Imagine you are a family physician, one of your patients visits you for a routine checkup. During this checkup you notice their cholesterol levels are too high, so you stress the importance of regular exercise and eating a healthy diet composed of fresh fruits and vegetables in order to maintain a healthy lifestyle. However, the patient complains there are no public parks in their neighborhood and that the local convenience store does not sell fresh fruits and vegetables. You might ask, why does it matter whether there are any parks in this patient’s neighborhood, or, why they are buying their groceries at a convenience store. To answer this question we must consider alternative factors that affect one’s lifestyle.
Regardless of income status, public parks provide a free and safe space for citizens to exercise, thus the lack of public parks makes free and safe exercise more difficult to practice. Here, we see how poor urban planning results in a resource deficient physical environment, which in turn contributes to the poor health outcomes of residents. Similarly, poor urban planning can also result in food deserts - communities without adequate grocery stores. Often these food deserts are in low-income communities, therefore residents may not have access to transportation to travel to their nearest grocery store. This is one of the ways in which income status also affects an individual’s health. Unfortunately, this case is not entirely hypothetical and is the reality for many Canadians.
One of the greatest challenges in health across the world is the task of reducing health inequalities (Lucyk, 2020). By reducing health inequality, there is potential to improve population health which can, in turn, can result in positive health externalities, such as improving national economies by establishing and ensuring a productive workforce. However, in order to address health disparities governments and health agencies must familiarize themselves with the social determinants of health – factors that influence health outcomes. In 2019, Prime Minister Justin Trudeau released mandate letters to departmental ministers with directives that focused on intersectoral action on the social determinants of health (Lucyk, 2020). These mandates outline initiatives in employment, housing, education, and other sectors (Lucyk, 2020). The Government of Canada recognizes 12 main determinants (“Social determinants of health and health inequalities - Canada.ca,” 2020):
1. Income and social status
2. Employment and working conditions
3. Education and literacy
4. Childhood experiences
5. Physical environments
6. Social supports and coping skills
7. Healthy behaviors
8. Access to health services
9. Biology and genetic endowment
10. Gender
11. Culture
12. Race/racism
In Nova Scotia, health policies and administration are governed by the Nova Scotia Department of Health and Wellness (DHW), the Nova Scotia Health Authority (NSHA), and the IWK Health Centre (“Health Authorities | novascotia.ca,” 2020). In a Population Health Brochure released by DHW (then called the Nova Scotia Department of Health Promotion and Protection) the social determinants of health identified were similar to those recognized by the federal government, excluding physical environment and race/racism (Healthy People, Healthy Communities, n.d.). In a 2012 statement about how public health in Nova Scotia was focusing on the social determinants of health and health equity, Dr. Robert Strang, Chief Medical Officer of Nova Scotia recognized income, education, housing, and health as important factors to address in order to improve health equity in Nova Scotia (Strang, 2012). The health priorities of the province have varied year to year depending on public need, these priorities can be identified in the annual DHW business plan. The 2020-21 departmental business plan identified 6 key priorities to support healthier communities and better access to care (Business Plan 2020-21, 2020):
1. Access to primary care
2. Access to specialists and orthopedic surgeries
3. Continued care
4. Mental health and addictions
5. Digital health and data analytics
6. NSHA and IWK Health Centre capital construction
While there is a general consensus to reduce the challenges introduced by health inequalities, the social determinants of health identified by each province and the health priorities across provinces vary. For example, in reviewing a comparative analysis of the social determinants of health and health priorities between British Columbia and Ontario, B.C identified income inequality, risk for children, and lack of affordable housing and homelessness as significant concerns for B.C public health (Thomson & Ratheeswaran, 2021). While Ontario also identified income inequality and affordable housing as main issues affecting population health, it also noted food insecurity as a key priority (Thomson & Ratheeswaran, 2021).
The health priorities of B.C and Ontario were relatively similar, however, they were quite different from the priorities identified by Nova Scotia. It is interesting to see how the factors that constitute the social determinants of health vary province to province, and between provincial and federal health departments. This variation of what social determinants of health are most likely plays a role in the varying quality, access, and priorities in healthcare between provinces.
For a quick summary of the social determinants of health, watch the video below
References
Business Plan 2020-21. (2020). Retrieved from https://novascotia.ca/government/accountability/2020-2021/Health-and-Wellness-2020-2021-Business-Plan.pdf
Health Authorities | novascotia.ca. (n.d.). Retrieved February 16, 2021, from https://novascotia.ca/dhw/about/health-authorities.asp
Healthy People, Healthy Communities: Using the Population Health Approach in Nova Scotia NOVA SCOTIA DEPARTMENT OF HEALTH PROMOTION AND PROTECTION Acknowledgements. (n.d.). https://novascotia.ca/dhw/publications/Public-Health-Education/Healthy-People-Healthy-Communities-Population-Health-Approach.pdf
Lucyk, K. (2020). Intersectoral action on the social determinants of health and health equity in Canada: December 2019 federal government mandate letter review. Health Promotion and Chronic Disease Prevention in Canada, 40(10), 314–323. https://doi.org/10.24095/hpcdp.40.10.03
Psych Hub. (2020, October 5). Social Determinants of Health. Retrieved February 16, 2021, from https://www.youtube.com/watch?v=17jeXGbKlTQ&ab_channel=PsychHub
Social determinants of health and health inequalities - Canada.ca. (n.d.). Retrieved February 9, 2021, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Strang, R. (2012). How public health in Nova Scotia is focusing on the social determinants of health and health equity | National Collaborating Centre for Determinants of Health. Retrieved February 16, 2021, from https://nccdh.ca/resources/entry/how-public-health-in-nova-scotia-is-focusing-on-the-social-determinants-of
Thomson, A & Ratheeswaran, K. (2021). Comparison Between BC and Ontario [Prezi Presentation]. https://prezi.com/view/3LE0Zgnwu891RTNKEnA6/
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