PROMOTING RECIPROCAL CARE IN HEALTH EQUITY

Identifying Vulnerabilities, Barriers, and Opportunities

A systems approach is needed to map the systemic barriers to health equity. Health equity impact assessment methods were developed to help consider the cumulative effects (positive and negative) of a specific policy, program, or project on vulnerable groups of people. These tools have a distinctly anthropocentric perspective. Identifying cumulative impacts is increasingly seen as a best practice in conducting environmental assessments. This approach strives to assess the incremental impact of the action when added to other past, present, and reasonably foreseeable future actions, but it tends to have a focus on biophysical rather than social impacts. Integrated environmental impact assessment aims to combine dimensions of human determinants of health with biological and physical environments to provide a holistic understanding of the interrelationships between the human and the natural environment to help identify the unintended effects of initiatives on human health and/or on the environment. They tend to have more of a focus on sustainability than on health equity. There is a large variety of impact assessment tools and approaches but none have satisfactorily integrated the concerns of equity with human, animal, and ecosystem health. One Health practitioners will need to borrow from and adapt the various tools to best suit the context of specific issues. Figure 3.1 proposes a rubric that might guide an assessment of the interspecies, intergenerational health equity implications of a policy, intervention, or program.

Figure 3.1 considers three equity questions: (i) How will the proposed activities or decisions increase or decrease unnecessary, avoidable, and/or unjust impacts or health outcomes? (ii) How will the proposed activities or decisions increase or decrease the access, quality, or quantity of social or environmental resources or ecological services that are needed to fulfil the determinants of health for humans, animals, and the environment? (iii) How will the policies or practices needed to implement the activities or decisions systematically prevent humans or animals the opportunity to benefit from a determinant of health? Each of these questions will have both spatial dimensions (i.e. over what geographic scale does one consider these questions?) and temporal dimensions (i.e. are these questions answered in the present, over the life course of individuals, other generations, or all of these time periods?). These questions are asked for people, animals, and ecosystems that will be influenced by the decisions and activities being reviewed.

Conceptual framework to guide an interspecies, intergenerational health equity assessments

FIGURE 3.1 Conceptual framework to guide an interspecies, intergenerational health equity assessments.

Identifying which people, animals, or ecosystems are vulnerable to changes due to the proposed activities will require a collaborative, interdisciplinary, and equity informed set of approaches to appraising the situation. The success of such analytical exercises will be influenced by who is involved and what knowledge they bring to the process, underscoring the importance of considering cultural safety and related equity, diversity, and inclusion guidelines. The goal is not to produce an exhaustive conceptualization of the issues and relationships at play because this is rarely possible due to the complex, dynamic nature of ecosystem relationships in a changing world as well as due to intersectoral and disciplinary challenges to integrating knowledge. Rather, the goal is to identify who or what might be vulnerable to socially produced advantages or disadvantages derived from the proposed activities, which in itself will not be a simple or straightforward task. Identifying the right set of variables that allow one to directly measure the impact of a decision on the health of all species and forecast future impacts involves dealing with (i) difficulties detecting changes in ecological drivers of vulnerability and resilience for all species within an effected ecosystem, (ii) insufficient evidence and agreement on the identification of thresholds of impacts that are un/acceptable, (iii) the lack of methods that can integrate multiple socio-ecological scales, (iv) the effects of socio-ecological processes may take decades before changes can be seen, making it hard to recognize relationships, and (v) institutional inertia or barriers to со-managing data, intersectoral or interagency relationships, and interdisciplinary knowledge production.

There is a clear urgency to fully address health inequity as we plan strategies and interventions to cope with the threats and changes acting at the interface of animals, health, and society. One Health actions need to be attentive to barriers preventing individuals and populations, be they human or animals, from accessing and benefiting from the conditions needed to reach their full health potential. Paying attention to the “causes of the causes” of poor health and how they are distributed across species can both help prevent unanticipated consequences and ensure that we create circumstances that concurrently protect and promote the health of people, animals, and their shared environment in a just and fair manner.

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