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There is widespread recognition that local community driven initiatives play a key role in alleviating health disparities. Determine, the second stage of the EU's Closing the Gap project, has created a detailed report highlighting some innovative bottom-up case studies from around that world that deal with health equity.

The Ontario Physicians Poverty Work Group are publishing a very useful series of three articles on the links between poverty and health on the Ontario Medical Association web site. The articles are by local physicians and members of Health Providers Against Poverty, public health leaders and Wellesley Associate Michael Rachlis, and provide excellent overviews of the adverse impact of poverty on health and what physicians can do to mitigate the worst health effects of poverty.

Further information on Health Providers Against Poverty’s research, advocacy and education activities can be found on its web site.

In March 2007, the Public Health Agency of Canada, supporting Canadian involvement in the World Health Organization Commission on Social Determinants of Health, held a consultation with civil society organizations on how to move a social determinants of health agenda forward. I participated on behalf of the Wellesley Institute. Key challenges were identified:

• public policy discourse that focuses only on economic growth and efficiency is too restricted to accommodate SDoH approaches
• limited public awareness of the impact of social determinants, and
• how to build a case for investment in SDoH

Prevailing themes in the discussions were the importance of comprehensive coordinated polices across social, economic, education, health and other key spheres that address SDoH, the need for governments to develop far better cross-sectoral collaboration and to get beyond departmental and jurisdictional silos, simpler clearer language to promote SDoH, and building on the many community-based initiatives that take broad SDoH approaches.

Download the full consultation report, or for more information on the Social Determinants of Health visit our collection of the WHO's SDoH Knowledge Networks.

Bob Gardner, director of policy and research at the Wellesley Institute, has recently been working with the Toronto Central LHIN to help them develop health equity policies.  Here is an interesting workbook providing a step-by-step approach to designing health promotion policies through a health equity lens.  Some best-practices are outlined and case-studies provided.

I developed and presented a workshop on health promotion with policy impact to the annual Health Promotion Ontario conference. It was designed to help people in various health promotion positions and sectors make a strong case for needed programmes, research and innovation to policy makers. The workshop focussed on how to identify the policy implications of the projects they were working on, translate these initiatives into ‘policy speak’ with cost-benefit, risk assessment, options and concrete recommendations and ‘asks’, and effectively present and promote their cases to decision makers.

Health Promotion with Policy Impact by Bob Gardner

Wellesley Board member Jan Campbell, in her capacity as a consultant to the Greater Toronto CHC Network, and Bob Gardner, Director of Policy and Research, along with Lynne Raskin, ED of South Riverdale CHC, and Laura Cowan, ED of Street Health, facilitated a workshop on applying the urban health framework developed by the GT CHCs to planning diabetes. It was part of a daylong conference sponsored by the Ontario Hospital Health Promotion Network and St Joseph’s Health Centre on Working Together to Prevent and Manage Chronic Disease held May 23, 2008 in Toronto. The goal of the workshop was to demonstrate and refine the urban health framework as a tool to better plan and coordinate community-based initiatives and innovation addressing chronic conditions, especially for disadvantaged populations. Bob’s notes on Diabetes Planning Through an Equity Lens were part of setting the context for the workshop, which worked through planning for diabetes and vulnerable populations such as homeless people and newcomers.

Diabetes Planning Through an Equity Lens

Congratulations to the Ontario government for its decision to provide health care funding for people who require sexual reassignment surgery. For the handful of Ontarians facing this costly procedure, the treatment is both medically necessary and - for most - financially impossible. And a big thank you to the courageous individuals (including Martine Stonehouse and Susan Gapka) who helped lead this campaign for health justice.

Health policy experts believe that the decision of a previous Ontario government a decade ago to de-list sexual reassignment surgery was almost certainly trans-phobic (that is, motivated by a fear and prejudice against transgendered people). Some of the critics of the decision to re-list it as a medically-insurable procedure will no doubt also be motived by trans-phobia.

The current government took a number of years to make the decision, but almost certainly not because of trans-phobia. Instead, the Ontario government is likely infected with cost-phobia. That is, the government was afraid that if it did the right thing for people who need SRS, then it would face demands from others who need medical treatments that are excluded from Ontario Health Insurance Plan coverage. After all, the government announced the decision on the Friday of a holiday weekend and included a stern warning that people shouldn't expect that this will set a precedent for re-listing other medically-necessary services that aren't covered by OHIP.

