreciative inquiry method. Key informants identified factors or conditions that influenced effective public health leadership to address social determinants of health and health equity. Responses were analyzed and coded thematically using grounded theory method.

FINDINGS

Three overall themes of contributing factors emerged: organizational supports, bridging organizational activities with community actions, and professional competencies.

Organizational supports

• Explicit commitment from formal leaders

• Allocate budget to smaller agencies, research and staff

• Human resources, policies, and strategies that support health equity activities

• High-quality population level data on health equity and the social determinants of health

• Contribute to and adhere to external policies and standards on health equity

Bridging organizational activities with community action

• Participate in and acceptance of public health’s role in community action

• Partner and engage with health equity champions, community organizations, and agencies that share health equity values

Professional competencies

• Ensure essential knowledge, skills, and attitudes required to advocate for health equity

HOW WILL THE RESULTS BE USED

This project contributed to the evidence base on public health leadership for health equity. The results will be used to identify and foster those factors in organizations that support effective leadership for health equity, provide examples of successful leadership activities, and describe the role of public health leadership in building community partnerships for action.

CONCLUSIONS

• Leadership capacity in Canada exists, but more can be done.

• Leadership competencies of public health professionals in the area of social determinants of health and health equity need to be expanded.

• Policy and theoretical frameworks are important to ensure financial and human resources to create energy and commitment for this work.

• Organizational and individual values drive a social justice agenda.

• Passion and moral belief motivate effective organizational and individual public health leadership for health equity.Leadership is about influence that moves individuals,

groups, communities and systems toward achieving goals that will end in results for better health.1

REFERENCES 1. Betker C. & Bewick D. Financing, policy, and politics of healthcare delivery. In Stamler, L. & Yiu, L.,

editors. Community health nursing: a Canadian perspective (3rd Ed). Toronto, ON: Pearson Education Canada; 2012.

2. National Collaborating Centre for Determinants of Health. Integrating social determinants of health and health equity into Canadian public health practice: environmental scan 2010. Antigonish, NS: Author; 2011.

3. Butler-Jones D. The Chief Public Health Officer’s report on the state of public health in Canada, 2008 Addressing health inequalities. Ottawa, ON: Public Health Agency of Canada; 2008.

4. Gatherer A, Fraser A, Hayton P & Moller L. Public health leadership, social justice and the socially marginalized. Public Health. 2010; 124:617-9.

5. Public Health Agency of Canada. Core competencies for public health in Canada: release 1.0 [internet]. Ottawa, ON: Author; 2007 [cited 2013 Sep]. Available from: http://www.phac-aspc.gc.ca/php-psp/ccph-cesp/about_cc-apropos_ce-eng.php

FOR MORE INFORMATION

Download the key messages, summary and full document and find out more about our leadership initiatives at www.nccdh.ca. This information is also available in French at ccsdh.ca.