Tuesday, June 26, 2012

[EQ] Better Health: An analysis of public policy and programming focusing on the determinants of health and health outcomes

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

Carles Muntaner, University of Toronto, Bloomberg Faculty of Nursing

Edwin Ng, University of Toronto, Dalla Lana School of Public Health

Haejoo Chung, Korea University, Department of Healthcare Management

Canadian Health Services Research Foundation CNA/CHSRF series of reports to inform the CNA National Expert Commission

The Health of Our Nation – The Future of Our Health System: Paper 1, 2012

Available online PDF [70p.] at: http://bit.ly/KBUd9B

To advance the role of nursing in reducing health inequalities, this paper conducts a scoping review to assess the empirical association between social determinants and health outcomes and to identify public policies and political activities that reduce health inequalities.

Guided by the CSDH’s conceptual framework, which emphasizes the “causes of the causes” to reduce social inequalities in health, this paper moves beyond the consideration of immediate causes such as medical treatments or lifestyle choices.

Three questions are addressed:

- What is the current scope of knowledge from Canadian research on SDOH, conceptualized as income, housing, food insecurity and social exclusion?

- What is the role of nursing in reducing health inequalities within Canada’s political and economic contexts?

- Which policy recommendations have the potential to narrow health inequalities?

Scoping review methods consisted of five steps.


First, the electronic database PubMed was searched using these keywords: “income” or “food insecurity” or “housing” or “social exclusion” and “population health” or “health inequalities” and “Aboriginal Peoples” or “First Nations” or “Métis” or “Inuit” and “Canada”.

, we screened potentially relevant studies and included them if the studies presented empirical findings and tested at least one SDOH measure.

Third, we charted descriptive and empirical data using a coding template.

Fourth, studies grouped by theme were coded as positive (social determinant of health is positively associated with health), negative (social determinant is inversely associated with health), mixed (social determinant is inconsistently related to health) or no impact (relation between social determinant and health is not significant). Effect size metrics were also extracted to compare the strength of associations between social determinants and health-related outcomes.

Fifth, we searched government reports, international commissions and cost-benefit analyses to augment and inform our policy recommendations….”







3.1 Descriptive characteristics

3.2 Nature of empirical associations

3.2.1 Food insecurity

3.2.2 Housing

3.2.3 Multiple SDOH

3.2.4 Income

3.2.5 Social exclusion

3.3 Strength of SDOH associations


4.1 The role of nursing in addressing SDOH

4.2 The political economy of public policies


5.1 Income

5.2 Food insecurity

5.3 Housing

5.4 Social exclusion

5.5 Wide-ranging SDOH



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