Reducing Health Disparities - Roles of the Health Sector: Discussion Paper

Reducing Health Disparities - Roles of the Health Sector: Recommended Policy Directions and Activities

Canadians are among the healthiest people in the world, but major health disparities exist; the most important relate to socio-economic status (SES), aboriginal identity, gender and geographic location.

Two reports from the former Federal, Provincial and Territorial Advisory Committee on Population Health and Health Security (ACPHHS) provide important tools to engage decision-makers and researchers in an informed discussion about health disparities in Canada and options for addressing them.

• The discussion paper focuses on (1) the state of health disparities in Canada and their consequences and (2) current roles and activities of the health sector in Canada and elsewhere to address health disparities.

• The policy report provides the health sector with opportunities for action in areas within its span of direct control and through influencing partnerships with other sectors.

Social Determinants of Health: Canadian Perspectives

Uniting top academics and high profile experts from across the country,
this contributed volume is the first of its kind published in Canada. It
summarizes how socio-economic factors affect the health of Canadians,
surveys the current state of eleven social determinants of health across
Canada, and provides an analysis of how these determinants affect
Canadians’ health. In each case, the book explores what policy options
would contribute to better health outcomes, and how to ensure that these
options are pursued.

Eleven critical areas are investigated: Aboriginal status, early life,
education, employment and working conditions, food security, health care
services, housing, income and its distribution, social safety net, social
exclusion, as well as unemployment and employment security. Gender, and how
its meaning is constructed within Canadian society, is another important
social determinant of health. All contributors systematically consider how
it impacts upon and interacts with their specific social determinant of
health to influence health.

The Tides of Change: Addressing Inequity and Chronic Disease in Atlantic Canada

This paper looks at the relationship between chronic disease and inequity in the context of the particular social and economic patterns that influence health in Atlantic Canada. It will be of interest to anyone working on either chronic disease prevention or equity issues. It includes an examination of the three pathways by which social determinants of health may result in increased chronic disease: the materialistic, psychosocial, and political/economic pathways. Policy implications are also examined and a number of recommendations for action are proposed.

The Social Determinants of Health: An Overview of the Implications for Policy and the Role of the Health Sector

In late 2002, 400 social and health policy experts, community representatives, and health researchers met at York University at a conference entitled "Social Determinants of Health Across the Life-Span". The purpose of the conference was to consider the state of key social determinants of health (SDOH) across Canada, explore the implications for the health of Canadians, and discuss policy directions to strengthen these social determinants of health.

Summaries of a series of research papers and presentations on the nine SDOH below were produced by Health Canada, including an overview paper that ties all of the issues together under a population health approach.

• income inequality
• social inclusion and exclusion
• employment and job security
• working conditions
• contribution of the social economy
• early childhood education and care
• food security
• housing
• education

Improving the Health of Canadians, 2004
Improving the Health of Canadians focuses on why some Canadians are healthy and others are not; and underscores some of the choices communities face in creating more equal opportunities for good health. It is the first in a biennial report series produced by the Canadian Population Health Initiative and builds on earlier reports on the health of Canadians from the Federal, Provincial and Territorial Advisory Committee on Population Health. The 2004 Report explores in-depth four key issues: income, early childhood development, Aboriginal Peoples' health and obesity.

Social determinants of health. The solid facts (2003)
Edited by Richard Wilkinson and Michael Marmot
This second edition relies on the most up-to-date sources in its selection and description of the main social determinants of health in our society today. It then looks at the role that public policy can play in shaping a social environment that is more conducive to better health.

Social Disparities and Involvement in Physical Activity: Shaping the Policy Agenda in Healthy Living to Successfully Influence Population Health
by Lise Gauvin, Ph.D.,GRIS (Groupe de recherche interdisciplinaire en santé - Interdisciplinary Research Group on Health), Université de Montréal

The purposes of this paper include:

• To formulate a statement regarding the direction and magnitude of the relationship between socio-economic disparities and involvement in physical activity across different population subgroups
• To explore if socio-economic disparities act as moderators or mediators of the influence of interventions (psychosocial, community, or otherwise) on physical activity
• To explore if interventions designed to reduced socio-economic disparities may result in changes in the prevalence and distribution of physical activity
  

How our Programs Affect Population Health Determinants: A Workbook for Better Planning and Accountability
June 2003

PDF Version

The Population and Public Health Branch, Manitoba and Saskatchewan Region, is pleased to release a workbook, "How our programs affect population health determinants: A workbook for better planning and accountability" that will assist community programs, funders and other services to know more about how their health promotion activities contribute to change in population health determinants.

Elements of the framework developed for this workbook can be used as a planning tool for the purposes of program development. As well, documenting each of the elements as the program progresses can be useful to improve future programming; accounting for existing programs; and demonstrating that health promotion can make a difference on population health determinants.

Investment in Population Health in Five OECD Countries
OECD Health Working Papers N-2, 2003

There is growing interest in the potential for preventive interventions to improve average health status in OECD countries and to tackle remaining health inequalities. The paper focuses on population health investment in Australia, Canada, Korea, Sweden and Switzerland. The paper concludes there are many population health investment activities, which have been shown to be cost-effective, involving interventions such as health education, community participation, government regulation and taxation. However, there are also barriers to population health investments, including the fact that evaluation of such investments is difficult and evidence of their cost-effectiveness is generally lacking. Also, it is often difficult to co-ordinate action across different government agencies when there are multiple risk factors. Some suggestions are made about carrying forward aspects of the population health agenda in OECD's future program of work on health.

