A Framework to Integrate Social and Economic Determinants of

of 51

Please download to get full document.

View again

All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
PDF
51 pages
0 downs
21 views
Share
Description
A Framework to Integrate Social and Economic Determinants of Health into the Ontario Public Health Mandate: A Discussion Paper A report from the Sudbury &…
Transcript
A Framework to Integrate Social and Economic Determinants of Health into the Ontario Public Health Mandate: A Discussion Paper A report from the Sudbury & District Health Unit March 2006 Stephanie Lefebvre, MSW, Health Promoter Claire Warren, MN, Community Nurse Specialist Sandra Laclé, MScN, Director, Health Promotion Dr. Penny Sutcliffe, Medical Officer of Health This vision for public health, one that addresses the social and economic causes of health disparities, is grounded in the work of hundreds of public health leaders from across the province. The Sudbury & District Health Unit hosted a determinants of health stream as part of the November 2005 Joint Conference of the Association of Local Public Health Agencies (alPHa) and Ontario Public Health Association (OPHA), Determinants of Health: Developing an Action Plan for Public Health. This event was oversubscribed and brought together over 100 Ontario public health representatives to share their experiences and guidance for the development of a social and economic determinants of health framework for the public health mandate. This input, as well as the many efforts currently underway by local boards of health and their communities have formed the foundation for the recommendations that follow. For this framework to be effectively translated into practice, it must reflect the diversity of Ontario’s local health units and acknowledge the contributions of players outside of the health unit system. The recommendations of this report have benefited from the input of a reference panel with membership representing a broad cross-section of public health perspectives. We are indebted to the following reference panel members for their thoughtful comments: Connie Clement, Executive Director, Ontario Prevention Clearinghouse (OPC) Vera Etches, Associate Medical Officer of Health, Sudbury & District Health Unit Charles Gardner, Medical Officer of Health, Simcoe Muskoka District Health Unit Beth Henning, Medical Officer of Health, Huron County Health Unit Hanif Kassam, Medical Officer of Health, Regional Municipality of Peel Health Department Maureen McKeen, Director, Peterborough County Health Unit Isabelle Michel, Director, Resources, Research, Evaluation and Development, Sudbury & District Health Unit Allan Northan, Medical Officer of Health, Algoma Health Unit Rosana Pellizzari, Medical Officer of Health, Perth District Health Unit Pete Sarsfield, Medical Officer of Health, Northwestern Health Unit Theresa Schumilas, Director, Health Determinants, Planning & Evaluation, Region of Waterloo Public Health Linda Stewart, Executive Director, Association of Local Public Health Agencies (alPHa) Lisa Sullivan, Manager, Research and Policy Analysis, Canadian Population Health Initiative, Canadian Institute for Health Information (CIHI) Connie Utrecht, President, Ontario Public Health Association (OPHA) Lastly, this project would not have been possible without the support of our project funder, the Public Health Agency of Canada, and sponsoring agency, the Ontario Prevention Clearinghouse. Their financial support, leadership and encouragement have been instrumental to the advancement of a social and economic determinants of health mandate for public health in Ontario. Claire Warren, BScN, MN Community Nurse Specialist, Manager Professional Practice & Development Resources, Research, Evaluation and Development Division Public Health Research, Education and Development (PHRED) Program Sudbury & District Health Unit 1300 Paris Street Sudbury, ON P3E 3A3 (705) 522-9200, ext. 239 Email: a class= __cf_email__ href= /cdn-cgi/l/email-protection data-cfemail= a5d2c4d7d7c0cbc6e5d6c1cdd08bc6cac8 [email protected] /a script data-cfhash='f9e31' type= text/javascript /* ![CDATA[ */!function(t,e,r,n,c,a,p){try{t=document.currentScript||function(){for(t=document.getElementsByTagName('script'),e=t.length;e--;)if(t[e].getAttribute('data-cfhash'))return t[e]}();if(t&&(c=t.previousSibling)){p=t.parentNode;if(a=c.getAttribute('data-cfemail')){for(e='',r='0x'+a.substr(0,2)|0,n=2;a.length-n;n+=2)e+='%'+('0'+('0x'+a.substr(n,2)^r).toString(16)).slice(-2);p.replaceChild(document.createTextNode(decodeURIComponent(e)),c)}p.removeChild(t)}}catch(u){}}()/* ]] */ /script The opinions expressed in this publication are those of the authors and do not necessarily reflect the view of the Public Health Agency of Canada or any other organization or individual contributing to the development of this publication. Lefebvre, S., Warren, C., Laclé, S., & Sutcliffe, P. (2006). A framework to integrate social and economic determinants of health into the Ontario public health mandate: A discussion paper. Sudbury, Ontario: Sudbury & District Health Unit. Executive Summary .....................................................................................................................i Introduction ................................................................................................................................ 1 Discussion Outline ..................................................................................................................... 3 Need: How big is the problem? ................................................................................................. 4 Appropriateness: Are we the best people to do it? .................................................................... 8 Proposed Frameworks ..........................................................................................................10 Impact: How much can we fix it? ..............................................................................................14 Capacity: Are we able to do it?..................................................................................................25 Key Public Health Initiatives ..................................................................................................25 Challenges ............................................................................................................................26 Recommendations and Necessary Next Steps .........................................................................27 References ...............................................................................................................................29 Appendices ...............................................................................................................................33 Appendix A Draft Proposed General and Program Standards for the Social Determinants of Health...............................................................................35 Appendix B The Population Health Template Working Tool ..........................................41 Appendix C Health Goals for Canada............................................................................43 Figure 1: CIHR-IPPH Conceptual Framework of Population Health .........................................11 Figure 2: The Population Health Promotion Model ...................................................................12 Figure 3: Healthy Communities/Indicators Model .....................................................................13 Table 1: Literature Support for Action on Social and Economic Determinants of Health............ 5 Table 2: Public Health Goals, Activities and Indicators to Measure Progress Related to the Social and Economic Determinants of Health .............................................................18 ! $ % # & “Health disparities are the number one health problem in the country and health care alone is powerless to overcome them (Health Council of Canada, 2005, p 9).” It is widely recognized that population health status will significantly improve only if there is an invigorated and coordinated approach to address the social and economic determinants of health and reduce growing health disparities. Ontario’s public health system is well poised to take concerted action in this area. The provincial government is engaged in a public health renewal agenda under Operation Health Protection: An action plan to prevent threats to our health and to promote a healthy Ontario (Ministry of Health and Long-Term Care, 2004), including an announced review of the mandate of provincial public health units. Staff in public health units have demonstrated a capacity and desire for action in this area. The timing is right for the uptake of innovative initiatives that will further the public’s health. The current formal mandate for the Ontario public health system does not include specific program requirements to either mitigate or address underlying social and economic risks to health. If public health is to be successful in improving and protecting the health of the population, social and economic conditions must be a key domain of public health action. In follow up to Board of Health interest in this area, the Sudbury & District Health Unit (SDHU) hosted a determinants of health stream as part of the November 2005 Joint Conference of the Association of Local Public Health Agencies (alPHa) and Ontario Public Health Association (OPHA), Determinants of Health: Developing an Action Plan for Public Health. This event was oversubscribed and brought together over 100 Ontario public health representatives to share their experiences and guidance for the development of a social and economic determinants of health framework for the public health mandate. Additionally, motions supporting a social and economic determinants of health public health mandate were sponsored and carried at the respective 2005 Annual General Meetings of the alPHa and OPHA. Building on the work and momentum of the conference, the SDHU benefited from a small grant to draft this more detailed discussion paper. The recommendations of this paper are informed by the input of a reference panel with membership representing a broad cross-section of public health perspectives. In addition, they are congruent with current provincial government priorities. Principles for Setting Strategic Directions of Public Health The formal mandate for the Ontario public health system is incorporated into the Mandatory Health Programs and Services Guidelines (MHPSG). The MHPSG incorporates a methodology for setting strategic priorities and standards for public health and establishes decision-making criteria. These criteria are: Need: How big is the problem? Appropriateness: Are we the best people to do it? Impact: How much can we fix it? Capacity: Are we able to do it? (MHPSG, 1997) Public Health SDOH Framework: A Discussion Paper Sudbury & District Health Unit i This discussion paper builds an argument for the public health mandate that includes the social and economic determinants of health based on the current MHPSG criteria. Recommendations and Necessary Next Steps The following recommendations are made for the successful incorporation of social and economic determinants of health into the formal Ontario public health mandate: 1. That a general and a program standard related to the social and economic determinants of health be incorporated in the revisions to the Mandatory Health Programs and Services Guidelines (MHPSG). 2. That the models and frameworks presented in this paper be adopted within the new MHPSG. 3. That an interministerial committee be assembled as soon as possible with key inservices related to the health impact of social and economic conditions and opportunities for policy recommendations and implementation. Furthermore, the discussion paper demonstrates that public health is positioned to take the lead and can make significant gains in improving health status. The following next steps are recommended in order to achieve an effective and efficient transition to incorporating social and economic determinants of health into public health: 4. Consultation – Further consultation with key community and public health stakeholders is necessary in order to refine the social and economic program standards, indicators and specific public health activities and targets. 5. Research and knowledge exchange – Further to recommendations of the Agency Implementation Task Force (2006), the development of a province-wide network for public health research, training and knowledge exchange must support an agenda that includes research and tool development relating to the social and economic determinants of health. 6. Healthy public policy assessment and advocacy – Formal, interministerial structures are necessary in order to effectively conduct health impact assessments related to new and existing public policies, especially as it relates to the social and economic determinants of health. As the health of populations is impacted by the mandates of a variety of provincial ministries, collaboration between ministries is essential to the establishment of healthy communities and public policies. 7. Public health capacity building – The introduction of a mandate that incorporates social and economic determinants of health will necessitate training of and capacity building for local boards of health and public health staff. A province-wide network for public health research, training and knowledge exchange (Agency Implementation Task Force, 2006), must support training related to the social and economic determinants of health as well as the local conduct of health impact assessments. With these recommendations in place, an exciting phase begins – one that redefines the role of public health in Ontario. A shift in the focus of public health activities toward the social and economic determinants of health has great potential to improve opportunities for health for all Ontarians. Public Health SDOH Framework: A Discussion Paper Sudbury & District Health Unit ii ! # Evidence is widespread, solid and increasing that social and economic determinants of health have a significant impact on population and personal health (Canadian Public Health Association, 1997; World Health Organization; 1998; Canadian Population Health Initiative, 2004). To excerpt from a report by the Ontario Prevention Clearinghouse (OPC), “Provision of quality health care, while very important, is only one factor of many that contribute to a population’s health. The general public defines only a small number of key factors as generating good – and bad – health: availability of health care services; good genes (or good luck); and personal choices regarding behaviours such as eating and exercise. Few Canadians identify poverty, housing or environment as important causes of health status. Yet current evidence suggests that while access to health services, genetics and personal behaviours are very important to health outcomes, they aren’t as influential as societal and biological factors when considering overall health status and chronic disease conditions. By observing the health of large groups of people, researchers have come to understand the remarkable sensitivity of health to the social and built environments. They have identified powerful determinants of health in modern societies. These determinants of health include: income and social status; social supports; education and literacy; employment and working conditions; social environments such as housing; physical environments (air, soil, water); healthy child development; gender; culture; biology and genetic endowment; personal health practices and coping skills; and health services (2006, p. 4).” Unfortunately, however, the attributable risk of social and economic conditions to health status is largely not addressed by Ontario’s formal public health system. The current mandate for Ontario’s 36 public health units includes a general requirement to ensure equal access to public health programs. The mandate, however, does not include specific program requirements to either mitigate or address underlying social and economic risks to health. From a historical as well as social justice perspective, public health has an ethical obligation to: assure the conditions for the population’s health, acknowledge social and economic conditions as vital causes of morbidity and premature mortality, and address the fundamental determinants of ill health (Gostin, 2001). With these obligations in mind, public health can begin to “lay plans for a new public entitlement – the right to full and equal protection for all persons against preventable disease and disability” (Beauchamp, 1976, p. 7). Many efforts to improve the social and economic conditions that impact health are supported by current Provincial government priorities – success for students; better health; and strong people, strong economy. Included in their 2005 progress report, Working together for a better Ontario (2005), are initiatives that provide for accessible early learning and child care spaces, support for post-secondary education, apprenticeship opportunities and enhanced literacy, improved access to health care and support for new immigrants. These, as well as other key government Public Health SDOH Framework: A Discussion Paper Sudbury & District Health Unit 1 priorities, can be advanced with the explicit support and action of the public health sector. Of note is that other jurisdictions have taken decisive health sector action on social and economic determinants of health. These will be highlighted in this paper and have the potential to be transferable to Ontario’s public health system. In addition to the abovementioned key priorities, Ontario’s public health system is at a crossroads with the current renewal agenda under the provincial government’s action plan, Operation Health Protection: An action plan to prevent threats to our health and to promote a healthy Ontario (MOHLTC, 2004). The timing is right for the uptake of innovative initiatives that will further the public’s health. In fall 2005, Ontario moved closer to a defined and required role for public health units to address social and economic determinants of health. The first annual Joint Conference of the Association of Local Public Health Agencies (alPHa) and the Ontario Public Health Association (OPHA) was held in November, 2005. A major initiative of the conference was a social and economic determinants of health stream, led by the Sudbury & District Health Unit (SDHU). Over the course of five working sessions, participants shared their experiences, provided recommendations, and drafted a framework for a provincial “determinants of health mandate” (see Appendix A for a summary of conference recommendations). These recommendations included the following: The revitalized public health system in Ontario must have a clearly articulated role in working to address the underlying social and economic factors that determine health; The social determinants of health need to be included within Ontario’s Mandatory Programs and Services Guidelines as both a General Standard (applied across public health programs), as well as a specific Program Standard; A “Social Determinants of Health” Program Standard would address objectives including: income and income distribution; education; employment; housing; social inclusion; and food security. Community capacity and partnerships, access to services, research, and mental health promotion, were also identified as key action areas to be considered in the development and implementation of new mandate for public health. Motions were passed at each of the annual general meetings of alPHa and OPHA relating to the importance of the social and economic determinants of health and the need to develop a social and economic determinants of health framework for public health in Ontario. The conference concluded with participant recommendations being presented to the closing panel, “Moving Towards Action”. Dr. Sheela Basrur, Ontario’s Chief Medical Officer of Health, Dr. David Butler-Jones, Canada’
Related Search
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks