The social determinants of health have been notoriously difficult to implement into concrete policy and programmes. Still, groups across the country are analysing and experimenting with how social determinants and health equity can be addressed on the ground through front-line service delivery and through community development. One such group is the Edmonton Social Planning Council. They developed a discussion paper on Creating Social and Health Equity: Adopting an Alberta Social Determinants of Health Framework. It sets out concrete directions to foster political will for major change, create cross sector collaborations, develop healthy public policy and establish a province-wide framework for sharing evidence-based best practices that address social determinants.
The Interior Health Authority in southern BC has developed Beyond Health Service and Lifestyle: A Social Determinants Approach. Using a very clever snakes and ladders metaphor (in which children born into poor families and living in disadvantaged neighbourhood have far more snakes to overcome towards good health and fewer ladders than more advantaged kids), it emphasized the need to build ladders that addressed the primary social determinants of secure income and socio-economic status, early life, education, meaningful and safe work, secure housing in safe neighbourhoods and strong social networks. They set out an action plan for building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and re-orientating health services.