Thinking and Speaking Differently: Reframing Health Equity

The Walter Gordon Symposium is an annual conference co-hosted by the School of Public Policy and Governance and Massey College. In the lead up to the 2015 Walter Gordon Symposium, students, speakers, faculty, and community members are invited to share their reflections on the theme of ‘Confronting Complexity’ in Canadian society. ​This year’s conference will take place on March 25 and 26, 2015.

Andrea Bracaglia

A team of inner city family physicians at St. Michael’s Hospital in Toronto have recently identified, through their clinical practice, that “health and wealth go together.” While I am sure this statement comes as no surprise to many, it has historically not been reflected in public policy. The ramifications of the social determinants of health (SDOH) and how they affect the health status of Canadians is something that is only recently beginning to gain traction on the Canadian political scene.

There is substantial evidence that shows many chronic illnesses — including asthma, arthritis, diabetes, and cancer — are more prevalent amongst the poor. This is no coincidence. The SDOH, defined by the Canadian Public Health Association, are:

“The social and economic factors that influence people’s health … These are apparent in the living and working conditions that people experience every day.”

Race, gender, aboriginal status, disability, income, education, and housing are all examples of social determinants of health. These factors can have both a positive and negative impact on individual’s lives. The SDOH are also directly related to another concept: that of health equity. According to the Center for Addiction and Mental Health (CAMH), health equity is “concerned with creating equal opportunities for good health for all and reducing avoidable and unjust differences among population groups.” The concern is that some Canadians are being left behind in our health care system: individuals who are homeless, or have precarious housing, and/or who are low-income earners are particularly vulnerable for being in poorer health due to factors unrelated to the system itself. So where do policymakers start? Should they concern themselves with trying to improve an individual’s health status? Or should they first try to address the various social and economic issues that are playing a contributing role?

With respect to the 2015 Walter Gordon Symposiums’ theme of “confronting complexity”, this is arguably one of the most complex and challenging problems facing Canada today. Even with the existence of a universal healthcare system, providing access to both physician and hospital services, the issues presented by a lack of health equity amongst Canadians — and therefore the divide between rich and poor, and the healthy and the sick — are not easy to solve.

Yet despite the complexity of these issues, there are various individuals and groups who have begun to take action. Physicians and the not-for-profit sector have been the primary actors involved in bringing health equity to the forefront, and they have been able to garner significant attention. Just a few weeks ago, I attended an event in Toronto hosted by MASS LBP, The Wellesley Institute, and Upstream called “Upstream Action: New Approaches for Connecting Politics and Health.” The event brought together healthcare providers, community activists, students, and policy advisors to discuss ways in which to focus both the public and political discourse on addressing health equity concerns. The three panelists, all well known physician-activists, discussed the challenges posed by the SDOH in the Canadian welfare state and contended that the solution does not lie solely within the health care system, but rather across government programs (similar to a ‘Health in All Policies’ approach that has been adopted in Finland). Other policy recommendations included the introduction of a guaranteed annual income and various income security programs.

The right to good health is political and needs to be recognized as such. Politicians and policymakers can be influenced to adopt a lens that incorporates the SDOH into decision-making to ensure that Canadians have a right to achieving good health. No single policy can achieve this on its own, but rather an explicit commitment from governments that confronts the various socio-demographic factors that are too often standing in the way. It is time to reframe the discussion surrounding health equity, and support has been growing. As George Lakoff, an American author and linguist said in the book ‘Don’t Think of An Elephant’:

“Reframing is changing the way the public sees the world … Thinking differently requires speaking differently.”

It is time to think upstream, and begin talking about the ways in which governments, private business, and not-for-profit sector can work together to help vulnerable individuals achieve good health.

** For those who are interested in learning more about health equity, check out the work being done by these organizations:

  • Michael’s Hospital Inner City Health Team
  • Upstream
  • The Wellesley Institute

Andrea Bracaglia is a 2015 Master of Public Policy Candidate at the School of Public Policy in Governance , University of Toronto. She recently completed a LEAD internship in conjunction with the Faculty of Medicine, and interned at the Princess Margaret Cancer Centre on a health equity project. Andrea has a strong interest in health policy and hospital management, and hopes to continue to explore the field of palliative care policy.

[Image: Getty]

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