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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.

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.

The new year is a time for resolutions. When it comes to urban health, Toronto's pioneering Medical Officer of Health, Dr. Charles Hastings, laid down a strong challenge almost nine decades ago. In December of 1918, Dr. Hastings was elevated to President of the American Public Health Association. It was not only a great honour, but well-deserved recognition of his work as Toronto's first-ever Medical Officer of Health in making dramatic health advances. The key to his success was in tackling the fundamentals of good health - such as safe food and affordable homes.

Dr. Hastings delivered his inaugural address as people around the globe were sighing with relief at the end of the first world war: "Our nations have for the past four years been pouring out the best of their blood... The war has demonstrated, as never before, the value of  man power, whether in war and peace. Every nation has been expecting every man to do his duty, and now that the war is over, every man will expect every nation to do its duty..."

"Every nation that permits people to remain under the fetters of preventable disease, and permits social conditions to exist that make it impossible for them to be properly fed, clothed and housed, so as to maintain a high degree of resistance and physical fitness, and that endorses a wage that does not afford sufficient revenue for the home, a revenue that will make possible the development of a sound mind and body, is trampling a primary principle of democracy under its feet."

"Will any of the democracies of today stand the test?"

Well, how about it: Toronto, Ontario and Canada? Will 2008 be the year when elected officials, working with community and business leaders, finally take the pledge to create healthy and strong communities?

The Inclusive Cities project is a partnership of community social planning organizations and municipal politicians from across the country that seeks to enhance cities’ ability to enable and sustain social inclusion and to ensure the full diversity of community voices are valued and recognized. They have developed a range of very useful papers, including on:

• how neighbourhood councils and forms of more local community engagement can make a key contribution to both overall civic engagement and good inclusive planning 
• how indicators of social inclusion can be used to address social determinants of health in local planning.

While the fundamental social determinants of health will only be fully addressed with major shifts in government policy and action, there are many innovative and effective ways in which their impact on health disparities can be tackled more immediately in front-line service delivery.  One direction is where regional health authorities, community health centres and social service providers are delivering more coordinated community-based primary care, other health care, health promotion, public health and social services, often out of single locations.

An interesting example is underway in Winnipeg.  The Winnipeg Regional Health Authority and Manitoba Family Services and Housing have been partnering on a new model to integrate health and social service delivery called the Winnipeg Integrated Services Initiative:

The vision of integrated community-based and social services is to provide efficient, effective and holistic services which are person or family focussed and recognize the principles of population health and primary health care.

Part of the integration of services is the creation of access models. Three of these models have already been announced. One in each of the River East, Transcona and Inkster areas.

An Access model is a provincially funded site that will provide community-based, integrated health and social services. Each model will offer a broad range of services that reflect the needs of the communities they serve. Where services are not available within Access, the public will be referred to related community resources. Access will provide a one-stop source of information to the community and will support community activity and development.

The WRHA, Manitoba Family Services and Housing and Manitoba Health are committed to working with communities to ensure that citizens are involved in decisions that affect their lives. In each community, there will be opportunities for citizens to express their opinions about Access as it is developed in their area. Watch for information about public consultation in your community.

They had earlier developed a comprehensive conceptual framework for how integrated health and social services and the community access model could work.

Appendices set out how this framework is solidly grounded in a determinants of health analysis, in the Alma-Alta declaration on primary care and in a wider commitment to primary care reform within the province.

The WHO Commission on Social Determinants of Health has been active on many fronts. One of the most interesting has been its various knowledge networks. The Health Systems Knowledge Network has recently published a series of literature reviews on key issues. These include papers on:

• primary care as a key strategy in enhancing health equity;
• comparative analysis of the forms of health management and stewardship most effective at tackling health inequity;
• planning and market regulation, including analysis of the inequitable impact of commercialization of health care provision;
• and gender analysis and health human resources.

The new British Prime Minister Gordon Brown, as he took office today, used the "h" word in his short (352 word), maiden speech as PM. He identified change with affordable housing as a priority of his administration. This is a significant recognition of the important role that the government plays in helping households access and maintain safe and affordable homes.

Here are some excerpts from the Labour web site, where the governing party calls for an increase in social housing (few politicians in Canada use the term social housing after it was demonized in the 1990s in a series of slurs by conservative politicians):

Labour also believes that everyone should have the opportunity to live in a decent, affordable home. There are now over a million more homeowners than there were in 1997. The quality of our social housing stock has risen rapidly, through the Decent Homes Standard which by 2010 will have improved 3.6 million homes, benefiting eight million social tenants, with investment of over 40 billion. We now need to look to increase provision of decent and affordable housing to meet future needs.

How do we meet Britains housing needs and aspirations?

How can we ensure greater provision of affordable housing in the future?

What can we do to minimise the environmental impact of new housing growth?

How can we provide more social housing, including council housing, alongside improving existing stock?

A comprehensive new report by Gordon Laird for the Sheldon Chumir Foundation for Ethics in Leadership, released today, puts the cost of homelessness in Canada at $49.5 billion over the past decade.

The research study includes a number of important findings, including:

- poverty is the leading cause of homelessness;

- homelessness is on the rise throughout Canada;

- homelessness is a proven multiplier of social ills;

- housing is the critical pathway to address many social issues.

The full report well worth reading is posted here.

A number of European countries have long emphasized comprehensive national strategies to reduce health disparities and address the social determinants of health in their polices and programmes.

This has been particularly marked in the Nordic countries. A recent report from the Norwegian Ministry of Health and Care Services to the national parliament sets out a long-term strategy for reducing social inequalities in health.

Sweden also has developed comprehensive strategies. A recent national public health strategy includes such objectives as increasing public participation and influence within society, including of the most vulnerable and marginalized, and enhancing economic and social security as a pre-condition of good health. In fact five of its twelve objectives focus on non-health determinants. A speech outlining the strategy here and and the report here.

Dying For A Home is a dynamic new book by Toronto street nurse Cathy Crowe and ten experts on homelessness: Women and men who have lived on Toronto's streets. You can read compelling stories and learn about homelessness from the street level up. Highly recommended.

- Michael Shapcott