In the article by Gore and Kothari, they analyze the need for Federal and Provincial policy to tackle the structural social determinants of health. They begin with a focus on the Public Health initiatives of British Columbia and Ontario. These provinces focus primarily on lifestyle (individual diet and activity) and environmental (individual workplace or school) structures of social determinants of health, and only 11.5% of initiatives in BC and 15.0% of initiatives in ON focused on structured-based initiatives, which focus on how the social, political and economic create structural inequities in society that lead to chronic disease.
Gore and Kothari explain that a structural-based approach is based on the reality that people's daily living and working conditions do not promote a healthy lifestyle along with "broader structural determinants that create in-equities between populations." They continue to explain that what is required is a systemic overhaul of the social, political and economic approach required to reduce the inequities in areas of race, gender, job security, access to healthy foods and childcare, which they refer to as a political approach. From these structural inequities, they see a direct correlation to an increase in chronic disease.
What is lacking in the initiatives by BC and ON is moving away from expecting individuals and communities to rectify this problem at a community level with limited reach and resources, and the federal and provincial government needs to plan, promote and execute initiatives that impact the broader population.
There are two barriers to initiating a practical approach. The first is the neoliberal government's approach to governance, which is based on promoting free markets with limited government intervention. Another barrier is the lack of education and understanding of how these structural-based determinants of health affect a population's health and increase chronic disease.
The authors offer several examples of how others have approached this issue. The first is Mikkonen and Raphael's The Social Determinants of Health, which looks into implementing policies related to all sectors: education, employment, Aboriginal affairs, anti-discrimination policies, affordable housing and food strategies.
Another approach by the National Public Health Partnership in Australia focuses on a policy that intervenes in the "determinant that is causing the health problem, rather than the health problem itself."
Lastly, the authors focus on Northern European countries such as Sweden and Norway. Sweden initiated a public health policy in 2000 which stressed improving employment conditions and decreasing poverty as primary goals for improving health - significantly lowering obesity rates. Norway prioritized providing safe childhood conditions, fair income distribution, equal opportunities in work and education and social inclusion to all its citizens.
The authors conclude by restating that health should be viewed politically. Doing so will facilitate various approaches towards the social determinants of health from all three levels of government.
Reference: Gore, D., & Kothari, A. (2012, August 14). Social Determinants of Health in Canada: Are healthy living initiatives there yet? A policy analysis - international journal for equity in health. BioMed Central. https://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-11-41
In the video by Dr. Natalie Lovesey, Public Health – Concepts of Health and Its Determinants, she focuses on the importance of social context when discussing chronic disease. She begins with her definition of health, which includes wellness (quality of life), illness (a subjective experience), sickness ( a social and cultural entity), and disease (a pathological process in the body).
She points out that genetics, biology, and social context determine a person's health - which she feels is as important as physical symptoms.
To Dr. Lovesey, social context includes income, education and social network. She provides an example of what happens when a person experiences a social stressor. For example, if a person's income is low, this causes stress as the person may be unable to meet their basic needs, and social support is limited. Social stressors can lead to thoughts and feelings of uncertainty and an increase in chronic stress, leading to chronic disease.
Her approach is for physicians to "factor [social stressors] into their decision-making" when evaluating a patient's symptoms. Patients will be motivated to take control of their health journey and find measures they can implement to promote a better quality of life beyond being disease-free.
Reference: YouTube.(2016, June 29). Public Health – Concepts of Health and Its Determinants: By Natalie Lovesey M.D. https://www.youtube.com/watch?v=XQkYIpCmTDw
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