The social determinants of health are the foundation of health. The Public Health Agency of Canada (2016) notes that social determinants of health include income and social status; social support networks; education; employment/working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; gender; and culture. Canada is one of the healthiest countries in the world. According to results from the 2013 Commonwealth Fund International Health Policy Survey of the General Public 61% of Canadians rate their health as very good or excellent (Health Council of Canada, 2014).
Everyone living in Canada should have access to the same high level of health care. Guided by the Canada Health Act (2002), provinces and territories are responsible for delivering their respective health care services, with the mandate to ensure equitable care across the country. Needs, demographics, and resource availability vary greatly across Canada. Although ensuring the equitable distribution of resources that support capacity for health across social groups benefits everyone, there remains much more work to do to achieve the goal of true health equity across all areas of Canada (Public Health Agency of Canada, 2018).
In 2014, the British Columbia Ministry of Health released Setting Priorities for the B.C. Health System that outlines the broad strategy and guides the future direction of the British Columbia health care system. The strategy acknowledges that the B.C. system should continue to build on its success while making improvements to meet the short and long-term needs of the B.C. residents. Based on this strategy, the B.C. Ministry of Health developed several policy papers, focused on various key healthcare priorities, to help the government, health authorities and health care providers redesign the present health care system to better meet the needs of B.C. residents. These policy papers include Delivering a Patient-Centred, high performing and sustainable health system, Primary and Community Care in BC: A Strategic Policy Framework (includes Residential Care), Future Directions for Surgical Services in British Columbia, and Rural Health Services in BC: A Policy Framework to Provide a System of Quality Care. These documents are supported by the following enabling policy papers: The British Columbia Patient-Centered Care Framework, Enabling Effective, Quality Population and Patient-Centered Care: A Provincial Strategy for Health Human Resources, and Enabling Effective, Quality Population and Patient-Centred Care: A provincial Strategy for Health Information Management and Technology.
Healthcare workers in B.C. can play a significant role in addressing the social determinants of health at various levels. Healthcare workers are in a unique position to be able to advocate for and support healthy public policy and principles of social justice, work to improve the determinants of health for their patients/clients, and to gain an understanding and act upon, when possible, health disparities and inequities. When healthcare workers fully understand the determinants of health they can work towards reducing health inequities through collaboration with governments and public agencies, businesses, and health providers.
As a Registered Nurse, I feel that all nurses have a professional and ethical responsibility to promote health equity through action on the social determinants of health. Throughout my personal and professional life, I have witness first-hand the negative, as well as positive, impacts of social determinants of health. I have seen many clients present for health services as a direct result of unsafe or no housing, poor nutrition or no access to food at all, unemployment and poverty. I firmly believe that by supporting progressive policies that address the social determinants of health, nursing can, in turn, improve the health outcomes of the residents of B.C., as well as across Canada. Working to eliminate health inequities, or at least reduce them, should be a priority for all nurses.
References:
Canada Health Act. (2002). Retrieved from, http://publications.gc.ca/collections/collection_2017/bcp-pco/CP32-78-5-2002-eng.pdf
Health Council of Canada. (2014). Where you live matters: Canadian views on health care quality. Retrieved from, http://publications.gc.ca/collections/collection_2014/ccs-hcc/H173-1-8-2014-eng.pdf
Public Health Agency of Canada. (2016). Social Determinants of Health. Retrieved from, http://cbpp-pcpe.phac-aspc.gc.ca/public-health-topics/social-determinants-of-health/
Public Health Agency of Canada. (2018). Key Health Inequalities in Canada: A National Portrait. Retrieved from, https://www.canada.ca/content/dam/phac-