A Comparison of Determinants of Health in Canada & It’s Largest Province – Ontario

The World Health Organization (WHO) redefined health in its 1948 definition as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (Constitution, 2020). Canada, which is known for its reputation for world class care, has taken the WHO’s definition a step further and has provided clarification on the determinants of complete physical, mental, and social well-being. However, in Canada healthcare remains an area of shared jurisdiction between the federal government, the provinces, and territories (Health Canada, 2019), with most of the responsibility of delivery of health and social services landing on the provinces and territories (Health Canada, 2019). In this blog I hope to highlight the divergence between the determinants of health as identified by the federal government, and the shortfalls of its application in its largest province – Ontario.

The federal government of Canada acknowledges that there are many factors that contribute to an individual’s health and places great emphasis on social and economic determinants of health (Public Health, 2020). It states that the “Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health” (Public Health, 2020). According the government of Canada, the main determinants of health include income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, healthy behaviours, access to health services, biology and genetic endowment, gender, culture, and race/racism (Public Health, 2020).

In my previous blog I validated my support for the interactionist approach in defining health, and it appears that the government of Canada agrees. In its definition of determinants of health, it states: “In addition to our individual genetics and lifestyle choices, where we are born, grow, live, work and age also have an important influence on our health” (Public Health, 2020). The question is whether this is acknowledged at the provincial and territorial level, where most health and social services are delivered, or is the reality something else.

Raphael (2003) reported an interesting finding which I can relate to in retrospect reflecting on how services are offered at the institutions where I practice. He noted that despite Canada’s position on social and economic determinants of health, the province of Ontario as well as the other provinces remain focused on “downstream strategies focused on behaviour change”, rather than allocating resources to improve other determinants of health where there may be a gap, such as poverty (Raphael, 2003). He references Williamson (2001), an in-depth study of local public units across Canada which found that half of responding health units did not have any policy addressing poverty; and among those that did, the approach was consequence management based instead of promoting poverty prevention. 

Despite limited evidence supporting its effectiveness (Raphael, 2003), I believe the popularity of downstream behavioural approach is financial driven at the provincial level. Justifying a budget for dealing with a consequence is always easier than justifying a budget for preventing an issue. Arguably, the financial burden associated with addressing societal determinants of health is not insignificant, making it a less popular choice at the provincial level. Nevertheless, there is increasing evidence supporting the importance of societal determinants of health (Raphael, 2003), and the provinces must implement health and social programs that focus on an effective evidence-based approach, even if the approach is not financially efficient – after all, efficient healthcare does not always equate to effective healthcare.

References

Constitution. (n.d.). Retrieved October 15, 2020, from https://www.who.int/about/who-we-are/constitution

Dennis Raphael, Barriers to addressing the societal determinants of health: public health units and poverty in Ontario, Canada, Health Promotion International, Volume 18, Issue 4, December 2003, Pages 397–405, https://doi.org/10.1093/heapro/dag411

Health Canada. (2019, September 17). Government of Canada. Retrieved October 15, 2020, from https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html

Public Health. (2020, October 07). Government of Canada. Retrieved October 15, 2020, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Williamson, D. L. (2001) The role of the heath sector in addressing poverty. Canadian Journal of Public  Health, 92, 178–183.