According to the WHO, health equity “implies that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status or other socially determined circumstances.” (Whitehead, M) Although attaining equity in health is much broader than the health-care system, the system does make a difference and does have a role in addressing inequities. Factors such as accessibility, adaptability and appropriateness all contribute towards equity in the health-care system. Within the health system, equity means reducing systemic barriers by addressing the specific health needs of people, including the most health-disadvantaged populations. Health Care Equity Audits (HCEA) provide a framework that can assist organizations, departments or programs to assess whether inequity exists, and to what degree. It provides evidence that can enable systematic action to address local health inequities. Audits focus on how resources are distributed in relation to the health needs of different groups and consist of 4 key steps: 1) A systematic review and analysis of inequities in the causes of ill health; 2) A search through the evidence to identify potential interventions; 3) Implementation of those interventions and 4) Evaluation of success. Interventions may include for example, changes in policy, practice or service delivery models. Saskatoon Health Region (SHR) has conducted approximately 6 audits in the past 3 years in several areas including the immunization program, renal service, surgical services and diabetes prevention/management programs and it has been adapted to meet the specific needs of the key program areas. In the case of early childhood immunizations, it has gone through the cycle more than once. Using the audit process, inequities were identified, interventions implemented, evaluated and re-assessed. Using the HCEA process, the immunization coverage gap between the highest and lowest coverage steadily narrowed until this year when the gap increased slightly, reflective of growing population in the core, compared to rural areas. 17% more children were up to date at 2 years compared to 2011, but the population in the core increased by 35%. The absolute increase in overall coverage rates among 2 year olds for MMR was 6%, from October 2007 to 2009 (immunization reminders project-CIHR grant). Core neighbourhoods show the greatest increase since 2007 with an absolute increase of 13.4% for measles and 13.3% for diphtheria. The 2012 SHR target for the disparity ratio index was set at 1.16, as measured for 2 year old immunization (2 doses of Measles antigen). The target of 1.16 was exceeded in February and March 2012. The annual rate was 1.16. The impact of the interventions demonstrates success based on a focus on closing the inequity gap. To facilitate the audit process, SHR has developed a HCEA Guide. Use of the guide can be integrated within already existing processes such as quality improvement, strategic planning etc. and will be evaluated in the near future.

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