About this Article: Inequitable access to social factors that impact health lead to differing rates of disease, injury and mortality between advantaged and disadvantaged members of Ontario society. This article explores some of the causes or inequity and barriers to addressing them, and makes recommendations for action.
About This Series: The É/Exchange working paper series is designed to facilitate sharing of results and to encourage discussion of concepts, practices, and policies in applied health. This series provides a way to disseminate well-written, but not yet published, reports of research. It is also a way to make research conducted by affiliated community members accessible to a wider readership. The series is co-sponsored by The Population Health Improvement Research Network (PHIRN), Réseau de recherche appliquée sur la santé des francophones de l'Ontario (RRASFO); and the Ontario Health Human Resources Research Network (OHHRRN).
Social determinants of health refer to the economic and social conditions that shape health and create health inequities. They include amount of income, quality of employment, working conditions, and features of housing. When these factors are inadequate, they contribute to material deprivation, stress, a higher likelihood of adopting health threatening coping behaviours, and lower levels of access to quality health care, among other things. Canada's distribution of the social determinants of health is among the most unequal of wealthy developed nations. In this commissioned article, Raphael presents analysis of documents that recommend ways to address health inequity and examines public policy actions for Ontario.
Improving Daily Living Conditions
Reducing the level of childhood poverty and supporting early education help to address health inequities. Living conditions during childhood are related to both immediate and future health outcomes. Universal affordable child care enhances children's well-being, health development, and lifelong learning. It supports parents in education, training and employment, builds strong communities and promotes equity.
Inequities among adults can be addressed by reducing unemployment levels, increasing wages and benefits (such as vision and dental care, pensions and employment training), and promoting social protection by addressing housing and food security needs, and ensuring the existence of social safety nets.
Equitable Distribution of Power, Money and Resources
Progressive taxation, which collects and distributes a greater proportion of national economic resources, can improve population health and quality of life.
Government decision-making must include participation of, and be accountable to, the public. Public education about the social benefits of health equity and ensuring a place for these issues on the public policy agenda are important steps in working towards health equity, as is an effective publicly funded health-care system.
Improve Government Commitment
Governments at all levels need to make an explicit commitment to health and integrate a social determinants of health perspective across sectors, rather than addressing it through the health care sector alone. To do so, both policy-makers and the public must better understand the social determinants of health. In addition, more public health research should focus on these types of issues.
A systematic program to monitor the extent of health inequity and the state of the social determinants of health, as well as in allocation and use of resources is also needed to provide assessments of the effects of public policy.
Working towards health equity is about creating circumstances to reduce and eliminate health inequities among groups
Health Gaps in Ontario
Health inequities exist for life expectancy, infant mortality, and the incidence, prevalence and mortality rates of various diseases and injuries among advantaged and disadvantaged groups in Ontario. Disadvantage can be seen in many sectors:
- Poverty rates are increasing across all age groups and social assistance rates are below the poverty line;
- The number of regulated childcare spaces lags far behind demand;
- A great number of residents live with food and housing insecurity; and
- Unemployment rates, and the number of people who have low or minimum wage jobs are high.
Positive developments in Ontario include:
- The existence of the Health Equity Unit within the Ministry of Health and Long-Term Care;
- The requirement of Local Health Integration Networks to create Health Equity Plans;
- The Ontario Public Health Standards requirement that local health units monitor and report on the social determinants of health; and
- Ontario's Poverty Reduction Act.
Existing barriers to establishing health equity include:
- Current inadequate public policies in the areas of disability, family, income, taxation, labour and pension;
- The historical tendency of public policy to favor the marketplace rather than the State as the primary means of distributing economic resources among the population;
- The difficulty of aligning federal and provincial public policy under a federal system;
- The difficulty for political parties who favour health equity to gain power under the current electoral system and with current voter behavior; and
- The insufficient strength of unions, collective agreements and advocacy groups to pressure governments to implement health equity promoting public policy.
Ontario could promote health equity through:
- Raising minimum wage, social assistance and child benefit levels;
- Improving working conditions and employment standards and making it easier for workplaces to unionize;
- Creating a fairer tax system;
- Providing an affordable regulated childcare system;
- Ensuring affordable healthy foods and adequate housing;
- Including a consideration of health impacts when developing economic and other policies; and
- Ensuring public support through raising awareness for a health equity agenda.
Currently, the political context in Ontario is not one that easily aligns with the promotion of health equity with public policy action. However, some promising work is being done to gain pubic support for response to health inequalities.
Reference: Raphael, D. Working Towards Health Equity-Related Policymaking in Ontario. Exchange Working Paper Series, Volume 3, Issue 3. University of Ottawa, Ottawa, Canada. Available at rrasp-phirn.ca.