Canada's Response to WHO Commission on Social Determinants of Health

Canadian Reference Group

The Public Health Agency of Canada established the Canadian Reference Group to inform Canada's contributions to the WHO Commission by supporting Canadian Commissioners, Knowledge Networks and Country Partner network involvement. In addition, the Reference Group will play a role in connecting with key initiatives in Canada and advancing action on social determinants of health (SDH).

Who We Are

The Group is composed of experts in knowledge and policy development in the area of social determinants of health, including the Commissioners and Canadian knowledge network leads, selected federal government departments, provincial/ territorial health officials, Aboriginal health experts, academics and public health non-government organizations.

What We Do

The Canadian Reference Group:

• provides information to and advice for Canada's efforts related to the work of the WHO Commission on Social Determinants of Health,
• facilitates integration of lessons learned from the Commission into policy processes, and
• mobilizes action on the social determinants of health in Canada and globally.

Our Vision

The Group has articulated a Vision of Canada's progress on SDH in 3 years time:

• Greater knowledge about SDH and health inequality and how to address them
• Advancement in Canadian intersectoral health policy to address the SDH
• Increased evidence that Canada values, measures and reports on progress towards keeping all Canadians well
• Strengthen contribution to global action on SDH

Priority Areas for Action

The Group has identified three streams of work that they feel would be necessary to reduce health inequalities:

1. Systemic Change
2. Public Awareness and Engagement
3. Measurement/monitoring and Accountability

Action Plan

To take action in these areas while building on current activities and strengths, the group has identified the following as contributions that they could collectively make to advance towards systemic change, improved engagement and accountability.

1. Building the Knowledge Base

• Better understanding /critical analysis of potential application of a whole-of-government approach to addressing SDH in Canada;
• Learning from Canadian experiences with intersectoral action to advancing SDH;
• Working with Aboriginal stakeholders and international leaders in Indigenous health to better understand self determination and health; and
• Advance understanding of the economic implications of health inequalities and investment in social determinants

2. Increasing awareness and engagment

• Increase public understanding of what determines health and how it is distributed across the population through:
• Development and implementation of a civil society engagement plan.
• Showcasing Commission learnings at international conference venues.

3. Proposing Mechanisms for change

• Building on current efforts to develop indicators for measuring health disparities.

Progress to date in Achieving CRG Action Plan
Updated January 2007

1. Building the Knowledge base

Canadian experiences with intersectoral action. 

In conjunction with the Reference group, the Public Health Agency of Canada is undertaking a review of Canadian experiences with intersectoral action at both the Federal and Provincial Territorial levels in order to identify conditions under which activity has achieved objectives, mechanisms used, and barriers and challenges to effectiveness. The work will involve a review of literature, and a limited number of case studies of intersectoral initiatives, led by health and other sectors, designed to address SDOH and/or reduce health inequalities. 

Canada is contributing to global knowledge development regarding intersectoral action to address SDOH and reduce disparities by working in conjunction with the Health System Knowledge Network and further gathering and synthesizing information from other countries affiliated with the Commission. 

Self determination as a determinant of health among Aboriginal people

A successful Roundtable brought together Aboriginal leaders and researchers to discuss social determinants of health, explore self determination as a determinant of health and to identify priorities for action. Plans are underway to take action on recommendations.

Contacts will be made with key Knowledge Networks to determine potential receptors for Indigenous input. In addition, a collaboration with other countries (Australia, New Zealand, USA, potentially a few South American countries) is being developed to produce a paper or presentation to the Commission.  

2. Making the Case

Senate

On November 9, 2006, Senator Wilbert Keon moved that the Standing Senate Committee on Social Affairs, Science and Technology  be authorized to:

• examine and report on the impact of the multiple factors and conditions that contribute to the health of Canada's population — known collectively as the social determinants of health

• examine government policies, programs and practices that regulate or influence the impact of the social determinants of health on health outcomes across the different segments of the Canadian population, and that the Committee investigate ways in which governments could better coordinate their activities in order to improve these health outcomes, whether these activities involve the different levels of government or various departments and agencies within a single level of government; and

• study international examples of population health initiatives undertaken either by individual countries, or by multilateral international bodies such as (but not limited to) the World Health Organization

The committee will begin its work in early 2007 and submit its final report to the Senate in 2009.   This follows bids from both Commissioner Monique Bégin and the Canadian Public Health Association urging the Senate committee to study this topic.

The CRG will look for opportunities to inform and be informed by the work of the Standing Committee.

Economic implications - England, Sweden, Chile, Canada and WHO are all interested in advancing economic arguments in support of addressing social determinants of health inequities. An initial meeting was held in October 2006 to work out details of a collaboration on this issue. Canada will then convene an ad hoc working group to further its contribution to this effort.

Conference Board of Canada Executive Roundtable on Socio-economic Determinants of Health - A broad spectrum of federal and provincial government departments (including the Public health Agency of Canada) and non-governmental organizations have joined Roundtable. The purpose of the roundtable will be to facilitate better understanding of social and economic factors affecting health outcomes, carry out rigorous research on key topics, and communicate findings to members, leaders and the public. The main outcome of the Conference Board Roundtable will be the development of an integrated framework that demonstrates how determinants are inter-related and how departments/sectors are linked.  This framework would help delineate the roles of the various players within the federal, provincial, municipal governments, non-governmental organizations and the business community to provide common ground from which to address the social determinants of health.

3. Public & Civil Society Engagement

Presentations at conferences: The WHO Commission and Canada’s related efforts have been profiled at the Canadian Society for International Health Conference 2005, and the Canadian Public Health Association Conference 2006, at the Journées Annuelles de santé publique in October 2006 and the Chronic Disease Prevention Alliance Conference, November 2006. A videoconference for public health professionals also occured in November 2006.  See What We Have Learned for a summary of what you have told us at these events about needed actions to address social determinants of health in Canada.

Civil Society Engagement Strategy – The Canadian Reference Group has hired a specialist to work with them to develop a more fulsome communications and engagement strategy for civil society organizations. A workshop of key organizations is planned for Spring 2007 and potentially an event at the IUHPE Conference in June.

4. Mechanisms for Change

Links have been made to work underway on indicators of health disparities, including expanding work on an Index of Deprivation, being developed out of Quebec, and the work of the Population Health Promotion Expert Group, a federal/provincial/territorial public health network which has made health disparities its priority and which has the mandate to review and make recommendations on indicator development needs.