1. Bob Gardner and Estelle Sun
Canadian Public Health Association
Annual Conference, June 22, 2011
ENHANCING HEALTH EQUITY:
THE POTENTIAL OF PEER HEALTH AMBASSADORS
www.wellesleyinstitute.com 1

2. Problem:
Health Inequities
Pervasive inequities in health outcomes are rooted in social
determinants of health and systemic inequalities
The most disadvantaged in SDoH terms can become more
marginalized in the health system
• Language • Sexuality
• Culture and Religion • Geography/Distance
• Socioeconomic Status • Age
• Race
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3. POWER Study
Gender and Equity
Health Indicator
Framework
Highlights
1. How the structure,
resources and
resilience of
communities
mediate the impact
of SDoH
2. Why we need to
take SDoH into
account in health
service planning
and delivery
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4. Building Solutions → Comprehensive Health
Equity Strategy
Need comprehensive strategy to address the foundations and impact of
health inequities →
+ Macro social and economic policy to reduce overall inequality
• from childcare through improving precarious employment to education
+ Comprehensive community initiatives to build resources and resilience
+ Community mobilization to push for necessary policy changes
Even though roots of health disparities lie in far wider social and economic
inequality, how the health system is organized and how services and care
are delivered is still crucial to tackling health disparities, including:
• Reducing barriers to equitable access to high quality care
• Targeted interventions to improve the health of the poorest, fastest
• Up-stream investments in primary and preventative care directed to
most vulnerable
• Delivering a full continuum of services in coordinated way at
community/local level
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5. Part of the Solutions:
Community-Driven Innovation
Need innovative community-based service delivery and
partnerships
Peer Health Ambassadors
• Members of the community, from the community
• Working with established healthcare providers to improve
access and quality of care for targeted populations
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6. Our Research
Purpose
• Survey the range and impact of Peer Health Ambassadors
• Assess their potential to meet needs of marginalized
populations
• Identify key success conditions and enablers to realize this
potential
Methods
• Review of literature
• Key informant interviews with 10 Toronto community
organizations currently working with peer-based models
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7. Findings:
Great Potential
General congruence between literature review and
key informant interviews:
• Peer Health Ambassadors are a promising model for
improving health equity through eliminating barriers to health
care and improving engagement
• Marginalized groups prefer healthcare providers who have
personal experience with their problems, who understand
their viewpoints, and who share key traits
(race, gender, religion, sexuality, cancer, drug use, etc.)
• When community impact is reported, the results are generally
very positive
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8. Findings:
Characteristics of Peer Health
Ambassadors
• Wide range and no clear definitions of ``peer``
• Varies in level of expertise and “peerness”
• Three broad areas:
• navigating the system
• health promotion
• integrated into comprehensive service provision
• Volunteers vs. paid staff
• Tend to be women
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9. Findings:
Facilitators to Effectiveness and Impact
• Financial compensation
• Initial and ongoing training/support/mentoring for peers
• Clear roles and division of labour + flexibility to accommodate
dynamic needs of both peers and communities being served
• Participation of peers in program or service planning and
development
• Rigorous quality assurance at every stage
• Program evaluation to improve practices
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10. Findings:
Barriers
• Peer life-stage, ability to adapt their own health and
lifestyle to work environment
• Breach of peers’ personal boundaries by clients and
co-workers, because of the highly personal nature of
this work
• Organizational capacity to support peer
needs, service demands and client expectations
• Client preferences for credentialed professionals or
specific delivery settings
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11. Findings:
Barriers (cont’d)
• Resistance from professionals or institutions
to community-based delivery
• Mainstream marketing doesn’t work for
marginalized populations
• Unstable funding
• Scaling up to larger projects
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12. Realizing the Potential of Peer
Health Ambassador Initiatives
• Enlist users in planning and development
• Provide ongoing training and support, driven by peer and
community needs
• Provide financial compensation, even during training
• Allow for adaptability and flexibility of training and program to
suit the needs of peer workers and clients
• Monitor and evaluate for quality
• Market the services using mediums that can reach the target
population
• Actively pursue alternative funding sources
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13. Key Messages
• Need comprehensive strategy to address health inequities
• Part of this is ensuring equitable access to high-quality care
for all – even the most vulnerable and isolated
• Peer ambassador type initiatives have shown great potential
in being able to reach, support and involve marginalized
populations
• In line with key themes of this conference:
• Address complexity of social determinants of health through flexible
and creative policy, programs and collaboration
• Build on potential of community initiatives and innovation
• Build on community empowerment and engagement
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14. THANK YOU
Please visit us at
www.wellesleyinstitute.com