The History of Canada’s Study of Determinants of Health: A literature review

Canadian physicians and nurses agree that attention to social determinants of health is a crucial component of development of national policy and is essential to the wellness of Canadians and the longevity of our healthcare system (Canadian Nurses Association, n.d.). Here is a brief synopsis of two peer reviewed journal articles that help us to understand how Canadian healthcare providers came to use the terms "determinants of health" and its importance in public policy formation today.

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Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2010). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy, doi:10.1016/j.healthpol.2010.08.022

This article by Bryant et al (2010) displays the initial achievements that Canada made in addressing determinants of health in the late 1970’s with the introduction of the universal public health insurance program in 1971 and the release of the LaLonde report in 1974. Canada became a world leader in population health and saw a drastic decline in health inequities, specifically those related to treatable medical conditions. The authors demonstrate that Canada as a nation has failed to develop the application of social determinants of health into public policy change since that time. Since 1980 Canada has fallen in ratings of the Organization for Economic Cooperation (OECD) from tenth (out of thirty) to twenty-fourth. The article demonstrates that lack of knowledge around determinants of health is not the problem, as multiple public health agencies publish numerous reports about the topic, but that a shift of Canada’s political and economic system has failed to turn these identified concepts into national public policy. The article highlights how income inequity, housing affordability, reduction of family and childhood poverty and early childhood development are negatively affected by ineffective federal policy related to determinants of health. The article concludes that in order to effect positive change in determinants of health, nations policy shifts that are in line with research social movements will require strong federal leadership and national policy development.

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Globerman, S., & Millar, J. (2003). Evolution of the Determinants of Health, Health Policy, and Health Information Systems in Canada. American Journal of Public Health. 93(3). https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.93.3.388

Globerman & Millar (2003) give a history of how determinants of health are defined in Canadian healthcare and health policy and how these determinants shape our view of population health in Canada today. The article describes how the Lalonde report in 1974 and the Canadian Institute for Advanced Research outlined determinants of health and identified how statistical data should be gathered in Canada. The initial determinants of health outline in 1974 were human biology, health care systems, environment and lifestyle. The main focus of health promotion at that time was to use media to direct people to live healthier lifestyles (ie activity, smoking cessation, healthy eating). In 1996 in order to lesson “victim blaming” the concept was expanded to include a variety of social factors and emphasize the need for multilevel health collaboration involving research, education, community development and healthy public policy. The authors demonstrate the need for regional health management that focuses on local determinants, Ontario at the time of publication was the only province that did not have regionally managed healthcare services. [Note: Since publication Ontario has introduced Local Health Integration Networks in or to address this need.] The article outlines some public policies that have been developed in order to ensure a national strategy on addressing determinants of health and social inequities and highlights information systems that are used to gather data nationally on population health. The article concludes that although several Canadian health commissions publish reports on the importance of addressing social determinants of health, there remains a lack of national evidence-based policy to address the issues.

Reference

Canadian Nurses Association. (n.d.) Health in All Policies National Action Plan. Retrieved from https://www.cna-aiic.ca/-/media/nurseone/page-content/pdf-en/hiap-national_action_plan_e.pdf?la=en&hash=FB495B27139AAB8767E5A94E84033DFEE5C4F04C