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Table 2 Results of the world cafe participatory workshop. Barcelona 2017–2018

From: Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency

Actions

1. Improve the training of ASPB staff and clinical resources linked to social determinants, inequalities and axes of inequalities. Also include training in the perspective of gender.

2. Provide arguments to the technical workforce to communicate the results of the process of prioritisation in the interventions when they have to interact with the general population.

3. Improve internal training on participation techniques to adapt interventions to the needs of the population e.g. families, neighbourhoods, etc.

4. Improve the visibility and external communication of the ASPB by providing all the necessary mechanisms such as social networks, sessions, interventions and products, and free delivery days that allow the ASPB to respond to the population’s health concerns.

5. Systematically use easy reading and computer graphics for ASPB products and presentations in order to adapt technical discourse to the general population.

6. Improve internal communication in the ASPB between services, programmes, circuits and ASPB resources using participatory techniques to achieve this goal.

7. Change the ASPB services portfolio so that it better reflects what are made by the ASPB, e.g. the heath in the neighbourhoods programme, which would facilitate this program.

8. Provide the ASPB with a checklist tool that would help to identify the inclusion of axes of inequality in ASPB interventions, programs and products.

9. Have a person or group of people who liaise with different departments of the ASPB to support the process of incorporating the axes of inequality into the various activities of the ASPB and resolve doubts.

10. Because of the complexity of inequalities, it was thought that a single person could not serve as a point of reference and be an expert on all the issues. This was a point to be discussed in a group of experts in the ASPB.

11. Incorporate the gender perspective into all the activities carried out by the ASPB.

12. Incorporate gender-based violence into the lines of work of the ASPB.

13. Increase ASPB co-production capacity in the design and implementation of City Council policies.

14. Participate in the decision-making process of all issues affecting the health of the city’s population by, for example, detecting cases of lead detection, infestations, participate in the decision-making tables of all those who struggle to serve environments to promote healthy leisure.

15. Improve communication and information on the resources of the sectors of the City Council with which the ASPB regularly works, such as social services, education, housing and mobility to increase the effectiveness of joint work.

16. Make progress in collaborative networking with districts and the key agents of the neighbourhood to allow integration of the interventions.

17. Work to ensure that the Department of Health of the regional Government incorporates health into the school curriculum in a clear and operational manner.

18. Promote the evaluation of the policies of the City Council to prevent gentrification and increased inequalities and generate recommendations by the sectors involved.

19. Evaluate the impact on health as well as, for example, the impact of traffic noise on health.

20. Prioritise ASPB interventions and/or recommendations aimed preferably at modifying the causes of health risks, rather than adapting to risk situations as is the case for example, when giving priority to actions to reduce the sources of noise instead of recommending double glazing.

21. In assessing ASPB interventions, systematically incorporate assessment of the impact on health inequalities and that of gentrification, for example, in the case of superblocks and differences between intervening zones and adjacent zones.

22. To work in cases of lead detection and how they generate inequalities.

23. To think about reducing residues in our activities, interventions and programs, and not only recycling them.

24. Include social clauses for external companies that work for ASPB.

25. Review whether the working conditions of ASPB employees make it difficult to address social inequalities in health, and assess the measures needed to avoid or reduce them (e.g. working hours).

26. To identify the ASPB’s working conditions to be able to carry out an organisation-wide action to improve them.

27. Improve citizen participation in the different stages of ASPB studies or interventions by using more innovative participatory techniques that make participation easier and more attractive.

28. Implement participatory techniques with differential approaches to ensure the co-production of certain collectives such as families, the most vulnerable groups, etc. For example, using cultural mediators to generate greater participation of vulnerable collectives.

29. Report the results of our participatory processes to the population.

30. Provide opportunities for internal coordination and knowledge sharing between ASPB services through innovative participatory techniques, allowing the sharing of information on actions.

31. Adapt interventions to changing realities and make the actions more flexible so that they respond to the population’s diversity. This flexibility in interventions could improve co-production with the community as a whole. Include in the participatory diagnostics and in the design of interventions neighbourhood residents that are not organized in the work tables where technicians, organizations and neighbourhood associations normally participate.

32. Incorporate the various axes of inequality in the interventions designed for the ASPB and those in which there is some type of participation.

33. Propose interventions in vulnerable populations and those with which the ASPB has worked less, for example, interventions for female sex workers, since all interventions are aimed primarily at men, probably originating with the beginning of the AIDS epidemic.

34. Increase coordination between programmes so that some interventions are shared, for example, food safety interventions could think of actions related to energy poverty.

35. Improve collaborative relationships with other sectors or entities to share information/indicators for inclusion in the different products produced by the ASPB, e.g. indicators to make visible the problems of habitat, gentrification, etc.

36. Improve the various information systems of the ASPB to ensure the collection of relevant data for the analysis of health inequalities.

37. Propose collection of inequalities in the information systems of other entities, such as primary care.

38. To define a way of systematically collecting inequitable gaps in all ASPB-dependent information sources across the organisation.

39. Identify and improve information on vulnerable groups not only according to the region but also by defining new categories of social class or socioeconomic position. For example, people with disabilities are a precarious collective hidden within the collective of workers and very precarious workers with long working hours, low pay, and poor working conditions.

40. Increase knowledge on the physical environment, for example, on walking, shopping, healthy eating, mobility and urbanization that allows ASPB staff to diagnose needs and design interventions.