Tackling health inequalities: Moving theory to action

被引：14

作者：

Signal L. ^{[1
]}

Martin J. ^{[1
]}

Reid P. ^{[2
]}

Carroll C. ^{[3
]}

Howden-Chapman P. ^{[1
]}

Ormsby V.K. ^{[2
]}

Richards R. ^{[3
]}

Robson B. ^{[2
]}

Wall T. ^{[3
]}

机构：

[1] Department of Public Health, University of Otago, Wellington

[2] Te Ropu Rangahau Hauora a Eru Pomare, University of Otago, Wellington

[3] Ministry of Health, Wellington

来源：

International Journal for Equity in Health | / 6卷 / 1期

关键词：

Health Inequality; Institutional Theory; Health Impact Assessment; Senior Staff; Institutionalize Racism;

D O I：

10.1186/1475-9276-6-12

中图分类号：

学科分类号：

摘要：

Background. This paper reports on health inequalities awareness-raising workshops conducted with senior New Zealand health sector staff as part of the Government's goal of reducing inequalities in health, education, employment and housing. Methods. The workshops were based on a multi-method needs assessment with senior staff in key health institutions. The workshops aimed to increase the knowledge and skills of health sector staff to act on, and advocate for, eliminating inequalities in health. They were practical, evidence-based, and action oriented and took a social approach to the causes of inequalities in health. The workshops used ethnicity as a case study and explored racism as a driver of inequalities. They focused on the role of institutionalized racism, or racism that is built into health sector institutions. Institutional theory provided a framework for participants to analyse how their institutions create and maintain inequalities and how they can act to change this. Results. Participants identified a range of institutional mechanisms that promote inequalities and a range of ways to address them including: undertaking further training, using Māori (the indigenous people) models of health in policy-making, increasing Māori participation and partnership in decision making, strengthening sector relationships with iwi (tribes), funding and supporting services provided 'by Māori for Māori', ensuring a strategic approach to intersectoral work, encouraging stronger community involvement in the work of the institution, requiring all evaluations to assess impact on inequalities, and requiring the sector to report on progress in addressing health inequalities. The workshops were rated highly by participants, who indicated increased commitment to tackle inequalities as a result of the training. Discussion. Government and sector leadership were critical to the success of the workshops and subsequent changes in policy and practice. The use of locally adapted equity tools, requiring participants to develop action plans, and using a case study to focus discussion were important to the success for the training. Using institutional theory was helpful in analysing how drivers of inequalities, such as racism, are built into health institutions. This New Zealand experience provides a model that may be applicable in other jurisdictions. © 2007 Signal et al; licensee BioMed Central Ltd.

引用

共 23 条

[1]

Of Health M., The New Zealand Health Strategy, (2000)

[2]

Saving Lives: Our Healthier Nation, Cm 4386, (1999)

[3]

Ostlin P., Diderichsen F., Equity-oriented National Health Strategy for Public Health in Sweden, (2001)

[4]

Stronks K., The Netherlands, Reducing Inequalities in Health: A European Perspective, (2002)

[5]

Howden-Chapman P., Tobias M., Social Inequalities in Health: New Zealand 1999, (2000)

[6]

Ajwani S., Robson B.T., Tobias M., Bonne M., Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980-1999, (2003)

[7]

Of Health M., Reducing Inequalities in Health, (2002)

[8]

For Disability Issues M., The New Zealand Disability Strategy: Making a World of Difference: Whakanui Oranga, (2001)

[9]

Inequalities Awareness Workshops: Needs Assessment with Ministry of Health and District Health Boards, (2002)

[10]

Krieger N., A glossary for social epidemiology, J Epidemiol Community Health, 55, 10, pp. 693-700, (2001)

← 1 2 3 →