Health equity – missing in action

I’ve been reading a new book called Oppression: A Social Determinant of Health, edited by Elizabeth McGibbon.  The book raises the question of why we continue to have such vast health inequities in Canada, despite the volume of evidence pointing to the large role played by the social determinants of health in causing illness and injury.  Why does there continue to be such disconnect between evidence and action?

The federal government’s response to obesity provides a perfect example of a well-intentioned program that will fail because it does not account for the social determinants of health.  The recently announced Healthy Eating Awareness and Education Initiative takes a narrow view of the issues behind unhealthy eating and obesity.  While the initiative contains sound information, it misses the mark in improving population health and incorporating health equity, because it ignores the strong links between poverty and obesity.  The initiative’s approach tends to be most effective for middle and higher income families. Those who need help the most will not be helped and we actually risk widening the health equity gap. Having more information on how to read a food label doesn’t help someone whose income is so low that they are food insecure and must access food banks every month.  Food banks provide little choice, and most items provided are packaged and processed.

Why is healthy equity missing in action? There seem to be a few underlying reasons:

– Discussions and reports on the social determinants of health tend to be too jargon-laden – and so do not resonate with the public;

– The implementation of a social determinants of health approach is incompatible with the reigning ideology of tax cuts and reduced social spending.

The case of obesity highlights a central argument in Oppression:  since Canadians have little awareness of the important role that living conditions play in determining health, there is limited public pressure on governments to address the social determinants of health.  If decision makers are to be persuaded to make the necessary investments to address health inequities, we must raise awareness about the social determinants of health amongst ordinary citizens in a way that engages them and makes sense.  The Robert Wood Johnson Foundation has done some great work in this area with their report A New Way to Talk About the Social Determinants of Health.

For more information on how to drive health equity strategies into practice, check out the Wellesley Institute’s tool kits and resources.