The Ontario Health Equity Impact Assessment
Learn about the Health Equity Impact Assessment (HEIA) to support improved health equity and improved targeting of health care investments.
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The Health Equity Impact Assessment (HEIA) is a decision support tool which guides users through the steps of identifying how a program, policy or similar initiative will impact population groups in different ways.
The HEIA tool surfaces unintended potential impacts and the goal is to deliver equitable delivery of programs, services, and policy by maximizing positive impacts and reducing negative impacts that could potentially widen health disparities between population groups.
Effective use of the HEIA tool is dependent on good evidence.
Between 2009 and 2010, the former Ministry of Health and Long-Term Care partnered with health system organizations across Ontario to conduct regional pilots and gather further input on the Tool. The response to the HEIA tool was overwhelmingly positive and participants provided feedback to:
- increase user-friendliness
- create a companion workbook
- integrate the social determinants of health
Feedback from participants also informed the type of support and ongoing collaboration necessary to ensure effective use of the HEIA tool.
The HEIA tool has four key objectives:
- help identify health equity impacts (positive and negative) of decision-making on specific population groups
- support equity-based improvements in policy, planning, program or service design
- embed equity in an organization’s decision-making processes
- build capacity and raise awareness about health equity throughout the organization
The HEIA tool includes a template and a workbook that provide users with step-by-step instructions on how to conduct a HEIA. The workbook guides users through five steps:
- potential impacts
The results are recorded in the HEIA template.
The tool includes four supplements that focus on various priority populations or sectors, including:
- LGBTQ2SQ populations
- immigrant populations
- public health units (PHU)
- French Language Services (FLS)
HEIA in practice
The tool is used by organizations across the Ontario health care system, such as Home and Community Care Support Services organizations, public health units, and health service providers. It can also be used by organizations outside the health care system whose work can have an impact on health outcomes.
The HEIA is intended to be completed by the planning, program or policy development team, and not an external third party.
HEIA tools have been adopted in a number of international jurisdictions including:
- New Zealand
- United Kingdom
The HEIA is also used and advocated by the World Health Organization (WHO) and incorporates international evidence as well as input gathered during regional pilots, conversations with health service providers and is a recognized health equity resource.
The Ministry of Health continues to work collaboratively to support and promote a culture of health equity across government and the health sector.
For example, the Ministry of Health works with the HEIA Community of Interest (COI), which is web-based and hosted by the Centre of Addiction and Mental Health, to support the implementation of the HEIA tool within Ontario’s mental health and addiction sector and to encourage HEIA tool users to share their results. Through this knowledge exchange, the COI enhances the evidence base for the HEIA tool in Ontario, Canada, and internationally. Join the HEIA Community of Interest.
Download the HEIA tool
Please refer to the Centre for Addiction and Mental Health (CAMH) website for links to the HEIA workbook, toolkit and supplements
With the former Ministry of Health and Long-Term Care (MOHLTC), the Centre for Addiction and Mental Health (CAMH) developed a free self-directed interactive e-learning course on the HEIA Tool. The HEIA course will interest policy, program and planning teams to integrate equity considerations into their initiatives. Access the course here.
Completing a HEIA requires gathering evidence to inform analysis. A broad consideration of evidence will facilitate a robust analysis and ensure that you have sufficient information to assess the needs of populations. All evidence sources should be weighed based on their strength and quality.
Evidence sources include:
- grey literature (project/program reports, informal practice guidelines, recommended or promising practices etc.)
- inter-jurisdictional evidence
- online resources
- consultation and community engagement findings
- key informant interviews (for example, with local experts or staff from relevant organizations)
- program evaluation results
- client surveys
The following online resources may be useful to support your health equity impact assessment.
Research and data to support Health Equity Analysis
- Project for an Ontario Women’s Health Evidence-Based Report, the POWER Study
- CIHI Measuring Health Inequalities: A Toolkit
- Health Inequalities Data Tool
- Wellesley Institute
- National Institute of Public Health in Quebec
- World Health Organization
- Government Equalities Office (UK)
- HIA connect (NSW Australia)
- National Collaborating Centre for Determinants of Health (NCCDH)
- Public Health England
- Sexually Transmitted and Blood-Borne Infections (STBBIs)-Specific Health Equity Impact Assessment — Canadian Public Health Association (CPHA)
- Health Equity Assessment Toolkit (HEAT) — World Health Organization (WHO)
- Urban Health Equity Assessment and Response Tool (HEART) — World Health Organization (WHO)
- Health Equity Assessment Tool (HEAT) — England
- Equity-Focused Health Impact Assessment (EFHIA) — Australia
- Health Equity Assessment Tool (HEAT) — New Zealand
- Whānau Ora Health Impact Assessment (WOHIA) — New Zealand