Poverty Reduction, Social Determinants of Health and Why We Need to Adopt a Health Equity Approach

Research shows that there is an unequal distribution of health equity in the society. This inequity can be linked to  the social determinants of health; the economic and social conditions in which people live which determine their health. Chronic diseases such as hyper-tension, depression, cardiovascular disease, cancer, and diabetes are among the most common health problems facing Canadians today  They are also considered to be among the most preventable diseases, and are believed to be directly linked to social determinants of health.. Factors such as socio-economic status, gender, immigration status, ethno-racial or faith-religious background have been found to be related to differences in health status. Aboriginal identity, disability, sexual orientation or gender identity, family status, health status and age are well associated with different risk factors, susceptibility to disease as well as premature death. According to the Health Equity Council, “Adverse socio-economic circumstances during childhood are repeatedly found to be more potent predictors of the incidence of cardiovascular disease and diabetes than later life circumstances and lifestyle behaviours”. These health inequities are largely systemic, unjust and avoidable.

On Friday, September 25, 2009, a workshop, entitled “Poverty Reduction, Social Determinants of Health and Why We Need to Adopt a Health Equity Approach” was held at the Folk Arts Multicultural Centre of St. Catharines. Organized by two provincial organizations, Ontario Healthy Communities Coalition and Health Nexus, this workshop brought together 60 experts, community leaders, service providers, policymakers, researchers, advocates and individual community members to work together on increasing health equity and reducing poverty.

The workshop was facilitated by michael kerr, a long-time community development worker and equity and human rights advocate, micheal is also the coordinator of  the Colour of Poverty Network of Ontario.

The day opened with a warm welcome from Jim Bradley, Minister of Transportation and MPP for St. Catharines. Minister Bradley briefly overview the current work being done by the Ministry of Transportation  stating that the Ministry is no longer “just about highways” and that they supporting active modes of transportation such bike lanes, public transit and other modes of transportation. The Minister acknowledged the work done by those in communities across Ontario with encouraging words:  “as volunteers and staff who often aren’t paid a great deal for their efforts, you may not hear this every day, but there is a deep appreciation for the role that you play- so thank you.”

Chris Coloumbe, President –Elect of the Ontario Healthy Communities Coalition also welcomed participants to the workshop, particularly French speaking participants, and invited all to stay for the OHCC Annual General Meeting after the workshop. Chris also thanked St Catharines Healthy City Committee and the OHCC Diversity Committee for their assistance in hosting and organizing the event.

The day progressed with keynote speaker Madina Wasuge, Executive Director of Hamilton’s Centre for Civic Inclusion. Ms Wague approached  the topic of poverty and health equity in acknowledging the changing face of Ontario. She noted that immigrant and aboriginal populations are the fastest growing populations in Ontario. To improve health equity she emphasized the importance of integrating a health equity approach into service delivery; which would in turn lead to  financial benefits.  She stressed the need for collaboration across sectors and governments, and identified three priority areas as social investment, community capacity building and intersectoral action.

The room was then invited to participate in conversation circles, facilitated by michael kerr. The first conversation circled centered around the question ‘What is health equity and why is it necessary?’.  The panelists included Subha Sankaran (Health Equity Council and Health Nexus), Pat Wright (Hamilton’s Centre for Civic Inclusion), Dianne Patychuk (Steps to Equity) and Bob Gardner (Wellesley Institute). Each panelis had the opportunity to respond to the question, then the conversation was opened to all participants. After a break, the second conversation circle built on the first, asking “How can we work towards health equity?”. Panelists included Marc Todd (Region of Niagara), Pat Wright (Hamilton’s Centre for Civic Inclusion), Dianne Patychuk (Steps to Equity), and Bob Gardner (Wellesley Institute).

The conversation circles generated a great deal of information.  Ideas and views were shared about the causes and implications health inequities, and about research, policy and service initiatives aimed at increasing health equity. The following are some of the ideas that were generated by the conversations:

a)      Health is a human right and a matter of social justice

b)      Healthy disparities result in Increased health care

c)      health equity needs to be looked at in three different ways 1) unequal access to services 2) unequal opportunity 3) unequal outcomes

d)     Need to measure/monitor peoples’ access to services

e)      Need to build community capacity and build public policy

a)      Collaboration and integration are key to increase access to health care services

b)      Region of Niagara Report “Legacy of Poverty in Niagara Region” – indicators of poverty and recommendations, as a result of the report 32 projects throughout the Niagara region were funded (eg the Good Food Box)

Following the lunch break, Brian McMullan, Mayor of St. Catharines, welcomed participants to St. Catharines. Mayor McMullan also discussed some the difficulties St Catharines is having as a town in transition: with high level of poverty and the reduction and changes in employment. He also highlighted some of the Healthy Communities initiatives that have been taking place in the St Catharines such as their anti-idling campaign and cycling initiatives, and noted the good work of the St. Catharines Healthy Cities Committee.

The later part of the afternoon was spent in a mini-workshop facilitated by Liz Weaver from the Tamarack Institute. She started with a 5W exercise; i.e. she asked a series of five “why” questions to get participants thinking about the roots of poverty:

1. Canada is a country with great wealth, so why do we have such poverty?

  Summary of discussion: Because wealth is not evenly distributed and is accumulated at the top.

2. Why is the wealth accumulated at the top?

      Because people with wealth have power and are unwilling to give it up.

3. Why do people with wealth have power and are unwilling to give it up?

      Because they have direct access to the government and are allowed to be that way.

4. Why do they have direct access to the government?

      Because they know how to use the government to their advantage.

5. Why do they use the government to their advantage?

      Because we allow it to happen 

This exercise led to the expression of many different ideas and perspectives and increased participants’ awareness of the issues of health equity and poverty.

In small groups, participants were asked to look one of of the social determinants of healh and map out for their particular determinant: desired outcomes, what organizations should be involved and what changes we would see. Reporting back to the large group, it was clear that the discussions had been very rich and spanned many areas of concern. Numerous recommendations for action were noted.

The workshop and the day as a whole demonstrated that poverty is a complex issue requiring complex solutions. There are a variety of ways to understand andreduce poverty. We must  mobilize all capacity communities to address mutli-faceted issue of poverty.

For  more detailed information about this workshop, please contact info@ohcc-ccso.ca

Posted November 10, 2009.