A huge body of research demonstrates that health and health inequalities are shaped by income distribution, access to education, availability of affordable adequate housing, childcare and early child development, social exclusion, environmental factors and other social determinants of health. These determinants of health interact and intersect with each other to produce reinforcing and cumulative impacts over people’s lives and on the health of particular populations or communities. All of this takes place in a constantly changing and dynamic environment; in fact, through multiple interacting and inter-dependent economic, social and health systems playing out in particular neighbourhoods and regions.
Determinants of health have been the focus of sustained high-level policy attention in recent years: from the World Health Organization’s Special Commission on Determinants of Health, through European Union and other broad efforts, to comprehensive policies to address the determinants and their impact on health inequalities in many countries.
Much of the Wellesley Institute’s work is about how the social determinants and health inequalities can be addressed through policy action. We have developed an overview Roadmap for Health Equity setting out key directions needed.
Research reports, policy papers, presentations and blog commentaries analyzing specific social determinants of health (for example, housing & homelessness) or particular health equity issues (such as immigrant health or driving equity into health system reform) are available on other pages.
Next month the World Health Organization (WHO) is holding a Conference on the Social Determinants of Health in Rio de Janeiro. The conference aims to strengthen commitments by member states to develop and implement national policies on the social determinants of health to reduce health inequities; and, to share experiences, challenges, and technical knowledge on how to address social determinants of health.
Recently, the Wellesley Institute hosted a consultation by the Public Health Agency of Canada (PHAC) in preparation for the conference. The discussions centred on five themes: governance, community participation, role of the health sector, aligning global priorities and stakeholders, and monitoring progress. [...]
Social policy can’t just be about addressing the easy issues – there are very few – but has to tackle really deep-seated and complex problems such as poverty, health disparities or homelessness. I just published an article on promising community-driven directions for addressing such fundamental inequalities and the policy frameworks needed to address such “wicked” policy challenges.
I was really pleased to speak at an OPSEU symposium on equity over the weekend. Unions have long played a central role in the broad community coalitions that are so vital to addressing the underlying social determinants of health inequalities. And OPSEU and other union members work on the front-lines of health and are vital players in the innovative solutions needed to build equity into all service delivery and planning. [...]
Evidence from around the world shows that enhancing access to high quality comprehensive primary care for disadvantaged people and communities is one of them most important directions for addressing health inequalities. Community health centres are a vital part of this direction in Canada and many other countries, and the recent AOHC conference on Health Equity: Pushing the Boundaries highlighted how to drive this into action on the ground (I spoke on how do this). [...]
There is always a huge amount to be learnt from equity strategy and interventions in other countries. I presented a lecture on health equity strategy in Ontario and Canada to a seminar of public health professors and other leaders in Berlin. [...]
The Ontario Agency for Health Protection and Promotion has a vital role in supporting an innovative and effective public health system. The Agency has highlighted equity in its strategic priorities. I presented a workshop there on how to build equity into practice through planning, priority setting, resource allocation and performance management, and how health promotion can be approached through an equity lens. [...]
It’s really hard to boil down complex policy and social challenges into snappy and popular language. Here is a recent attempt in an interview I did at the Association of Ontario Health Centres conference.
An interesting recent report from New Zealand highlights the importance of urban environments for population health. Healthy Places, Healthy Lives examines research evidence and sets out a number of case studies that illustrate ways to design cities, towns, neighbourhoods and streets to promote health. [...]
One critical way to drive health equity is by building expectations and requirements into system and performance management. Several LHINs have required their partner service providers to develop health equity plans which identify vulnerable populations and access barriers, detail plans to address those challenges, outline initiatives underway addressing equity in service delivery, and set out priorities for the future. [...]
The World Health Organization created a Commission on the Social Determinants of Health, whose site publishes a wide range of useful information resources. It has mobilized polity research and initiatives around the world, working with many countries including Canada. Its report is the subject of intensive discussion in many jurisdictions. The Public Health Agency of Canada and the National Collaborating Centre on the Determinants of Health have led discussion of the implications of the WHO findings and recommended policy directions within Canada. [...]
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.
Presentation to the Conference Board of Canada Roundtable on Social Determinants of Health, by Bob Gardner, Director Public Policy, Wellesley Institute, October, 2006. [...]
