Examining the Social Determinants of Health

Socio-economic position is one of the most crucial determinants of health inequities within societies. Health inequities are differences in health between specific population groups that are systematic, avoidable, unfair and unjust. Health inequities systematically place individuals who are already socially disadvantaged, in terms of income, gender, race and/or ethnicity, at further disadvantage related to health (Raphael, 2003). Globally, there is momentum to investigate and act upon health inequities by strengthening the social determinants of health, including early childhood development, adequate income, fair income distribution, high educational attainment, non-precarious employment, safe working conditions, food security and affordable housing. Power of government at all jurisdictional level (example local, provincial, national) to enact policies that facilitate structural improvements to the social determinants of health, strengthening political will or motivation to act, is a critical concern for addressing health inequities (Raphael, 2003). In Canada’s most populous province of Ontario, while there has been some recent action in creating more equitable access to healthcare system, there has been little action to address other social determinants of health (Turnbull, 2017) . Such policy inaction could be due to a numerous of factors, including competing political and social agendas or the status of economic development, however, may also be due to a lack of political will to tackle health inequities (Gore & Kothan, 2012). Research has shown that in democratic countries, public opinion can influence political buy-in and public policy outcomes especially in the areas of social welfare and poverty policy; the more salient an issue is to the public, the stronger the relationship to the formulation of the policy agenda (Turnbull, 2017). In the Canadian context, and more specifically Ontarian’s, a study of public opinion about health equity policy interventions that address the social determinants of health, in additional engaging a debate in the equity literature that considers whether policy interventions to reduce health inequities should be universal or targeted to the socially disadvantaged (Turnbull, 2017 and Gore & Kothan, 2012). As part of these analysis, to examine the relationship between how the public attribute health inequities and support for targeted vs. broader health equity interventions (Krist et al, 2017). The survey asked a series of questions related to three thematic areas: 1) awareness of health inequities; 2) explanations or attributions of health inequities; and 3) opinions about possible solutions to health inequities. Ontarian participants where asked to respond to the following questions: “ 1) the importance of addressing health inequities in Ontario; 2) fairness in health status in Ontario; 3) possible intervention approaches to address health inequities in the province; and 4) support for specific intervention types (Krist et al, 2017).”

The results concluded (Krist et al 2017):

1. 64% agreed that people need to take self responsibility for their own health and not expect the government to address this;

2. 98% agreed Ontarian’s should have the same opportunity to live a ling and healthy life;

3. 47% agreed that Ontarian’s actually have this opportunity;

4. 58% Ontario society needs major changes in order to make things more equitable among people;

5. 48% agreed that the government should address health inequities by increasing taxes;

6. 65% agreed that the government should address health inequities through redistributive processes, whereby resources are shifted away from the wealthy to support lower income.

Addressing the social determinants of health necessarily means moving away from depoliticized framework. Attention to the social determinants and inequities has been growing, as health promotion movements evolve within Ontario and across Canada.

Reference

Gore, D. & Kothan, A. (2012). Social determinants of health in Canada: Are healthy living

initiatives there yet? A policy anaylsis. International Journal of Equity Health 11(41), doi:

10.1186/1475-9276-11-41. Retrieved October 16, 2020 from,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492195/

Krist, M., Shankardass, K., Singhal, S., Lofters, A., Muntaner, C. & Quinonez, C. (2017).

Addressing health inequalities in Ontario, Canada: what solutions do the public

support. Retreived October 16, 2020 from,

https://link.springer.com/article/10.1186/s12889-016-3932-x

Raphael, D. (2003). Barriers to addressing the societal determinants of health: public health

units and poverty in Ontario, Canada. Health Promotion International, 18(4), doi:

10.1093/heapro/dag411

Turnbull, J. (2017). Health Quality Ontario. What is health Quality. Retrieved October 16,

2020 from, https://www.hqontario.ca/Blog/health-equity/health-equity-in-northern

ontario-thinking-locally