Abstract
BackgroundAddressing the social determinants of health (SDH) is identified as a role for local public health units (PHUs) in the province of Ontario. Despite this authorization to do so there is wide variation in PHU practice. In this article we consider the factors that shape local PHU action on the SDH through a critical realist analysis.MethodsInterviews with Medical Officers of Health (MOHs) and lead staff from nine PHUs in Ontario identify the structures and powers that allow PHUs to address the SDH as well as the many factors that either activate or inhibit these structures and powers.ResultsWe found that personal backgrounds and attitudes of MOHs and leading staff people as well as local jurisdictional characteristics shape whether and how PHUs carry out SDH-related activities.ConclusionsAction on the SDH is a result of a complex interplay of micro-, meso- and macro-level factors that requires recognition of the contested nature of public health, presence of Ministry of Health mandates, local jurisdictional characteristics, and politics. The most effective way to assure PHU action on the SDH is for the Ministry of Health and Long-Term Care to mandate such activities and develop accountability mechanisms that assure implementation.
Highlights
Addressing the social determinants of health (SDH) is identified as a role for local public health units (PHUs) in the province of Ontario
We found that regional PHUs are faced with challenges related to the nature of their Board of Health, wider geography, and fewer community agencies concerned with SDH-related issues
It is difficult to isolate the specific characteristics of jurisdictions that shape the PHUs activities, but after reviewing our findings we identify five distinctive groupings that illustrate how jurisdictional characteristics that have been discussed in the previous section are associated with PHU SDH approach
Summary
Addressing the social determinants of health (SDH) is identified as a role for local public health units (PHUs) in the province of Ontario Despite this authorization to do so there is wide variation in PHU practice. Acting on the social determinants of health (SDH) has become a critical concern of the global public health community [1] This concern is evident in numerous statements and documents provided by international, national and local public health authorities. Despite this apparent consensus, there is wide variation among national [2] and local jurisdictions in the implementation of the SDH concept [3,4]. These interpretations are shaped by the form
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