Paddling up the river and heading down the rabbit hole

Adventures in Curating resources and health literature related to the Social Determinants of Health

I went down a rabbit hole this week with my curated list with the topic “Social Determinants of health” (SDOH), located here. I started with a broader search of definitions and articles first looking at Canada wide resources. There I found a great definition from a government website explaining not only the social determinants of health, which include the main determinants such as;

-Income and social status

-Employment and working conditions

-Education and literacy

-Childhood experiences

-Physical environments

-Social supports and coping skills

-Healthy behaviors

-Access to health services

-Biology and genetic endowment

-Gender

-Culture

-Race / Racism

but also health inequities such as poor access to fruits and vegetables for Canadians who live in the north (Public Health Agency of Canada, 2020). The website further discusses strategies in which the Canadian Government is working to reduce health inequities (Public Health Agency of Canada, 2020).

Narrowing the lens to look at Ontario websites, I found that regional public health agencies such as Niagara region, The Grey Bruce Health Unit, and The Simcoe Muskoka District Health unit, just to name a few, have similar themes such as the link between poverty and poor health outcomes, and a how policies and systems that take into account the SDOH can lead to improved health (G.B.H.U, 2013., Niagara Region, 2021., and Simcoe Muskoka District Health Unit, n.d.).

I like the fact that Ontario Public Health resources tend to focus quite heavily on reducing health inequities by looking at the broader picture of systems and policies to work towards equity and lead to improved health. (McPherson et al., 2016). I do find though, and certainly see in practice, that despite the growing body of evidence to support the impact of the SDOH, there remains bias amongst the healthcare field where interventions or “blame” is directed at the individual without factoring in the SDOH. One example discussed recently in the Journal of Obesity where authors Alberga Et al (2018) criticize a recent Senate report on Obesity in Canada for putting the blame on the individual, which the authors lay out a compelling argument for how this approach can lead to negative outcomes such as weight stigma, and further, promote shame, fear, and blame. For this reason I think there is still much work to be done to move towards an approach that uses a “health equity lens” (Niagara region, 2021).

A few themes emerged when I was looking at recent journal articles on this topic, the first and more relevant one being the link between Covid19 public health measures and the social determinants of health. One recent longitudinal study found that several SDOH such as employment status, physical environment and living situation were predictive of a decreased adherence to public health preventative measures for parents in urban settings (Yoshida-Montezuma et al., 2021). The authors recommended approaches that considered health inequities as strategies to improve adherence to these measures.

I also looked specifically at studies and reviews focusing on Ontario issues and found a common theme of inequity surrounding both Ontarians living in northern communities, as well as indigenous populations, and the challenges they face due the lack of access to basic necessities and care. One case study looking at unregistered births among indigenous people living in northern Ontario highlights the barriers and impact that environmental conditions have on an individual’s life and health that comes with inability to access essential services. (Sanders &Burnett, 2019). The authors present the case of “Susan” and the many systematic challenges she faces in obtaining a birth certificate for her daughter which is essential for her to access services and attend school (Sanders &Burnett, 2019).

And finally, an interesting qualitative study looking at behaviors of home visiting nurses that I found very relevant for my current position in home healthcare, found that while these home health providers were aware of and screening for social supports, environment and financial barriers, there was a need for a streamlined process to address the SDOH in this setting to highlight those at greatest risk of inequity (Irani et al, 2019). The authors discuss the need for ways to both better prepare healthcare workers to consider the complex social needs of their patients, as well as integrating social care into regular health care (Irani et al, 2019). The authors also highlight the need to integrate Social Workers into home health care and for leaders to advocate for models that factor in social needs (Irani et al, 2019). Challenge accepted.

References;

Alberga, A. S., McLaren, L., Russell-Mayhew, S., & von Ranson, K. M. (2018). Canadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma. Journal of Obesity, 2018, 1–7. https://doi.org/10.1155/2018/8645694

G.B.H.U. [YouTube]. (2013, October 11). Lets Start a Conversation [Video]. Lets Start a Conversation. https://www.youtube.com/watch?v=wsi_VqO1DsM&t=2s

Irani, E., Hirschman, K. B., Cacchione, P. Z., & Bowles, K. H. (2020). The Role of Social, Economic, and Physical Environmental Factors in Care Planning for Home Health Care Recipients. Research in gerontological nursing, 13(3), 130–137. https://doi.org/10.3928/19404921-20191210-01

McPherson, C., Ndumbe-Eyoh, S., Betker, C., Oickle, D., & Peroff-Johnston, N. (2016). Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity. International journal for equity in health, 15(1), 129. https://doi.org/10.1186/s12939-016-0419-4

Mental Health Commission of Canada. (2009). Toward recovery & well-being: A framework for a mental health strategy for Canada. Retrieved from http://www.mentalhealthcommission.ca.

Niagara Region. (2021, July 12). Social Determinants of Health for Health Care Professionals. Niagara Region, Ontario. Retrieved June 6, 2022, from https://www.niagararegion.ca/health/professionals/social-determinants-of-health.aspx

Public Health Agency of Canada. (October 7, 2020). Social determinants of health and health inequalities. Government of Canada. Retrieved June 11, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Sanders, C., & Burnett, K. (2019). A Case Study in Personal Identification and Social Determinants of Health: Unregistered Births among Indigenous People in Northern Ontario. International journal of environmental research and public health, 16(4), 567. https://doi.org/10.3390/ijerph16040567

Simcoe Muskoka District Health Unit. (n.d.). Determinants Of Health. Simcoe Muskoka Health Stats. Retrieved June 13, 2022, from https://www.simcoemuskokahealthstats.org/topics/determinants-of-health

Yoshida-Montezuma, Y., Keown-Stoneman, C., Wanigaratne, S., Li, X., Vanderhout, S. M., Borkhoff, C. M., Birken, C. S., Maguire, J. L., & Anderson, L. N. (2021). The social determinants of health as predictors of adherence to public health preventive measures among parents and young children during the COVID-19 pandemic: a longitudinal cohort study. Canadian journal of public health = Revue canadienne de sante publique, 112(4), 552–565. https://doi.org/10.17269/s41997-021-00540-5