This is a guest blog by Nicoda Foster and Christine Chan, Masters of Public Health Students at the University of Toronto and University of Liverpool respectively. They also both work in policy analysis and project management in the health sector in Toronto, Ontario.
We would like to share findings from a survey we conducted over June to September 2012. Borrowing from the Ontario’s Chief Medical Office of Health, Dr. Arlene King, whose 2009 report carried the title “Public Health is Everyone’s Business”, we embarked on a qualitative study of the government ministries of Ontario to investigate whether health was indeed every Ministry’s business. Our study consisted of largely unstructured interviews arranged with policy analysts or managers within each of the ministries. Two core questions were asked of each Ministry: (1) how does the work of your Ministry impact health and; (2) to what extent does the work of your Ministry impact on the social determinants of health.
We received responses from 17 Ministries of the 24 who we contacted. Upon completion of the interviews, we were able to identify key factors influencing whether a ministry adopted a determinants approach to their work. The key factors identified were:
- Political climate: which is naturally dependent upon the political party in power and its ideological influences. E.g. The Ministry of Community Safety and Correctional Services expressed that their policy making was dynamic and politically driven.
- Champions: which refers to the need to have influential and knowledgeable individuals to lead and support the implementation of a determinants approach. The abolition of the Ministry of Health Promotion led to the transfer of determinants-minded staff to the Ministry of Tourism, Sport and Culture, and the Ministry of Children and Youth Services, which has instilled a determinants approach within these ministries.
- Legislation: the need for legislation which supports or compels ministries to use a determinants approach. E.g. The Ministry of Community Safety and Correctional Services is an example of a ministry that is largely driven by legislation.
- Mandate-driven: which refers to whether employing a determinants approach is a part of the organization’s mandate. e.g.. The Ministry of Economic Development and Innovation was clear that their mandate was to spur growth in the economy and that in times of fiscal constraints, their definition of prosperity is sharpened and the need is for immediacy and fast results towards this mandate. Considerations relating to quality of life are necessarily relegated to a lower priority.
- Policy processes: we found that many ministries use a horizontal policy development processes which engages other ministries in the development of policies so as to ensure the inclusion of a wide range of factors in the development of policies and to avoid negative unintentional effects. Ministries that mentioned that they engaged in horizontal policy development include the Ministry of the Environment, Ministry of Children and Youth Services, and the Ministry of Northern Development and Mines. The Ministry of Transportation and the Ministry of Community Safety and Correctional Services were two examples of Ministries that did not mention using a horizontal policy development process.
- Capacity building tools: this refers to tools designed to facilitate the use of a determinants approach such as the Health Equity Impact Assessment (HEIA) tool developed by the Ministry of Health and Long Term Care.
- Moral imperative: which refers to the conviction that using a determinants approach is the ‘right thing to do’. The Ministry of Children and Youth Services and the Ministry of the Environment were two ministries who mentioned this.
From our study, we have come to the unfortunate confirmation that most ‘non-health’ ministries still view health as largely the responsibility of the Ministry of Health and Long Term Care and its partners, and that the definition is health in Ontario is still seen through a very narrow lens. The survey has highlighted a misconception that exists in some ministries on the non-health drivers that impact health. We recommend that the Ontario government begin to take the necessary steps needed to firstly increase the awareness of the Ontario ministries of their role in impacting health, and secondly, to build capacity to more vigorously use a determinants approach in policy-development and decision-making.
A presentation we made at the Health Promotion Ontario conference on September 27, 2012 is below.