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Barriers to addressing the social determinants of health: Insights from the Canadian experience

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  • Raphael, Dennis
  • Curry-Stevens, Ann
  • Bryant, Toba

Abstract

Despite Canada's reputation as a leader in health promotion and population health, implementation of public policies in support of the social determinants of health has been woefully inadequate. The continuing presence of income, housing, and food insecurity has led to Canada being the subject of a series of rebukes from the United Nations for failing to address child and family poverty, discrimination against women and Aboriginal groups, and most recently the crisis of homelessness and housing insecurity. In this article we consider some of the reasons why this might be the case. These include the epistemological dominance of positivist approaches to the health sciences, the ideology of individualism prevalent in North America, and the increasing influence on public policy of the marketplace. Various models of public policy provide pathways by which these barriers can be surmounted. Considering that the International Commission on the Social Determinants of Health will soon be releasing its findings and recommendations, such an analysis seems especially timely for understanding both the Canadian scene and developments in other nations.

Suggested Citation

  • Raphael, Dennis & Curry-Stevens, Ann & Bryant, Toba, 2008. "Barriers to addressing the social determinants of health: Insights from the Canadian experience," Health Policy, Elsevier, vol. 88(2-3), pages 222-235, December.
    • Handle: RePEc:eee:hepoli:v:88:y:2008:i:2-3:p:222-235
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    References listed on IDEAS

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    1. Raphael, Dennis & Bryant, Toba, 2006. "The state's role in promoting population health: Public health concerns in Canada, USA, UK, and Sweden," Health Policy, Elsevier, vol. 78(1), pages 39-55, August.
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    1. Wagemakers, Annemarie & Vaandrager, Lenneke & Koelen, Maria A. & Saan, Hans & Leeuwis, Cees, 2010. "Community health promotion: A framework to facilitate and evaluate supportive social environments for health," Evaluation and Program Planning, Elsevier, vol. 33(4), pages 428-435, November.
    2. Helen Chung & Ming Ye & Chris Hanson & Oluwaseun Oladokun & Michael J Campbell & Gordon Kramer & Ordan J Lehmann, 2012. "Disparities in Healthcare Utilisation Rates for Aboriginal and Non-Aboriginal Albertan Residents, 1997–2006: A Population Database Study," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-7, November.
    3. Deborah Stienstra, 2018. "Canadian Disability Policies in a World of Inequalities," Societies, MDPI, vol. 8(2), pages 1-13, May.
    4. Natasha Prodan‐Bhalla & Annette J. Browne, 2019. "Exploring women's health care experiences through an equity lens: Findings from a community clinic serving marginalised women," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(19-20), pages 3459-3469, October.
    5. Senese, Laura C. & Wilson, Kathi, 2013. "Aboriginal urbanization and rights in Canada: Examining implications for health," Social Science & Medicine, Elsevier, vol. 91(C), pages 219-228.
    6. Scott J. Fitzpatrick & Bronwyn K. Brew & Donna M. Y. Read & Kerry J. Inder & Alan Hayes & David Perkins, 2019. "Rethinking Suicide in Rural Australia: A study Protocol for Examining and Applying Knowledge of the Social Determinants to Improve Prevention in Non-Indigenous Populations," IJERPH, MDPI, vol. 16(16), pages 1-13, August.
    7. Jansson, Elisabeth & Fosse, Elisabeth & Tillgren, Per, 2011. "National public health policy in a local context—Implementation in two Swedish municipalities," Health Policy, Elsevier, vol. 103(2), pages 219-227.
    8. Yuan Liang & Yan-Hong Gong & Xiao-Piao Wen & Chao-Ping Guan & Ming-Chuan Li & Ping Yin & Zhi-Qing Wang, 2012. "Social Determinants of Health and Depression: A Preliminary Investigation from Rural China," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-7, January.
    9. Katerina Maximova & Nancy Hanusaik & Natalie Kishchuk & Gilles Paradis & Jennifer L. O’Loughlin, 2016. "Public health strategies promoting physical activity and healthy eating in Canada: are we changing paradigms?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(5), pages 565-572, June.
    10. Guglielmin, Maria & Muntaner, Carles & O’Campo, Patricia & Shankardass, Ketan, 2018. "A scoping review of the implementation of health in all policies at the local level," Health Policy, Elsevier, vol. 122(3), pages 284-292.
    11. Bryant, Toba & Raphael, Dennis & Schrecker, Ted & Labonte, Ronald, 2011. "Canada: A land of missed opportunity for addressing the social determinants of health," Health Policy, Elsevier, vol. 101(1), pages 44-58, June.
    12. J. Masuda & T. Zupancic & E. Crighton & N. Muhajarine & E. Phipps, 2014. "Equity-focused knowledge translation: a framework for “reasonable action” on health inequities," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(3), pages 457-464, June.
    13. Kelsey Lucyk & Lindsay McLaren, 2017. "Taking stock of the social determinants of health: A scoping review," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-24, May.

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