Determinants of Health

In 2018, the Canadian Nurses Association (CNA) put out a position statement on the social determinants of health. The CNA gave four distinct statements, one which is general, and three others to support nurses in how to address inequities in the health care system. These are written as below:

· A Health in All Policies approach is best situated to promote health equity. Policies addressing income, employment, education, housing, transportation and others should be evaluated in their planning stages for their impact on health.

· All facets of nursing practice, in collaboration with others in and outside of the health sector, should strive to reduce, and ultimately eliminate, health inequity.

· Nurses must include the social determinants of health in their assessments and interventions with individuals, families and communities.

· Nursing education must incorporate the analysis of the social determinants of health, starting with a critical understanding of the political, economic and social factors that are the root causes of health inequities.

The CNA further outlined four beliefs which include nurses have both professional and ethical responsibilities, the ability to influence the health care system, the requirement to work collaboratively with all others in the health care system, and utilizing this collaboration to support change at all levels of government.

In 2010, a very comprehensive report was written with the endorsement of the Honorable Monique Begin, who at the time was a Member of WHO Commission on Social Determinants of Health and is a Former Minister of National Health & Welfare. She wrote the forward on this report as a “call to action”, encouraging Canada to understand who suffers from health inequities, as well as challenging those in power to remove barriers and ensure Canadians have equal access to health despite their situation.

Another important document from 2013 discusses Aboriginal Health. Reading and Halseth (2013) conclude after looking at many factors for our indigenous peoples that along with colonization, marginalization and discrimination are also factors that contribute to the ongoing health inequities. Much of this is echoed in Reading and Lopper (2009), although they included overcrowding and food insecurity as factors, which may be correlated with colonization.

A much more recent (and topical) resource from Public Health Ontario (PHO) (2020), discusses “material deprivation” in relation to health inequities in neighbourhoods suffering more from COVID-19. In its second report, PHO reports on how the Ontario Marginalization Index contributes to poverty, connecting not only the individual’s inability to attain basic needs, but also that of the community. “Similar to the first report, the broad purpose of this report is to help policy makers and program planners to identify populations for which prioritization of public health and health system resources and interventions are needed to mitigate the disproportionate impact of COVID-19.”

References

Canadian Nurses Association, 2018, Position Statement, Social Determinants of Health.

Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts.

Toronto: York University School of Health Policy and Management.

Reading, J. & Halseth, R. (2013). Pathways to Improving Well-Being for Indigenous Peoples: How Living Conditions Decide Health. Prince George, BC: National Collaborating Centre for Aboriginal Health.

Reading, C., & Wien, F., (2009). Health Inequities and Social Determinants of Aboriginal Peoples’ Health. National Collaborating Centre for Aboriginal Health.

Public Health Ontario (2020). COVID-19 in Ontario - A Focus on Material Deprivation: January 15, 2020 to June 3. Enhanced Epidemiological Summary COVID-19 in Ontario – A Focus on Material Deprivation.