The Ontario government sees equity as a key part of high quality health care1. So, in 2010 and 2011, the Ontario Ministry of Health and Long-Term Care (MOHLTC) worked with others in the health care system to create a Health Equity Impact Assessment (HEIA) tool2. This tool aims to reduce health differences between population groups and to improve how health care dollars are spent3.
What is HEIA?
HEIA is based on a health impact assessment developed and advocated by the World Health Organization. Similar tools have been adopted in a number of places, including Australia, New Zealand and the United Kingdom4. In Ontario, the MOHLTC developed its HEIA using international evidence, as well as the input and cooperation of many health organizations in the province5.
Why do HEIA?
HEIA can help you:
• build health equity into your organization’s decision making process
• raise awareness about health equity in your organization
• spot the unintended effects of a policy or program on the health of vulnerable or marginalized groups
• improve the design of your policy or program to increase the positive, and reduce the negative, health equity impacts.
When to do HEIA?
HEIA is most effective when it’s used as early as possible in the planning of a policy or program. This allows you to adjust the initiative while it's still relatively easy to do so. However, if needed, HEIA can be done at any time, as long as you’re able to put in place some ways to deal with the health equity impacts you identify.
The figure below shows the stages in which the HEIA tool can be applied, as part of either a prospective or retrospective analysis.
HEIA can be used by any organization that is designing, delivering or evaluating services that have an impact on people’s health. A large range of services in our society have some impact on health6. So, although HEIA is very useful for health care organizations, it’s not only intended for them.
HEIA should be completed by the team in your organization that is developing a plan, policy or program7.
1 Ontario Ministry of Health and Long-Term Care, “Health Equity Impact Assessment (HEIA), Background - the Ontario HEIA,” Ontario Ministry of Health and Long-Term Care, April 19, 2013, http://www.health.gov.on.ca/en/pro/programs/heia/background.aspx.
3 Ontario Ministry of Health and Long-Term Care, “Health Equity Impact Assessment (HEIA),” Ontario Ministry of Health and Long-Term Care, April 19, 2013, http://www.health.gov.on.ca/en/pro/programs/heia/.
5 Ontario Ministry of Health and Long-Term Care, “Health Equity Impact Assessment (HEIA) Workbook” (Queen’s Printer for Ontario, May 2012), http://www.health.gov.on.ca/en/pro/programs/heia/docs/workbook.pdf.
6 World Health Organization, “Health Impact Assessment (HIA), The Determinants of Health,” WHO, accessed May 15, 2017, http://www.who.int/hia/evidence/doh/en/; Ontario Ministry of Health and Long-Term Care, “Health Equity Impact Assessment (HEIA) Workbook.”