Better Health: An analysis of public policy and programming focusing on the determinants of health and health outcomes that are effective in achieving the healthiest populations

Full Report (PDF, 685.51, KB)

Key Messages

Although major health inequalities exist in Canada, minimal action has been taken by municipal, provincial/territorial and federal levels of governments to narrow health inequalities through the social determinants of health (SDOH) and public policy.

Income, housing, food insecurity and social exclusion are four major social determinants in generating and reproducing health inequalities over the life course (childhood, adulthood and the elderly stage).

Low-income individuals and families have significantly higher rates of mortality, morbidity and healthcare use as compared with middle- and high-income groups. Health inequalities between the richest 20% and the poorest 20% have decreased from 1971 to 1996 in Canada; however, continued monitoring is needed given that income inequality has increased over the past decade.

Food insecurity and unstable housing are associated with poor health and, in turn, mediate the link between income and health (hunger and unstable housing affect health and result from low income). Mortality rates among homeless and marginally housed individuals were much higher than expected on the basis of low income alone.

Social exclusion is a powerful determinant of health inequalities; however, its effects are dependent upon which groups are compared. The health consequences of social exclusion are most unequal between Aboriginal and non-Aboriginal groups. Immigrant health favours recent arrivals over long-term residents. Compared with non-minority ethnic groups, minority racial/ethnic groups are more likely to experience social and health disadvantages. However, no clear association exists for health inequalities between minority racial/ethnic groups.

Taking action on SDOH to narrow health inequalities offers new opportunities for the nursing profession to expand its role to include:

  • supporting initiatives that reduce child and adulthood poverty levels by increasing financial assistance and social wages (SDOH provided through public funds)
  • supporting initiatives that increase minimum wages to “living wages” to ensure that economic security, stable housing and food needs are met
  • supporting campaigns and social movements that advocate for progressive taxation, the right to food security and affordable housing, and the enforcement of laws that protect the rights of socially excluded groups
  • advocating for intersectoral action on health at municipal, provincial/territorial and federal levels of government to coordinate action undertaken by sectors outside the health sector
  • supporting political parties at provincial/territorial and federal levels of government that are receptive to taking action on SDOH (such as those that are pro-labour or pro-redistribution of wealth)
  • encouraging greater workplace democracy to increase the number of unionized workplaces since labour unions are important determinants of generous welfare states, narrower social inequalities and better population health