Implementation of a Health Equity Impact Assessment tool in an evaluation unit in Manitoba, Canada
DOI:
https://doi.org/10.18357/cjpe.2026.40.1.25Keywords:
evaluation, equity, health equity tool, health equity impact assessment, healthcare, health system, retrospective, metaevaluationAbstract
A health equity impact assessment (HEIA) is used to identify and address health impacts of an initiative, policy, or program on specific population groups, support health equity in programs, and reduce avoidable health disparities. As one of several actions to address inequity, an evaluation unit in Manitoba identified the need to determine the health equity impact of previous evaluations. The unit conducted a metaevaluation and tailored an HEIA tool that was applied retrospectively to determine the health equity impact of evaluations conducted by the unit from 2019-2023 to identify gaps in the unit’s practices and implement recommendations to move towards more equity-focused evaluations in the future. Forty-one evaluation reports were assessed. Findings indicated that 51% of the reports evaluated the impact of initiatives on patients/clients, healthcare staff, and the health system. Results also showed that the unit is successfully engaging diverse population groups in evaluations and providing recommendations to evaluation partners to improve initiatives. However, the unit struggles with addressing whether the initiative, or the evaluation itself, had differential impacts on equity-deserving groups and documenting the unit’s process to develop recommendations collaboratively with evaluation partners. As a result of this HEIA, several processes are being implemented to foster equity-focused evaluations in the unit, including using a list of standard demographic questions developed by the unit for healthcare staff and patients and developing processes to increase efforts to include diverse population groups in evaluations. Assessment strengths included support from the unit’s leaders and organizational commitment to identify gaps and implement recommendations. The retrospective use of the tool was limited by inadequate detail in reports to assess the health equity impact of the evaluation due to evaluation and reporting practices in place during the assessment period. Health system evaluators must be intentional in fostering equity-centered evaluations through chosen approaches and practices.
References
Bamberger, M., & Segone, M. (2011). How to design and manage equity-focused evaluations. https://web.archive.org/web/20221113044331/http://mymande.org/sites/default/files/EWP5_Equity_focused_evaluations.pdf
Cameron, A., & Tedds, L. M. (2020). Gender-based analysis plus (GBA+) and intersectionality: Overview, an enhanced framework, and a British Columbia case study. https://dx.doi.org/10.2139/ssrn.3781905 DOI: https://doi.org/10.2139/ssrn.3781905
Canadian Public Health Association. (2020). Health equity impact assessment. https://www.cpha.ca/sites/default/files/uploads/policy/heia/heia-policy-e.pdf
Cohen, B., Salter, K., Kothari, A., Le Ber, M. J., Lemieux, S., Moran, K., Wai, C., Antonello, D., Robson, J., & Salvaterra, R. (2018). Indicators to guide health equity work in local public health agencies: A locally driven collaborative project in Ontario. Health Promotion and Chronic Disease Prevention in Canada, 38(7–8), 277–285. https://doi.org/10.24095/hpcdp.38.7/8.02 DOI: https://doi.org/10.24095/hpcdp.38.7/8.02
Fehr, R., Viliani, F., Nowacki, J., & Martuzzi, M. (2014). Health in impact assessments: Opportunities not to be missed. World Health Organization Regional Office for Europe https://iris.who.int/handle/10665/137369
Government of Canada. (2025, December). Delivering on Truth and Reconciliation Commission Calls to Action. Crown-Indigenous Relations and Northern Affairs Canada. https://www.rcaanc-cirnac.gc.ca/eng/1450124405592/1529106060525
Gutuskey, L. (2022). Centering equity in program evaluation (OPRE Report No. 2022-211). U.S. Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research, and Evaluation.