I have a family member who is a cancer survivor and she is required by her doctor to do an expensive diagnostic procedure every few years just to check whether the cancer is still lurking in her body. The procedure is expensive and most of the costs aren't covered by OHIP. Fortunately, our family has private health coverage, but those who don't have only one option: Wait and hope that the cancer is truly in remission. If it isn't, cancer survivors have to wait until the re-emerging cancer is serious enough that it qualifies for coverage under OHIP.

So, good for the Ontario government for taking the right step and re-listing sexual reassignment sugery. Now, let's look at all those other medically necessary procedures that were removed from OHIP, or never covered in the first place...

I recently presented to a Portuguese-Canadian National Congress action meeting on health. They were discussing the Viva! Health Project, really interesting research on the health situation and challenges of the Portuguese communities. My role was to set the context for this discussion by outlining the social determinants of health that underlie health disparities. But I also wanted to set out some lines of policy and community action that can be taken to address these determinants and disparities.

Blueprint for Action on the Social Determinants of Health and Health Equity

The KU Work Group on Community Health and Development provides a range of useful planning resources on community development as one crucial direction for improving population health and addressing health inequities. Established in 1975, it was designated by the World Health Organization as a WHO Collaborating Centre in 2004 Its core values and assumptions are:

1. Building healthy communities involves improving conditions and outcomes for the health and well-being of the population as a whole.
2. This requires changing conditions, including environmental and policy conditions, that affect behaviors and related outcomes.
3. Since health and human development outcomes are caused by multiple and interconnected factors, single interventions are likely to be insufficient.
4. Since environmental influences occur in different contexts, collaborative efforts must bring about changes in multiple sectors and systems.
5. Local people, including those most affected, should be active participants in changing local conditions.
6. Justice requires health and well being for all, including for marginalized groups that have different exposures, vulnerabilities, and consequences related to their situations.
7. To improve health for all requires addressing broader social determinants, such as social inclusion, income equality, and efficacy or the ability to have influence on conditions.
8. Collaborative partnerships act as catalysts for change; they convene key parties, broker relationships, and leverage needed resources.
9. The aim of support organizations is to build capacity to address what matters to people over time and across concerns.
10. Community health and development involves interdependent relationships among multiple parties in which none can function fully without collaboration with others.

The Work Group's Community Tool Box (CTB) is the world's largest resource (over 7,000 pages of content) for building capacity for community health and development. They also publish many guidelines and tool kits for health planning and community development, and provide links to a range of articles and reports.

Today is Earth Day 2008 - and a very happy birthday to a much-abused dear old planet Earth!

Statistics Canada has released this morning an update to its Human Activity and the Environment series that reports, among other things, that the emission of green house gases are up by 25% from 1990 to 2005. Lots more troubling indicators, including a stunning chart showing the remorseless rise in mean global temperatures.

Clean air and moderate temperatures are fundamental to good health. As Toronto braces for more smog days and extreme heat alerts, it’s important to remember that a safe and healthy environment, like most other determinants of health, is a fundamental health equity concern.

Some people in our city are more financially able to mitigate some of the worst effects of smog and heat than others (with air conditioning, vacations out of the city, etc.). 

Toronto enjoyed a spectacular weekend this past Saturday and Sunday – and we also puffed our way through the first two smog days of 2008. These smog days have come about a month earlier than expected. If this keeps up, we’ll be on track to beat the last record for smog days set in 2005. In that year, Toronto’s Medical Officer of Health released an epidemiological report surveying death data over several decades and reported that many more Torontonians are dying of heat and smog-related causes than cold injuries.

On the good news front, the provincial government announced today new rules to ban cosmetic pesticides and herbicides. They have taken the lead from the City of Toronto, which adopted its own anti-pesticides bylaw several years ago thanks to a vigorous campaign that was led by Toronto Environmental Alliance staff and volunteers.

It's been more than two years since Toronto City Council adopted an Urban Heat Island Mitigation Strategy - an acknowledgement of the serious environmental issues facing the city from killer heat and killer smog. Practical and effective action is still required.