Public Health Leadership to Advance Health Equity: A Scoping Review and Metasummary

Health inequities are health differences that are systematic across a population, result from the social conditions in which people live, and are considered unfair when by reasonable means they could be avoided. Health inequities are a pressing public health issue locally, nationally, and globally, and addressing these inequities is a matter of social justice. Public health leadership has been identified as critical for advancing health equity. Public health leadership has been defined as influence that moves individuals, communities, organizations, and systems toward achieving goals that will result in better health and well-being. But what type of leadership is required in public health to address the social determinants of health and advance health equity? How is it described? How is that leadership developed and supported? To begin to answer these questions and contribute to the knowledge and science of leadership in public health, an extensive scoping review of the literature was undertaken using Arksey and O’Malley’s (2005) six-phase framework. The scoping review explored the evidence base (close to 8,000 articles) and iteratively revealed the factors that contribute to public health leadership at the individual, organizational, community, and system levels. Further discussion is provided regarding innovative and emerging tools, strategies, and mechanisms for public health leadership. The study considered two further questions in an additional phase of the review using a metasummary method: How is leadership described in this literature set and what is the relationship between leadership and health equity in these studies? The responses to these questions are reflected through a series of data visualizations and thematic presentations. The dissertation concludes with a discussion of the findings and a set of considerations for practice, theory, policy, education, and research. These considerations are intended to provide a foundation for the development and support of public health leaders and leadership to address the determinants of health and advance health equity

Social Justice Is an Integral Part of the Work Done by Public Health Nurses

Many public health nurses already practice critical caring theory in their work. While they see social justice as vital to the work they do, human rights and equity are not yet a part of the CNA’s core responsibilities for nurses.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Health Inequities and Moral Distress Among Community Health Nurses During the COVID-19 Pandemic

     The core values of community health nursing practice are rooted in the social determinants of health, health equity and social justice.  Throughout the COVID-19 pandemic, community health nurses (CHNs) witnessed first-hand the impact on individuals in situations of marginalization. This research inquiry explored how health inequities among client populations contributed to experiences of MD among CHNs in Canada during the pandemic.      A total of 245 CHNs from across Canada participated in an online survey. Participants reported that during the pandemic individuals living in situations of marginalization were disproportionately impacted. CHNs were unable to provide the necessary health promotion interventions and experienced high levels of moral distress. The negative impact of the pandemic on individuals living in situations of marginalization illuminated the intersecting social and structural inequities that drive negative health outcomes and emphasized the need to adopt an equity focus for current and future pandemic planning, response, and recovery.  

Remembering Dr. Benita Cohen: A tribute to a life well-lived

To honor the legacy of Dr. Benita Cohen, this special volume of Witness: The Canadian Journal of Critical Nursing Discourses is dedicated in remembrance of her. This Invited Commentary reflects on Benita’s career, passions, personality and key contributions to public health and  nursing. Dr. Cohen was an exceptional nurse, researcher, educator, mentor, and health policy consultant. Her vision has shaped the fields of public health and community health nursing, and her impact will be felt for many generations to come.

The Governance of Core Competencies for Public Health: A Rapid Review of the Literature

Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH

Saying it out loud: explicit equity prompts for public health organization resilience

IntroductionIn the early days of the COVID-19 pandemic there were numerous stories of health equity work being put “on hold” as public health staff were deployed to the many urgent tasks of responding to the emergency. Losing track of health equity work is not new and relates in part to the need to transfer tacit knowledge to explicit articulation of an organization’s commitment to health equity, by encoding the commitment and making it visible and sustainable in policy documents, protocols and processes.MethodsWe adopted a Theory of Change framework to develop training for public health personnel to articulate where and how health equity is or can be embedded in their emergency preparedness processes and documents.ResultsOver four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured. Over four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured.DiscussionUsing the indicators and prompts enabled the leadership and staff to articulate what they do and do not know about their community partners, including how to sustain their involvement, and where there was need for action. Saying out loud where there is – and is not – sustained commitment to achieving health equity can help public health organizations move from theory to true preparedness and resilience

Additional file 1: of Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity

Examples of activities implemented by SDH-PHN positions Specific examples reported by SDH-PHN participants classified according to public health roles, components of public health action and level of practice, as interpreted by the authors. AdditionalFile_ExamplesSDHPHNactivities.pdf. (PDF 43 KB