In understanding Canada’s health care system, it is fundamental to consider the demographics of the country and the impact of certain life circumstances that influence the health of the individual, community and country at large. The government of Canada refers to this as ‘determinants of health’ which refers to personal, social, economic and environmental characteristics that a person endures guiding their health outcomes. (Health Canada, 2018). Determinants of health include income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, health behaviors, access to health services, biology and genetic makeup, gender and culture. Canadians are affected by differently by certain determinants of health depending on location. I will now further discuss determinants of health within specific to my region in norther Ontario.
As we dissect the determinants of health a little further, we begin to look at ‘social determinants of health’ which are the social, income and economic factors that influence the health of individuals. Social determinants of health can include one’s income, social status, education and/or employment and shape the health of individuals (Mikkonen & Raphael, 2010). These factors are often unchangeable making it difficult for the individual to improve them on their own and are referred to as health inequities (Health Canada, 2018). An example would be indigenous people facing unfair policies and unequal funding and health care delivery that hinder their ability to access health services within northern Ontario (Health Quality Ontario, 2017).
Health Quality Ontario’s Health Equity Plan highlights key social determinants influence healthy equity across Ontario. Specific to northern Ontario, strategies have been implemented, such as the Northern Ontario Health Equity Strategy to try and attain health equity-a fair and equal system that appropriately disperses health care funding and services to all. As each province in Canada varies in terms of funding allocation and legislation it is fundamental to review the impact of social determinants on the population's health depending on provinces and even region. My hope is to contrast this post with other classmates out of province to highlight differences within the health care system particular to social determinants of health.
“People living in northern Ontario are more likely to have worse health, poorer access to health care and to die earlier” (Health Quality Ontario, 2017). Access to health care due to geographical location, aboriginal status, and poor health outcomes due to living conditions are all common social determinants identified to influence the health of northerners.
The Northern Ontario Healthy Equity Strategy has identified 3 major needs for a strategy to improve health equity in Northern Ontario (Health Quality Ontario, 2018):
1. Northern Ontario has worse health outcomes compared to the rest of Ontario as they have:
-Shorter life expectancy
-Premature death
-Unequal access to primary care
-Large aboriginal and francophone population that are more prevalent to poor health outcomes
2. Northern Ontario has worse social outcomes compared to the rest of Ontario as:
-Unemployment rates are higher
-Fewer people have secondary or post-secondary education
3. Northern Ontario has specific health concerns specific to its region identified as priorities:
-Mental health and addictions
-Diabetes
-Parental & child health
It is necessary to point out that there is also a specific set of social determinants of health for aboriginal people as their culture has suffered generations of abuse, racism and discrimination from their experience in residential schools, forced relocation and unfair treatment from government and colonialism. Due to the history and generational experience of aboriginal peoples their health is at higher risk of being influenced by certain social determinants such as socioeconomic status, childhood experiences that further impact their ability to be employed, economic opportunity, safe/healthy living conditions and equal educational opportunities (Appiah-Kubi, 2015).
The Healthy Quality Ontario’s Health Equity Strategy sets out to address and improve the health care system to provide equity throughout the north. In doing so they have created 4 foundations of action and have emphasized addressing social determinants of health as first on the agenda. The hope is not only to identify the determinants but improve health care through sharing the findings with health care professionals to reduce health inequities in the north. Secondly the next foundation is to improve access to high quality and necessary services. Thirdly, providing culturally appropriate healing techniques for aboriginal populations and lastly creation of quality and accessible evidence for equity-based decision making (Health Quality, 2018).
The NE LHIN has supported these efforts by being a part of the action plan. The most recent strategies involved addressing housing needs in the region and created an Aboriginal Health Care Reconciliation Action plan. In addition to this the City of Greater Sudbury developed a report (2013): Opportunity for All: The Path to Health Equity that outlines specific social determinants that have a significant influence on the community's health such as mental health, access to a primary doctor, and chronic illnesses.
In conclusion, it is through identification of social determinants of health that the health care system can make improvements and reduce health inequities by region. In reviewing specific driving factors that are common determinants of health within the province and regions we identify problem areas and workable solutions for providing and accessible and equal health care system as a whole.
References
Appiah-Kubi, T. (2015). Social Determinants of Aboriginal Peoples’ Health in Canada. Healthy Weight Connections. Fact Sheet No.5. Retrieved June 8, 2019.
Cooke, M., & Long, D. (2011). Moving beyond the politics of Aboriginal well-being, health and Healing. Visions of the heart: Canadian Aboriginal issues (pp.310-313).
Health Canada. (2018). Social determinants of health and health inequalities. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Healthy Quality Ontario:Northern Ontario Health Equity Strategy [A plan for achieving health equity in the North, by the North, for the North]. (2018). 130 Bloor Street West, 10th Floor Toronto, ON M5S 1N5.
Mikkonen, J., & Raphael, D. (2010). Social determinants of health: The Canadian facts. Toronto, ON: York University School of Health Policy and Management. Retrieved from http://www.thecanadianfacts.org/
Ontario, H. Q. (2017, April,18). Health in the North: Inequities in health and health care. Retrieved June 8, 2019, from https://www.newswire.ca/news-releases/health-in-the-north-inequities-in-health-and-health-care-619673153.html
Opportunity for All: The Path to Health Equity (report). (2013, May). Retrieved June 9, 2019, from https://www.phsd.ca/resources/research-statistics/health-statistics/opportunity-path-health-equity-highlights/opportunity-path-health-equity-report