Social Capital as a Health Determinant: How is it Defined?
Working Paper Series, Health Canada, 2002

PDF Version

This report is a summary of social capital research commissioned by the Policy Research Division, Strategic Policy Directorate, Population and Public Health Branch, Health Canada. The work attempts to clarify the place of social capital among the social determinants of health. The report:

• analyzes the documentation on the origins of this concept and its use in the health field
• sets out four approaches in the area of social determinants of health (community health, social capital, socio-economic inequality and social cohesion). Research demonstrating the positive effects of social capital on health is also presented.
• briefly reviews the various methods used to measure social capital, as well as the indicators commonly used in research on the subject.
  
• explores the development of policies aimed at strengthening social capital

The companion report, Social Capital as a Health Determinant How is it Measured? focusses on the methodological aspects of social capital research.

Highlights of Our Work : Program Updates | Program Results | Special Initiatives
POPULATION AND PUBLIC HEALTH BRANCH BRITISH COLUMBIA
2002- 2003 Annual Summary
This report outlines the Branch's work and results for British Columbians over the past fiscal year and was developed by staff as a way to inform our partners and the public about who we are and the programs we deliver. Population health will only be achieved through all levels of government and communities working together on the conditions that affect our health and we encourage you to read the report and identify opportunities for joint initiatives.

Healthy Living Strategy Website
This site is designed to facilitate the consultation process to inform the development of the Integrated Pan Canadian Healthy Living Strategy. The consultations are taking place between January and April 2003. This site serves as an information hub for the consultation process and provides a central location where the following can be found:

• an explanation of healthy living
• background information including relevant documents and reports
• reports from the roundtables
• links to relevant websites
• an outline of the consultation process
• the consultation workbook
• FAQs

Economic Burden of Illness in Canada (EBIC)
EBIC provides valuable information that will contribute to a better understanding of the cost illness in Canada and its impact on the decision-making process of health policy and programs. This edition provides costs of illness by province/territory, as well as by gender and age-group; calculates the cost of over 40 disease subcategories in addition to the major disease categories; and features an on-line component enabling the general public to access some of the economic data used in this report, through the internet (http://ebic-femc.hc-sc.gc.ca).

Promoting Health in Canada An Overview of Recent Developments & Initiatives
This document outlines key developments and initiatives in Canada since the Fifth Global Conference on Health Promotion, in Mexico (June, 2000). It addresses developments in a some key areas such as knowledge development, exchange and capacity building; policies and actions; evaluation and accountability; and considers challenges and opportunities for the future.
PDF Version

Spanish version :

Promoción de la salud en Canadá Perspectiva general de los avances e iniciativas recientes
Este documento esboza los avances e iniciativas fundamentales realizados en Canadá desde la Quinta Conferencia Internacional de Promoción de la Salud, celebrada en México (junio de 2000). El documento trata los avances en algunas áreas clave como el desarrollo, intercambio y fomento de la capacidad en materia de conocimientos; las políticas y acciones; la evaluación y rendición de cuentas; y considera los desafíos y oportunidades
para el futuro.
PDF Version

Creative Spice: Learning From Communities About Putting The Population Health Approach Into Action  

This report by the Social Planning and Research Council of BC is a synthesis and discussion of the lessons learned by participants in eleven voluntary-sector projects in BC and the Yukon that received funding assistance from Health Canada's Population Health Fund to put a population health approach into action at the community level.

This report is intended for:

• communities interested in obtaining a better understanding of the benefits and challenges of using a population health approach in promoting the well-being of their communities;
• researchers exploring the implementation of population health concepts at the community level;
• policy-makers and program workers seeking to refine and increase the effectiveness of new government programs that are designed to be implemented by community associations through project funding.

Health Promotion Effectiveness
Health promotion is a key strategy in a population health approach, one that involves multiple interventions, often for prolonged periods of time, and relies on action at several levels and across a number
of sectors. This complexity raises a number of important questions — for example:

This issue of the Health Canada Health Policy Research Bulletin explores these and other challenges and presents some "real life" examples of how they are being addressed. It also highlights a major international evaluation initiative, as well as other important initiatives under way across the country.

An Assessment of the Methods and Concepts Used to Synthesize the Evidence of Effectiveness in Health Promotion: A Review of 17 Initiatives

Health promotion presents unique challenges for synthesizing evidence of effectiveness. These include its use of a mix of strategies and a focus on populations and communities. The field also applies both qualitative and quantitative approaches to research and evaluation. This working paper, available on the website of the Canadian Consortium for Health Promotion Research, examines how seventeen Canadian and international initiatives synthesized evidence of effectiveness. The processes are critiqued from a health promotion perspective and an ideal framework for conducting syntheses is proposed.

Case Studies of the Regional Mobilization of Population Health
This report presents the findings from six case studies across Canada, as well as a cross-case analysis, focussing on clusters of lessons learned in the regional mobilization of population health. This evidence can be used to inform the practice in the field and to market the population health approach to key decision makers in health policy and planning.

The Population Health Template: Key Elements and Actions That Define A Population Health Approach (2001)
Organizes and consolidates current understandings of population health.  The template outlines the procedures and processes required to implement a population health approach. 
Also see: The Population Health Template Working Tool and Overview/Handout (colour version / black and white version)

Population Health Newsletter - Fall 2001 Issue
In this issue we profile case studies that demonstrate how population health has been implemented at the regional, national and international levels. We are at an exciting stage in our knowledge of population health, with the availability of a growing number of documented examples of population health in action to stimulate analysis, learning and further development.

List of International Conferences

Conference Sites:

The Population and Public Health Branch is pleased to announce publication of the Population Health Newsletter online. With an enhanced presentation and new features, the newsletter highlights the latest information and developments in population health, including a summary of results from the first research project of the Canadian Population Health Initiative.

Important Notices