Abstract
Addressing social determinants of health (SDoH) has been acknowledged as an essential objective for the promotion of both population health and health equity. Extant literature has identified seven potential areas of investment to address SDoH: investments in sexual and reproductive health and family planning, early learning and child care, education, universal health care, as well as investments to reduce child poverty, ensure sustainable economic development, and control health hazards. The aim of this paper is to produce a ‘report card’ on Canada’s success in reducing socioeconomic and health inequities pertaining to these seven policy domains, and to assess how Canadian trends compare to those in the United Kingdom (UK), a country with a similar health and welfare system. Summarising evidence from published studies and national statistics, we found that Canada’s best successes were in reducing socioeconomic inequalities in early learning and child care and reproductive health—specifically in improving equity in maternal employment and infant mortality. Comparative data suggest that Canada’s outcomes in the latter areas were like those in the UK. In contrast, Canada’s least promising equity outcomes were in relation to health hazard control (specifically, tobacco) and child poverty. Though Canada and the UK observed similar inequities in smoking, Canada’s slow upward trend in child poverty prevalence is distinct from the UK’s small but steady reduction of child poverty. This divergence from the UK’s trends indicates that alternative investment types and levels may be needed in Canada to achieve similar outcomes to those in the UK.
Highlights
Socioeconomic inequalities in health are known to result from societal socioeconomic inequalities—experienced even before birth and accumulated throughout life (Marmot et al, 2010)
These can be summarized into seven domains: 1) sexual and reproductive health, family planning, and pre- and perinatal care, 2) labour market and tax policies to reduce child poverty, 3) early childhood education and care, 4) secondary and post-secondary education, 5) accessible and highquality primary, secondary, and tertiary health care, 6) economic and marketing controls on health hazards, and 7) sustainable economic development to support meaningful employment. Though many of these areas overlap, and alternative classification systems can be used, this broad taxonomic classification of investment areas offers a valuable framework to guide the study and interpretation of health equity-related outcomes. These investment areas were identified as priorities for Abbreviations: ECEC, Early childhood education and child care; CANSIM, Canadian Socio-Economic Information Management System; CCS, Canadian Cancer Society; CIHI, Canadian Institute for Health Information; GDP, Gross domestic product; OECD, Organisation for Economic Co-operation and Development; ONS, Office for National Statistics; social determinants of health (SDoH), Social determinants of health; UK, United Kingdom; WHO, World Health Organization
The aim of this study was to assess national trends in health and socioeconomic outcomes in Canada according to seven broad areas of investment for health equity, and to assess how these trends compare to those in the UK, a fellow high-income “liberal” welfare state
Summary
Socioeconomic inequalities in health are known to result from societal socioeconomic inequalities—experienced even before birth and accumulated throughout life (Marmot et al, 2010). With the aim of improving both health and well-being for all, and reducing health inequities, extant reports on the Social Determinants of Health (Marmot et al, 2008; Marmot et al, 2010; Wilkinson & Marmot, 2003) have identified several areas of investment (Frank et al, 2015) These can be summarized into seven domains: 1) sexual and reproductive health, family planning, and pre- and perinatal care, 2) labour market and tax policies to reduce child poverty, 3) early childhood education and care, 4) secondary and post-secondary education, 5) accessible and highquality primary, secondary, and tertiary health care, 6) economic and marketing controls on health hazards, and 7) sustainable economic development to support meaningful employment. Differences between the two nations can highlight future areas for cross-national analysis of health and social policies, contexts, and interventions, and their differential impacts on health equity (Gilson, 2012)
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