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

Knowledge Networks

As part of the learning stream of the Commission's work, nine Knowledge Networks (KNs) have been established to generate and organize knowledge that could be used by governments to take action to improve, promote and protect health equity. These networks involve research partners from both developing and developed countries. Examples of the types of products expected from the KN(s) could include: consensus statements on specific issues/debates within the theme; discussion and thematic papers; an inventory of actions that can be taken by governments in the particular area to improve health equity; and establishment of a global network of researchers, policy makers and agencies that connect the developed and developing worlds on the specific theme. It is hoped that these networks will lead to better dissemination of global knowledge and eventually to global communities of practice.

Each network is managed by an organizational hub whose objective is to coordinate and contribute towards the knowledge generation activities and manage the budget for the networks. Six organizational hubs have been identified for the themes on: globalization; urban settings; health systems; measurement and evidence; women and gender equity; and early child development.

The following knowledge hubs are located in or supported by Canada:

1. Knowledge Network on Early Child Development (ECD)
Human Early Learning Partnership, Univ. of British Columbia http://www.earlylearning.ubc.ca/WHO/

The Knowledge Network for ECD will focus on the social determinants of ECD. Well established evidence illustrates that opportunities provided to young children are crucial in shaping lifelong health and development status. The Knowledge Network for ECD aims to raise the profile of early child development globally. It will take a broad conceptual approach to early child development, centred on the three primary developmental domains - physical, social/emotional, and language/cognitive - which spread out over the life course and influence a full range of outcomes in health, well-being and learning skills that are relevant to all societies.

In order to run an effective 'global conversation' on early child development, the Knowledge Network will place a priority on those things that are shared by all societies. The Network intends to promote the idea of a global measurement standard as a population-based indicator of children's well-being. Prior research and experience demonstrates that there are incremental effects on child development with incremental changes in socioeconomic conditions. As such, rather than targeted approaches, the ECD Knowledge Network is committed to affecting change on the social determinants of ECD along the full range of the socioeconomic spectrum. The focus is on universal access to nurturant conditions. This includes the ambient environments in which children live, as well as more indirect influences of social and economic policy decisions that affect children's well-being.

2. Knowledge Network on Globalization
Institute of Population Health, University of Ottawa (Canada)
http://www.iph.uottawa.ca

Globalization can affect health outcomes by way of four main mechanisms- social stratification, differential exposure, differential susceptibility, and differential consequences. Among the aspects of globalization in focus are: trade and financial market liberalization, financial flows, expansion of global production chains, commercialization and privatization of public services, changes in consumption and lifestyle patterns, changes in wealth and income.

The Commission's Knowledge Network on Globalization analyzed the uneven distribution of globalization's gains and losses and the impacts on health inequities. Among the issues for which research syntheses were carried out and policy options formulated:

• globalization, growth, wealth and health;
• global governance for health;
• changes in global power relations;
• trade liberalization;
• labour market restructuring;
• impacts on national 'policy space;
• health systems restructuring;
• intellectual property rights and access to medicines;
• aid flows, debt and poverty reduction;
• the global migration of health workers;
• water and sanitation;  
• food security and nutrition transitions; and
• case study of globalization and health in Latin America

3. Knowledge Network on Health Systems
Funded by the International Development Research Centre (IDRC)
http://www.idrc.ca/en/ev-101195-201-1-DO_TOPIC.html

Health systems are made up of the functions, resources and policies to deliver health care. Health systems are important because they can influence the health outcomes of populations through their design, quality, ability to be accessed and performance. The Health Systems Knowledge Network will identify and assemble existing evidence, and undertake new work to improve knowledge on 1) the impact of the health system as a social determinant of health and health equity; 2) the interaction between health systems and other social determinants; and 3) factors that explain these interactions. This work will be done for the purpose of identifying policy and practice opportunities for strengthening the role of health systems in responding to the social determinants of health, and improving health equity. Within this Network particular emphasis will be placed on the experience and needs of countries in the South, though knowledge from countries in the North will also be sought.

Funded by the International Development Research Centre (IDRC), a consortium made up of the Centre for Health Policy at the University of Witwatersrand (South Africa), EQUINET, a Southern African network devoted to promoting health equity (www.equinetafrica.org ), and the Health Policy Unit of the London School of Hygiene in the United Kingdom (www.lshtm.ac.uk/hpu ) has been appointed as the organisational hub of the Health Systems Knowledge Network of the Commission on the Social Determinants of Health.

The project’s specific objectives will be to:

• build and co-ordinate linkages across geographic boundaries between existing networks to increase knowledge sharing on health systems as a social determinant of health;
• develop existing knowledge on health systems as a social determinant of health and health equity;
• develop policy and planning recommendations, identifying potential facilitators and obstacles to their uptake;
• identify opportunities for integrating social determinant concerns into health systems planning (and performance), with a particular focus on reducing health inequalities;
• identify examples of successful health system interventions relating to point 4 above that could be taken into wider policy and practice;
• strengthen the ability of developing country networks to deal with the social determinants of health, reinforcing existing capacity building efforts; and
• produce and share evidence during the process in a form that supports the knowledge-to-policy loop in order to support debate within and beyond the knowledge network.