Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada

In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies.

This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban–rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018–2020) received from the 27 PHUs.

Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs’ activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban–rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities.

Findings suggest broad implementation of health equity approaches in public health independent of PHUs’ geographic size and population dispersion, though strategies and key challenges differ across units.