A realist impact evaluation of a tool to strengthen equity in local government policy-making.
Health equity impact assessment
Health equity tool
Intersectionality
Local government
Journal
International journal for equity in health
ISSN: 1475-9276
Titre abrégé: Int J Equity Health
Pays: England
ID NLM: 101147692
Informations de publication
Date de publication:
10 Sep 2024
10 Sep 2024
Historique:
received:
21
07
2024
accepted:
29
08
2024
medline:
10
9
2024
pubmed:
10
9
2024
entrez:
9
9
2024
Statut:
epublish
Résumé
Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.
Sections du résumé
BACKGROUND
BACKGROUND
Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts.
METHODS
METHODS
We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs.
RESULTS
RESULTS
Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support.
CONCLUSION
CONCLUSIONS
Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.
Identifiants
pubmed: 39252013
doi: 10.1186/s12939-024-02266-5
pii: 10.1186/s12939-024-02266-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
179Informations de copyright
© 2024. The Author(s).
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