- Health equity as an achievable social goal has gained new policy relevance. Internationally, the WHO Commission on Social Determinants of Health has focused attention on disparities in health that are avoidable by reasonable action, and therefore inequitable;
- Nationally, Canada’s Chief Public Health Officer has targeted health inequalities in his agency’s first annual report, noting the importance of policy intervention in improving health outcomes;
- Provincially, the Government of Ontario’s Poverty Reduction Plan has recognized social inequalities as important to health;
- There is clearly a growing need and demand for strategic short- and long-range policy evidence in order to inform action on reducing health inequity by way of the social determinants of health. The Patterns and Pathways of Inequities Program will seek to expand the evidence base for policy interventions related to the social determinants of health;
Areas of investigation
- The intersections among different forms of social stratification (e.g. socioeconomic status, gender and ethno-cultural background);
- The connections between proximal and distal determinants of ill health;
- The institutions and processes that influence the allocation of health and social resources;
- The global context affecting choices about resource allocation at national (Canada) and sub-national (Ontario, community) levels;
- This program of research will be collaborative and network-building, drawing on the expertise of Ontario health equity researchers;
- It will emphasize a mixed-methods approach valuing both qualitative and quantitative research methods; support new studies; undertake systematic reviews; and attend particularly to analyses of transferrable policy interventions that have worked to reduce health inequities in other jurisdictions;
- The program will pay close attention to the difficult and contentious policy questions that surround health equity, and will attempt to ground proposals for eliminating health inequity in Ontario using the best available scientific evidence and policy models from around the world.
- To explore the impacts of closing the inequality gap on various outcomes, including health care utilisation, social services utilisation, and disease preventing behaviours. This will aid in an assessment of what economic and social impacts can be expected through efforts such as poverty reduction strategies.
- To conduct retrospective and prospective analyses of governmental and non-governmental policies which are likely to have an influence on equity in health and social determinants of health. This will aid in an assessment of the distributional impacts of various policies from the perspective of ‘health in all policies’.
- To explore the nature of intersectionality, that is, how various social and cultural categories of discrimination interact on multiple and often simultaneous levels to influence health. This will aid in an assessment of where governments can concentrate efforts to have the greatest impacts.
- To explore citizen engagement and priority setting around health equity policies. This will aid in an assessment of what the public perceives as important, and what opportunities are available for change.
- To both explore and engage in effective knowledge transfer and exchange activities (both academic and popular) that will inform the public and policy dialogue on achieving greater health equity by ‘levelling up the bottom.’
Social determinants of health, health equity, health disparity, mixed methods
Ronald Labonté is Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and Professor, Faculty of Medicine, University of Ottawa. Current research includes: globalization as a ‘determinant of determinants;’ global health development; health worker migration; comprehensive primary health care; and community development/local food security.
Carlos Quiñonez is an Assistant Professor and Director of the Specialty Training Program (Dental Public Health) at the Faculty of Dentistry, University of Toronto. Carlos maintains a research program in health services and policy research, with both a qualitative and quantitative focus.