Promising practices in equity in mental healthcare: Health Equity Impact Assessment

What you need to know

The Health Equity Impact Assessment (HEIA) tool is a decision-support tool that can help users recognize and reduce potential health inequities. This tool can help those who plan or develop programs, policies and services improve access and quality of care for marginalized and vulnerable populations within the general population.

In this issue of Promising Practices we look at the Health Equity Impact Assessment. Read it below or download the PDF.

The Problem

Groups that are socially disadvantaged based on characteristics such as income, gender, sexual orientation, race or disability are more likely to experience poor mental health due to greater exposure to negative life events and everyday stressors. Inequity in mental health care puts these groups at a further disadvantage in terms of their mental health.

Health inequities are defined as differences in health between population groups that are “systematic, unfair and avoidable.”1 A promising practice to reduce health inequities is the use of the Health Equity Impact Assessment (HEIA) tool developed by the Ontario Ministry of Health (MOH).

The tool was created to help people who plan and develop policies, programs and services to identify and address potential health inequities. In Ontario, various health organizations have used the HEIA tool for a number of key initiatives and programs, including the Centre for Addiction and Mental Health (CAMH), Public Health Ontario (PHO) and the Wellesley Institute.

This Promising Practice summarizes a recent paper on the HEIA, by Dr. Branka Agic, which sheds light on a tool that has the potential to promote health equity within the mental health system.

The Promising Practice

The HEIA tool is a decision-support tool that can help users recognize and reduce potential health inequities. This tool can help those who plan or develop programs, policies and services improve access and quality of care for marginalized and vulnerable populations within the general population.

How it works

Several equity-focused impact assessment tools have been used in different countries, including Australia, New Zealand and the United Kingdom. These tools provide a framework for addressing health inequities in a systematic way and offer a step-by-step approach toward improving health equity.

The HEIA tool helps identify vulnerable or marginalized groups that may be differentially impacted by a policy, program or service, as well as potential unintended impacts (positive or negative) of an initiative on these groups. After identifying the unintended impacts, users can determine and recommend mitigating strategies to increase positive impacts and reduce negative impacts on the identified populations. These strategies are then monitored to determine their effectiveness. Users should also document and share the HEIA results with relevant stakeholders.

Key lessons from the practice

According to Dr. Agic, the HEIA tool has helped identify potential unintended impacts of policies, programs and services on the mental health and well-being of vulnerable or marginalized groups. This has allowed users to adjust their plans to minimize potential negative impacts that could contribute to health inequities. The use of the HEIA tool can be strengthened by embedding health equity into system performance targets, providing education and training on health equity and the HEIA tool to both leadership and staff, and making relevant evidence more accessible for HEIA users.

Currently, the evidence about the effectiveness of the HEIA tool is still limited. Even though the tool has been used in different settings, researchers have not evaluated its impact on decision making and implementation in health service planning. However, the available evidence indicates that the HEIA tool is a promising practice for identifying the potential unintended impacts of an initiative on vulnerable or marginalized groups and increasing awareness about health inequities.

Why this initiative is promising

The HEIA tool has the potential to integrate health equity into mental health service planning and improve access to and quality of care for marginalized and vulnerable groups. At a system level, the tool can help reduce unfair and avoidable differences in health outcomes between groups. This tool can be used across the health system. For example, the Provincial System Support Program (PSSP) at CAMH used the HEIA tool in its work with Systems Improvement through Service Collaboratives. This provincial systems-level initiative was designed to improve the coordination of services across sectors to better support individuals with mental health and addiction needs.

More generally, tools that assess the health equity impact of policies, programs and services are a promising method for incorporating equity considerations into decision making and reducing preventable, socially constructed differences in health.

About the researcher

Branka Agic, MD, PhD, Director of Knowledge Exchange, Provincial System Support Program, Centre for Addiction and Mental Health; Assistant Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.

This Promising Practice resource is based on Dr. Agic’s article, “Promising practices in equity in mental healthcare: Health Equity Impact Assessment.”2

References

  1. Whitehead, M. (1992). The concepts and principles of equity and health. The International Journal of Health Services, 22(3), 429–445.
  2. Agic, B. (2019). Promising practices in equity in mental healthcare: Health Equity Impact Assessment. HealthcarePapers, 18(2), 42–47.

Author: Maryan Warsame