Health Equity and Environmental Public Health Practice

Health equity is achieved when everyone has a fair opportunity to meet their health potential. Health inequities result from systematic disparities in the social determinants of health (the external social, economic, environmental, or political factors that influence their life circumstances). Public health organizations in Canada recognize a role for all public health professionals to advance health equity. Environmental public health practice is impacted by determinants such as socioeconomic status, language or culture, education, geographic location, and mental health. These determinants can impact:

• exposure to unhealthy environments;
• vulnerability to environmental health hazards;
• ability to engage in health-supporting behaviours; and
• access to services (WHO, 2010).

Environmental public health practitioners can advance health equity in two main ways:

1. They can support individuals who face barriers related to their social circumstances, thereby increasing the likelihood of long term compliance and improved public health. 
2. They can advocate for and create policies and programs that remove structural barriers to health that affect various sectors of the population.

The National Collaborating Centres for Environmental Health (NCCEH) and Determinants of Health (NCCDH) have an ongoing partnership to support health equity through environmental public health practice. Please visit nccdh.ca for additional information and resources.

NCCEH Resources

• Handbook of health equity in environmental public health practice (2017)
  This handbook examines health equity in the context of environmental public health; identifies factors to facilitate the inclusion of health equity; provides practical tools to integrate equity into practice; and offers an evidence-based approach to support heath equity through planning and interventions in the built environment.
   
• Creating space: enabling organizational capacity for action on health equity (2016)
  These workshops at Annual Educational Conferences of the Canadian Institute of Public Health Inspectors (CIPHI) explored how practitioners can take action to support health equity, and identified opportunities to build organizational capacity around health equity.
   
• Key resources for environmental public health practitioners to address health equity: A curated list (2016)
  This curated list by the NCCEH/NCCDH identifies resources specific to environmental public health practitioners with respect to their roles in addressing the social determinants of health (SDH) and health equity in consultation, enforcement, and education.
   
• Toward health equity: practical actions for public health inspectors (2016)
  This Framework by the NCCEH/NCCDH outlines 10 considerations to help practitioners identify how equity work relates to their role and how they can begin to take action. It can be used by staff with any degree of knowledge or experience related to health equity. A User guide highlights potential points of influence for frontline staff, managers, and educators.
   
• Equity in environmental health practice: a role for public health inspectors (2015)
  This CHNET-Works Fireside Chat webinar was presented with the BC Centre for Disease Control (BCCDC) and NCCDH. It summarizes results of a pilot study exploring how public health inspectors respond to clients who face barriers related to the social determinants of health, and includes discussion about strategies to support vulnerable clients with experts from the field.

Selected External Resources

Health agency and government reports

• Equity 101: A video series for Environmental Public Health practitioners (BCCDC, 2018)
  This video series from the BCCDC provides a simple and quick overview of health equity concepts and issues specifically targeted to environmental health officers (EHOs) and health protection leaders.
   
• Equity and Environmental Public Health Handbook (BCCDC, 2016)
  This handbook from the BCCDC aims to increase knowledge about health equity in the context of environmental public health (EPH) practice and to develop resources that support the use of an equity lens in practice. 
• Health equity and environmental public health practice: stories from public health inspectors (NCCDH, 2016)
  This NCCDH blog post shares stories from environmental public health practitioners across Canada who are pioneering the use of an equity lens in different ways.
   
• Policy approaches to reducing health inequalities (NCCHPP, 2016)
  This briefing note from the National Collaborating Centre for Healthy Public Policy (NCCHPP) discusses the different policy approaches available to reduce health inequalities.
   
• Toward health equity: a tool for developing equity-sensitive public health interventions (Public Health Agency of Canada, 2015)
  This evidence-based report takes a five-step approach to guide public health practitioners and planners toward incorporating health equity into the design of upstream, midstream, and downstream interventions.
   
• Glossary of essential health equity terms (NCCDH, 2015)
  This NCCDH document promotes the use of clear and effective language – within public health and across sectors and regions in Canada – in order to enhance powerful communication and action on the social determinants of health and health equity.

Peer-reviewed articles

• Toward achieving health equity: emerging evidence and program practice (Dicent Taillepierre et al., 2016)
  This descriptive article characterizes the historic roots of public health as a tool to address health inequities and identifies six elements that enhance health equity impacts of public health programs.
   
• Integrating equity into environmental health practice: findings of a pilot study (Rideout and Oickle, 2016)
  This article summarizes the findings of an NCCEH/NCCDH pilot study to explore the intersection between environmental public health practice and health equity.
   
• Can focus groups be a tool for change? Introducing health equity to environmental public health practice (Rideout et al., 2016)
  This qualitative study examines how focus groups that were originally designed to explore the intersection between environmental public health practice and health equity could also be used to introduce new concepts, such as health equity, into public health practice.
   
• Opportunities for environmental public health action on the social determinants of health and health inequity (Rideout et al., 2015)
  This article highlights how environmental public health practitioners can support health equity. It is based on workshops held at CIPHI conferences.
   
• The environmental health practitioner: new evidence-based roles in housing, public health and well-being (Stewart and Bourn, 2013)
  This article examines how environmental health practitioners in the United Kingdom incorporated health equity into their inspection role by implementing a health-based housing rating system, which aimed to improve housing quality for low income owners and renters.
   
• The role of public health inspectors in maintaining housing in northern and rural communities: recommendations to support public health practice (Lefebvre et al., 2012)
  This article uses qualitative methodology to explore public health inspectors’ (PHIs) practices related to housing hazards, particularly for vulnerable populations. It identifies some of the challenges PHIs face in protecting vulnerable residents without legislation or clarity regarding jurisdiction over owner-occupied or rental housing.
   
• Environmental health and vulnerable populations in Canada: mapping an integrated equity-focused research agenda (Masuda et al., 2008)
  This systematic review identifies the uneven distribution and impacts of environmental hazards across different regions and populations within Canada.

Upcoming Research

• RentSafe is an initiative led by the Canadian Partnership for Children’s Health and Environment funded by the Ontario Trillium Foundation. Public health, legal, and community stakeholders are working together to address unhealthy housing conditions for low income tenants.

This list is not intended to be exhaustive. Omission of a resource does not preclude it from having value.