The social determinants of health have been a hot topic in health policy for quite some time. “Since the release of the final report by the Commission on the Social Determinants of Health, the social determinants of health (SDHs) have been widely acknowledged as a central driving force of population and health outcomes” (Ruckert & Labonte, 2016). Furthermore Ruckert & Labonte state that “the academic literature has recently established a strong link between the nature of welfare policy, with the institutional arrangements that it represents, and (inequitable) health outcomes.” Another article by Kirst et al goes onto say that “Socio-economic position is one of the most important determinants of health inequities within societies” (Kirst, et al., 2017). The public is not far behind in their belief that support for SDHs is important; “Globally there is momentum to investigate and act upon health inequities by strengthening the social determinants of health…” (Kirst, et al., 2017). The question remains that if everyone is on the same page regarding the importance of focusing on the Social Determinants of health to eliminate health inequities why aren’t we more committed?
I would argue there are two basic elements that hold back work on SDHs in Canada: scope and privilege. When it comes to the responsibility for SDHs and work implementation there is a lot of misunderstanding as to where the work best fits. Public Health seems like a logical place for SDH work as “Addressing SDH and responding to the presence of health inequalities is required under the Ontario Public Health Standards” (Brassolotto, Raphael, & Baldeo, 2014). The requirement is listed on the first page under a list of required activities by Public Health Units (Brassolotto, Raphael, & Baldeo, 2014). So why is this not being done effectively? Brassolotto goes on to argue it’s a matter of epistemological barriers or understanding of scope. If you don’t have concrete guidelines and understandings of how to fix the problem how do you know if you’re allocating resources appropriately? The literature merely says it must be addressed but not how so it’s left to a matter of understanding of one’s role in the larger picture. A lot of work around SDHs also occurs on a Macro scale which is often conflicts; “Canadian public health professionals are usually trained in clinical areas that work within a discourse of individualism. As a result, many of them adopt micro-level understanding of health. The SDH do not easily lend themselves to this way of thinking because they focus on the macro and meso-level contexts in which people become ill” (Brassolotto, Raphael, & Baldeo, 2014).
Another issue Public Health Units face when addressing SDHs is that they are influenced by public want and needs for their catchment areas. This is where privilege comes into play. The public as a whole admittedly agrees with the need to work on improving SDHs but when it comes to which ones it’s hard for the public to agree. Generally they view children as a vulnerable population that requires extra support but other than that support tends to be focused on the areas that most affect the people being polled. In one Canadian survey looking at SDHs and health inequalities “individuals were more supportive of government spending in child care, pharmacare, and dental and vision care, with differences by socio-demographic characteristics of participants. Males and parents with small children were more likely to rank child care as a priority for government spending. In contrast, adults < 45 did not rank pharmacare as a priority.” (Fuller, Neudorf, Bermedo-Carrasco, & Neudorf, 2016). Further, “being a Caucasian, having a household income greater than $75,000, being over 25 years of age and being a male were associated with having lower support…for policies to increase healthcare services, increase welfare, provide a guaranteed annual income or increase welfare payments” (Fuller, Neudorf, Bermedo-Carrasco, & Neudorf, 2016). A powerful incentive to fix this issue may just be showing privileged groups how that privilege is affected by a lack of equality.
References
Brassolotto, J., Raphael, D., & Baldeo, N. (2014). Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: a qualitative inquiry. Critical Public Health, 24(3), 321-336.
Fuller, D., Neudorf, J., Bermedo-Carrasco, S., & Neudorf, C. (2016, January). Classifying the population by socioeconomic factors associated with support for policies to reduce social inequalities in health. Journal of Public Health, 38(4), 635-643.
Kirst, M., Shankardass, K., Singhal, S., Lofters, A., Mutaner, C., & Quinonez, C. (2017). Addressing health inequities in Ontario Canada: what solutions do the public support? BMC Public Health, 1-9.
Ruckert, A., & Labonte, R. (2016). The first federal budget under Prime Minister Justin Trudeau: Addressing social determinants of health? Canadian Public Health Association, 107(2), 212-214.