Aliya Jamal

Topic

Understandings of health equity and organizational constraints on health equity work among frontline public health practitioners in British Columbia

School of Public Health and Social Policy

Date & location

• Wednesday, May 8, 2024
• 11:00 A.M.
• Virtual Defence

Examining Committee

Supervisory Committee

• Dr. Catherine Worthington, School of Pubic Health and Social Policy, University of Victoria (Supervisor)
• Dr. Bernie Pauly, School of Nursing, UVic (Co-Supervisor)

External Examiner

• Dr. Katrina Plamondon, School of Nursing, University of British Columbia - Okanagan

Chair of Oral Examination

• Dr. Allyson Hadwin, Department of Educational Psychology and Leadership Studies, UVic

Abstract

Health equity occupies a central place in the field of public health. However, significant challenges exist to public health practitioners promoting health equity, many of which are produced by the organizational contexts in which they work. This study explored how frontline public health staff engaged with health equity during a time when the organization they worked for had declared health equity an organizational priority. The project involved secondary analysis of focus groups and interviews conducted in 2014-2015 with frontline practitioners in a health authority in British Columbia, Canada. Using a critical discursive organizational approach, I identified a number of ideas at work in frontline staff’s construction of health equity. Frontline staff prioritized health equity in their work, even if they did not always use the term ‘health equity’. They most often articulated health equity as downstream access to services and less often as an upstream structural phenomenon. Some articulated concerning individualist ideas about health equity that pushed back against systemic approaches. Frontline staff described an organizational environment that mostly impeded their ability to promote health equity through inadequate resources, bureaucratization, an overemphasis on targeted programs, and limited professional scope. They posited that the organization’s lack of prioritization of health equity and the hierarchical distance between senior leaders and the frontline produced an organizational environment that was unsympathetic to and unsupportive of health equity. This research highlighted some of the relations of power that impacted frontline public health staff’s ideas and action on health equity, concluding that the conditions and dynamics of the organizational environment are critical factors in organization-wide health equity initiatives. It also raised concerns about how the concept of health equity plays out in real world public health contexts, questioning whether the concept is politically generative at the level of frontline practice.