January 2011 - Hot Topic

Ontario Public Health Units Address the Social Determinants of Health

In the summer of 2010, the Joint Association of Local Public Health Agencies/Ontario Public Health Association Working Group on Social Determinants of Health administered an online survey of Ontario’s health units to map out the scope of local public health activities and needs in addressing health inequities, social determinants of health (SDOH) and/or poverty reduction. The Activities to Address the Social Determinants of Health in Ontario Health Units – Summary Report [PDF] was released December 2010.

Twenty-three (64%) Ontario public health units responded and actions on the social determinants of health were evident in the work of the majority of health units across the province.

Virtually all strongly agreed that community engagement, multi-sectoral collaboration, and support for policy advocacy are appropriate domains of public health unit activity on the SDOH. Health units also noted that additional roles in action on the SDOH could be adopted by health units, including increasing awareness of the SDOH and assessing and planning for the health needs and impacts of priority populations. Notably, health units did not see their role limited to their local context. They also mentioned that contribution to the provincial system to build systemic capacity and coordination was also appropriate for health units to consider.

The wide variety of formats and topics that health units are using to communicate about the SDOH demonstrates the vigorous ways in which the SDOH are woven into health unit activity through the essential public health functions of population health assessment and surveillance. Health units are creating reports and research and awareness campaigns on an impressive array of the determinants and populations.

Health units’ actions on the SDOH also encompass many strategies to modify interventions for priority populations. These include adapting the types of offered services; reducing barriers to access programs such as, income, physical and geographic; and changing program formats. Health units are also explicitly addressing determinants like social support by fostering supportive social networks and coordinating client care and referrals to other resources. The ability of health units to play that nodal function suggests that health units have a wide span of reach and connectivity into their communities.

When health units were asked about areas requiring support to address the social determinants of health, policy advocacy and staff skill development were listed as the top areas for improvement at the local level. They also noted practical items such as knowledge brokering services, strategies, tools and checklists, and infrastructure to share information. These needs prompt potential for centralized bodies such as Association of Local Public Health Agencies (alPHa), Ontario Public Health Association (OPHA) the Ontario Agency for Health Protection and Promotion (OAHPP) and others, to support learning opportunities to build capacity at the local level.

Health units listed numerous forms of activity with components of the Ontario Poverty Reduction Strategy. In describing public health engagement in the provincial poverty plan, this report is the only one of its kind detailing public health activity with provincial poverty reduction initiatives. It is therefore expected to be informative to the provincial government, the OAHPP, OPHA, alPHa, Council of Medical Officers of Health (COMOH) and all Ontario health units.

In summary, the survey demonstrates strong support for and a wide range of local public health actions underway to address health inequities, SDOH and/or poverty reduction. The survey also provides direction regarding the areas in which local public units require support in order to work more effectively to address SDOH.

Ontario public health units clearly have strong interest and investment in this important area. The public health system and the health of Ontarians would benefit greatly from the leveraging of this energy through provincial leadership and coordination, the development of specific tools and supports and opportunities to learn from each other and from applied research.