CPHA and the Social Determinants of Health: An Analysis of Policy Documents and Statements and Recommendations for Future Action
Manzano, Azalyn T., Raphael, Dennis, Canadian Journal of Public Health
Recently published reports have raised the Social Determinants of Health (SDH) to a level of prominence that makes it difficult for governments and health agencies to ignore. This commentary analyzes CPHA (Canadian Public Health Association) policy statements and positions dating from 1970 to the present to identify where these stand in relation to seven SDH discourses. We locate where CPHA stands on the SDH, appraise its role in the SDH debate, and propose actions to better position CPHA to address SDH. Our analysis indicates that CPHA has not only kept pace with developments in the field of social determinants, but has arguably been well ahead of its time. However, CPHA's response to the World Health Organization's Commission on the Social Determinants of Health shows a striking similarity to earlier commitments that have had limited impacts. We propose that CPHA consider analyzing some of the economic and political structures and justifying ideologies that have prevented its work in the public policy area from promoting public understanding and achieving public policy traction over the past 30 years. We also offer several steps that CPHA could take to reduce the gap between knowledge and action on the determinants of health in Canada.
Key words: Public health; public policy; health promotion; social determinants of health
La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2010;101(5):399-404.
Social determinants of health (SDH) refer to the societal factors - and the unequal distribution of these factors - that contribute to both the overall health and existing health inequalities among Canadians.1 The publication of the Commission on the Social Determinants of Health's final report and those of its knowledge hubs has provided the SDH concept with a prominence that makes it difficult for policy-makers, health researchers and professionals to ignore.2
The SDH figure prominently in health policy documents produced by the Federal government,3,4 the Chief Health Officer of Canada,5,6 the Canadian Senate,7 numerous public health and social development organizations and agencies,8-10 and research funding agencies.11,12 Even the business-oriented Conference Board of Canada has established an initiative focused on the social and economic determinants of health.13 All imply that something should be done to strengthen them.
It is well documented, however, that actual implementation of these concepts in Canada lags well behind other jurisdictions.14-17 The SDH concept - and its public policy implications - conflict with current governmental approaches that reflect welfare state retrenchment and deference to the dominant societal institution in Canada, the marketplace.18,19 The result is that while Canada has a reputation as a "health promotion and population health powerhouse", 20,21 the actual reality is that inequalities in income and wealth have increased at the same time that governments have weakened their commitments to provision to citizens of various benefits and supports.22-24
What has the Canadian Public Health Association (CPHA) said and done about the SDH, and does it have a role to play in the SDH debate? To locate where CPHA stands on these issues, we analyze its policy statements and positions to identify where these stand in relation to seven SDH discourses (see Table 1). The discourse hierarchy appears to be an accurate depiction of how SDH issues have been portrayed within and between different jurisdictions, with resultant policy within Canada and other nations like the United States, the United Kingdom, Norway and Sweden.60,61 These discourses range from a narrow focus on providing health and social services to Canadians experiencing adverse living conditions to cutting-edge analyses of the economic and social forces that threaten the quality of the SDH in Canada. We then suggest actions to better position CPHA to address the SDH. …