Academic journal article Canadian Review of Social Policy

Placing Health in Welfare Policy: A HIAP Approach in Ontario Canada

Academic journal article Canadian Review of Social Policy

Placing Health in Welfare Policy: A HIAP Approach in Ontario Canada

Article excerpt


A longstanding concern in the literature has been a lack of interconnectedness between health and social policies that serves as a barrier to optimizing population health. The inability to successfully support population health through purely medical means is reflected in the following parable:

Sometimes it feels like this. There I am standing by the shore of a swiftly flowing river and I hear the cry of a drowning man. So I jump into the river, put my arms around him, pull him to shore, and apply artificial respiration. Just when he begins to breathe, there is another cry for help. So I jump into the river, reach him, pull him to shore, apply artificial respiration, and then just as he begins to breathe, another cry for help. So back in the river again, reaching, pulling, applying, breathing, and then another yell. Again and again, without end, goes the sequence. You know, I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them all in (McKinlay as cited in Rudolph, 2013).

This short parable exemplifies the weaknesses of a health system that is designed to fix presenting health problems rather than consider the root causes of these issues (Chief Medical Officer of Health, 2010; Keon & Pepin, 2009), which often stem from social factors - or social determinants of health (SDOH) - that sit "upstream" (Marmot, Bell, Houweling, Taylor, 2008; Raphael, Brassolotto, & Baldeo, 2015; WHO, 2010). SDOH are essential for health promotion (Raphael, Brassolotto, J, & Baldeo, 2015). A failure to address SDOH can increase health disparities among the most vulnerable populations, such as those living in poverty. The purpose of this paper is to explore how SDOH are considered within Ontario's Social Assistance government policies and reflections on Ontario's Social Assistance (SA) Program through a health-promotion lens.

Various health promotion approaches have been suggested to address complex health challenges conducted through a SDOH lens (Shankardass, Solar, Murphy, Greaves, O'Campo, 2012). One such approach gaining more traction in Canada is the Health-in-all-Policies (HiaP) approach (Shankardass, Murphy, Freiler, Bobbili, Bayoumi, O'Campo, 2011). The World Health Organization [WHO] (2014) defines HiaP as "an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity" (p. 3). Conceptualized over three decades ago, this approach considers how non-health ministries can incorporate health in their policy development process given that health is affected by many factors beyond clinical treatment for health conditions (Drummond, 2012; Raphael, 2011). The Standing Senate Committee on Social Affairs, Science and Technology in Canada affirmed the importance of this type of approach: "Income, level of education, occupation, social hierarchy and housing, which are all determinants of health, have direct and indirect consequences for the health and well-being of the population"(Keon & Pépin, 2009, p. 4). The HiaP approach requires government action focused on the equitable distribution of resources.

The delivery of social determinants of health, such as housing, income, education, and employment are within the purview of multiple ministries in Ontario (and in other jurisdictions), each with their own mandates, budgets, and expected outcomes. This siloed approach to government poses a challenge to developing policies that will benefit a specific target population such as social assistance recipients when the budget for the needed expenditures are spread across different ministries. Researchers have argued that evidence supporting the value of a shared government mandate for health promotion is needed (Greaves & Bialystok, 2011). This paper contributes to this effort by examining the social policies that have a major impact on the health of those who experience significant health disparities, namely social assistance recipients. …

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