Consultations with environmental public health practitioners in BC and across Canada indicate that there are multiple ways of viewing how health inequities and the social determinants of health relate to practice, and there are different approaches to responding to inequities.
Person-Centred Approach to EPH||
Systems Approach to EPH|
Focus on regulation and health protection, using education as a tool.
Focus on health promotion and creating supportive environments.
to health inequities
Respond to socioeconomic barriers
when they arise. Incorporate equity
into practice by providing tools for practitioners who work with individuals who face socioeconomic barriers.
Remove barriers to health in society. Integrate equity into the EPH mandate with policy and collaborative mechanisms across all areas of practice.
The Equity Quad: Moving toward an equity-oriented EPH practice. The top row (green) describes typical EPH practice, which has been gradually shifting from a regulatory compliance approach to one that incorporates health promotion and healthy environments as tools to both improve health and improve compliance. The bottom row (blue) indicates how an equity lens could be applied to either the Traditional or Emerging approaches to EPH practice.
Health protection and environmental public health have traditionally operated within a regulatory framework, with activities centred on inspection, education, and enforcement. Many regions have begun relying more on health promotion and other population health based activities and less on regulatory activities. Such approaches aim to protect people from environmental health hazards and prevent chronic diseases by creating healthy, supportive environments.
During traditional inspection and licensing activities, the social determinants of health may present as barriers to compliance related to language, education, geographic location, culture, or income, all of which can influence the interaction between a practitioner and individual. Responses to these barriers (see Figure) might involve actions to mitigate or work around existing barriers rather than a punitive response to non-compliance. Incorporating an equity lens to traditional practices is considered a transactional change[i] — it relies on tools and resources that practitioners can use to work more effectively to mitigate the effects of equity-related barriers. Although the explicit recognition of equity may be recent, many approaches that can mitigate health inequities are already used by individual EHOs as tools to better protect the public's health[ii].
Addressing barriers with an equity lens. Individual barriers may be manageable, particularly if they exist in isolation, while systemic barriers tend to create challenges that are more difficult to surmount. However, when multiple barriers of any kind are present, their combined challenges are complex and more difficult to address. (Adapted from Dr. B. Nummer.)
It is essential that population health activities focus on advocating for or creating environments that are more supportive of health[iii]. This can help address systemic factors (or hurdles; see Figure) that prevent people from living in healthy circumstances, accessing services, or meeting their full health potential. Systemic factors may also hinder a practitioner's ability to provide service to a broad spectrum of the population in a way that meets regulatory requirements or to address underlying factors that affect compliance. Creating more health-supporting environments requires a higher level of transformative organizational change[i] that can lead to better outcomes overall.
[i] Britnell M. Transforming health care takes continuity and consistency. Harvard Business Review. 2015 December 28. Available from:
[ii] Diez Roux, A. V. (2016). "On the Distinction—or Lack of Distinction—Between Population Health and Public Health." American Journal of Public Health 106(4): 619-620. Available from:
[iii] First International Conference on Health Promotion (1986). The Ottawa Charter for Health Promotion. Ottawa. Available from: