And we all thought the pandemic was about a virus...

Health is different to many people and it is achieved in different ways depending on your definition. When considering a person’s perspective on their health, it is essential to acknowledge the factors that influence health. The social determinants of health (SDOH) can have both negative and positive impacts on health depending on circumstances (CPHA, 2021).

According to Mikkonen & Raphael (2010), the 14 SDOH are as follows:

Income and Income Distribution, Education, Unemployment and Job Security, Employment and Working Conditions, Early Childhood Development, Food Insecurity, Housing, Social Exclusion, Social Safety Network, Health Services, Aboriginal Status, Gender, Race, and Disability.

Review of the topic is expansive and has led me down a bit of a rabbit hole so to speak. It highlights for me how universal the topic is, how important and valued it is by policy makers, researchers, and politicians. What I have found interesting is that most provinces take a preventative health approach to support initiatives aimed at improving health. After reviewing numerous provincial, regional, and municipal documents about programs to reduce smoking, chronic disease risk, mental health & addictions and tobacco control it is obvious that the SDOH are not considered in many of the approaches.

Healthy living which includes healthy eating and physical activity, has been identified as a strategy to reduce chronic diseases in Canada, however they continue to rise, however the focus has not shifted to account for SDOH that may be at the core (Gore & Kothari, 2012). In the past, healthy living was thought more in the context of lifestyle choices and not considering why they were made (Gore & Kothari, 2012). Although my training as a dietitian revolved around the lifestyle factors of chronic disease prevention, we did not place a high value on the why behind certain food choices in this context. Given the acknowledgement of Mikkonen & Raphael that there has been a lack of effort by policymakers to shift public policy action to enhance the social determinants of health I will try not to internalize my professional lack of accountability (2010).

Interestingly, disease incidence only related to behavioural factors occurs in a small proportion of Canadians (Raphael, 2003) and little emphasis was placed during my training on any societal factor such as poverty that may impact health.

Ontario is the largest province in Canada and over the last 2 years with a new government in place they have tried to streamline the delivery of care. Based on my research and review of documents, I have found that the current Covid-19 pandemic has superseded many initiatives that could have come to the forefront to improve health equity in Ontario. At first, I was focusing on the negative aspect on how funding has been changed to support the response to the pandemic. After reflecting on it for a few days I have conclude that it may help open some doors for vulnerable Ontarians and perhaps throughout Canada.

Given the transmission of this virus, it has perhaps opened the eyes of the current provincial government to some of the Social determinants of health (SDOH) as it is easy to see how they have played a role in risk of infection of Covid-19. Of note gender, Income & social status, race, employment & working conditions, Aboriginal status, physical environment (homelessness) have been highlighted (PHO, 2020). City of Toronto, ON swiftly implemented an approach to support vulnerable people in the spring 2020 with a 3-tiered approach to reduce spread of Covid-19: prevention, mitigation and recovery (City of Toronto, 2020). Prior to the pandemic, City of Toronto had made significant strides to support around 7000 homeless individuals and families through provision of shelter sites which included nearly 3000 people prior to the pandemic (City of Toronto, 2020). Data indicates that Toronto has the largest shelter system in Canada (City of Toronto, 2020). The transmission of the Covid-19 virus has brought to light the importance of space issues/distancing and proper hygiene faced by many people living without their own premise and relying on shelters for a place to sleep.

Ontario has a high percentage of residents who do not have English or French as a first language, and many residents do not have the adequate education to understand some of the messaging on ways to protect themselves (Suhasini, G, 2020). To address the SDOH of education & literacy, visual cues in posters / signs were created and put up to assist in Public Health initiatives to promote physical distancing, hand hygiene and mask wearing during the pandemic (City of Toronto, 2020).

References:

Canadian Public Health Association. 2021. What are the social determinants of health? https://www.cpha.ca/what-are-social-determinants-health

Gore, D., & Kothari, A. (2012). Social determinants of health in Canada: are healthy living initiatives there yet? A policy analysis. International journal for equity in health, 11, 41. https://doi.org/10.1186/1475-9276-11-41

Mikkonen J, Raphael D. 2010. Social determinants of health: the Canadian facts. Toronto: York University School of Health Policy and Management.

Raphael,D. 2003. Barriers to addressing the societal determinants of health: public health units and poverty in Ontario, Canad. Health Promotion International. 18 (4). 397–405, https://doi.org/10.1093/heapro/dag411

Suhasini, G. (2020, April 14). Language barriers and living conditions create special

COVID-19 challenges for refugee newcomers: York University expert. York Media Relations. https://news.yorku.ca/2020/04/14/language-barriers-and-living-conditions- create-special-covid-19-challenges-for-refugee-newcomers-york-university-expert/