Effectiveness of Narrative Messaging Styles about the Social Determinants of Health and Health Inequities in Ontario, Canada.

Emily Churchill,Louise Brooks,Maritt Kirst,Dana Wilson,Ketan Shankardass,Andrea M.L Perrella,Carlos Quiñonez,Aisha Lofters

doi:10.3390/ijerph182010881

Abstract

Health inequities are systemic, avoidable, and unjust differences in health between populations. These differences are often determined by social and structural factors, such as income and social status, employment and working conditions, or race/racism, which are referred to as the social determinants of health (SDOH). According to public opinion, health is considered to be largely determined by the choices and behaviours of individuals. However, evidence suggests that social and structural factors are the key determinants of health. There is likely a lack of public understanding of the role that social and structural factors play in determining health and producing health inequities. Public opinion and priorities can drive governmental action, so the aim of this work was to determine the most impactful way to increase knowledge and awareness about the social determinants of health (SDOH) and health inequities in the province of Ontario, Canada. A study to test the effectiveness of four different messaging styles about health inequities and the SDOH was conducted with a sample of 805 adult residents of Ontario. Findings show that messages highlighting the challenges faced by those experiencing the negative effects of the SDOH, while still acknowledging individual responsibility for health, were the most effective for eliciting an empathetic response from Ontarians. These findings can be used to inform public awareness campaigns focused on changing the current public narrative about the SDOH toward a more empathetic response, with the goal of increasing political will to enact policies to address health inequities in Ontario.

Highlights

Avoidable, and unjust differences in health between social groups [1]. These differences in health are often determined by factors such as income and social status, education, race/racism, and employment and working conditions, which are referred to as the social determinants of health (SDOH) and reflect the negative impact of social, structural factors, and systems on health
Changes to policy are considered to be the best way to decrease the negative effects of the SDOH [2,7]
Among a sample of Ontarians, over half believed that everyone in the province had an equal chance at a healthy life, but that the government had no role to play in addressing health inequity [15], suggesting a lack of awareness of the SDOH, resultant health inequities, and the critical role that government policy-making can play in addressing these issues [2,7]

Summary

Introduction

Avoidable, and unjust differences in health between social groups [1]. These differences in health are often determined by factors such as income and social status, education, race/racism, and employment and working conditions, which are referred to as the social determinants of health (SDOH) and reflect the negative impact of social, structural factors, and systems on health. While Canada spends a considerable amount of money on healthcare, in comparison to other wealthy nations, it is not developing policies or focusing energy and funding on addressing the negative impact of these social determinants to reduce health inequities [2]. In Ontario—Canada’s most populous province—there has been some action to create more equitable access to healthcare, such

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