How do we tackle inequities in health care?

February 01, 2018

​By: Michael Weyman, Regional Knowledge Exchange Lead, Provincial System Support Program, Centre for Addiction and Mental Health (CAMH); Mercedes Sobers, Evaluation and Research Coordinator, Health Equity Office, CAMH; Emma Pietropaolo, Volunteer, Health Equity Office, CAMH

"The essence of global health equity is the idea that something so precious as health might be viewed as a right," writes Paul Farmer, Chair of the Department of Global Health and Social Medicine at Harvard University.

The Ontario Government has identified health equity as a key component of health care[1]. Recently, it also added health equity to the mandate of the Local Health Integration Networks (LHINs), the province's regional health authorities[2]. As a result, identifying and responding to health inequities has become a growing concern for organizations across the province.

But how do we tackle this concern? Ontario's Health Equity Impact Assessment, or HEIA, is a key tool.

HEIA guides organizations in identifying and preventing the unintended health inequities that may result from a policy, product or service that might have an impact on people's health. It was developed by the Ontario Ministry of Health and Long-Term Care (MOHLTC) in collaboration with partners in the province's health care system, and is based on a health impact assessment developed and advocated by the World Health Organization. Similar tools have been adopted in a number of countries, including Australia, New Zealand, and the United Kingdom.[3]

HEIA can help:

  • build health equity into an organization's decision-making process;
  • raise awareness about health equity in an organization;
  • spot the unintended effects of a policy or program on the health of vulnerable or marginalized groups; and
  • improve the design of policies or programs to increase the positive, and reduce the negative, health equity impacts.

HEIA's application is broad. It's for any organization that is designing, delivering, or evaluating initiatives that could impact people's health. Although it's intended for use while a policy or program is being developed, it can also be applied retrospectively as part of an evaluation.

HEIA includes a workbook and template to guide the assessment and to identify ways to mitigate problems. The tool can then be used to monitor whether the mitigation strategies are successful. It's completed by the team that's developing or evaluating an initiative.

More information is available on the HEIA website or by contacting Mercedes Sobers at or (416)-535-3501 ext. 34027.


[1] Excellent Care for All Act, 2010, S.O. 2010, c. 14. Retrieved from

[2] Patients First Act, 2016, S.O. 2016, c. 30. Retrieved from

[3] Ontario Ministry of Health and Long-Term. "Health Equity Impact Assessment (HEIA): Background - the Ontario HEIA." April 19, 2013. Retrieved from

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