Harber, R. (2010). Health equity impact assessment: A primer. Wellesley Institute. https://www.wellesleyinstitute.com/wp-content/uploads/2011/02/Health_Equity_Impact_Assessment_Haber.pdf
Hillier, S. A., Chaccour, E., Al-Shammaa, H., Downey, B., Senese, L. C., Tinmouth, J., & Jumah, N. A. (2024). Funding the pandemic response for Indigenous Peoples: An equity-based analysis of COVID-19 using a Health Equity Impact Assessment (HEIA) Indigenous lens tool. International Journal of Circumpolar Health, 83(1). https://doi.org/10.1080/22423982.2024.2361987 DOI: https://doi.org/10.1080/22423982.2024.2361987
Kerimoğlu, E., Ülker, M. N. Ö., & Berk, Ş. (2023). How to conduct a metaevaluation? A metaevaluation practice. Canadian Journal of Program Evaluation, 38(1), 57–78. https://doi.org/10.3138/cjpe.71619 DOI: https://doi.org/10.3138/cjpe.71619
Kidder, D., Fierro, L., Luna, E., Salvaggio, H., McWhorter, A., Bowen, S., Murphy-Hoefer, R., Thigpen, S., Alexander, D., Armstead, T., August, E., Bruce, D., Clarke, S., Davis, C., Downes, A., Gill, S., House, L., Kerzner, M., Kun, K., … CDC Evaluation Framework Work Group Members. (2024). CDC Program Evaluation Framework, 2024. MMWR Recomm Rep., 73(6), 1–37. http://dx.doi.org/10.15585/mmwr.rr7306a1 DOI: https://doi.org/10.15585/mmwr.rr7306a1
Ontario Ministry of Health and Long-Term Care. (2012). The health equity impact assessment workbook. https://www.camh.ca/-/media/professionals-files/heia/health-equity-impact-assessment-workbook2012-pdf.pdf
Sadare, O., Williams, M., & Simon, L. (2020). Implementation of the Health Equity Impact Assessment (HEIA) tool in a local public health setting: Challenges, facilitators, and impacts. Canadian Journal of Public Health, 111(2), 212–219. https://doi.org/10.17269/s41997-019-00269-2 DOI: https://doi.org/10.17269/s41997-019-00269-2
Schultz S., Beissmann F., Zorbas C., Yoong S., Peeters A., & Backholer K. (2024). A realist impact evaluation of a tool to strengthen equity in local government policy-making. International Journal for Equity in Health, 23(1). https://doi.org/10.1186/s12939-024-02266-5 DOI: https://doi.org/10.1186/s12939-024-02266-5
Smith, E., Akroyd, C., Barnes, R., Beeston, E., Broomfield, J., Bujkiewicz, S., Darko, N., Newby, C., Rutherford, M. J., Smith, A., Stannard, R., Tyrer, F., & Gray, L. J. (2025). Equality, equity, diversity, and inclusion principles: How should we apply these to statistical methodology research? BMC Medical Research Methodology, 25(1). https://doi.org/10.1186/s12874-025-02564-8 DOI: https://doi.org/10.1186/s12874-025-02564-8
Stufflebeam, D. L. (2001). The metaevaluation imperative. American Journal of Evaluation, 22(2), 183–209. https://doi.org/10.1177/109821400102200204 DOI: https://doi.org/10.1016/S1098-2140(01)00127-8
Tyler, I., Amare, H., Hyndman, B., Manson, H., & Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2014). Health equity assessment: Facilitators and barriers to application of health equity tools. https://nccdh.ca/resources/entry/facilitators-and-barriers-to-the-application-of-health-equity-tools DOI: https://doi.org/10.1093/eurpub/ckt126.075
UN General Assembly. (2007). United Nations Declaration on the Rights of Indigenous Peoples. A/RES/61/295. https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf
Zaykowski, H. (2021). Implementation Evaluation. In J. C. Barnes & D. R. Forde (Eds.), The Encyclopedia of Research Methods in Criminology and Criminal Justice (pp. 253–257). https://doi.org/10.1002/9781119111931.ch49 DOI: https://doi.org/10.1002/9781119111931.ch49
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Copyright (c) 2026 Valerie Umaefulam, Shauna Zinnick, Amy Henderson, Dov Millstone, Olga Norrie, Leanne Dunne, Tara Stewart, Ashley Struthers
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