You cannot start to discuss health equity without first examining the social determinants of heath. The terms equity and equal may sound similar, but “the implementation of one versus the other can lead to very different outcomes for marginalized people” (Equity vs Equality: What's the Difference, 2023) The WHO defines the social determinants of health as “Non-medical factors that influence health outcomes” (WHO, 2023). The Public Health agency of Canada has identified 12 determinants of health. They include:
1. Income and social status
2. Employment and working conditions
3. Education and literacy
4. Childhood experiences
5. Physical environments
6. Social support and coping skills
7. Healthy behaviors
8. Access to health services
9. Biology and genetic endowment
10. Gender
11. Culture
12. Race/racism
(Determinants of health , 2023)
Equality
vs
Equity
The Canadian Health act was erected in 1984 with the objective to “protect, promote, and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (Canada Health Act Annual Report 2021-22). This outdated act speaks to “equal” health care for all Canadians without addressing the huge disparity in equity of health services. In Manitoba, we have the largest indigenous population in Canada, with 57.1% of Indigenous people living on a reserve (sac-isc.gc.ca, 2022) There is a 60-95% unemployment rate for First nations on reserves, 62% of First nations in Manitoba are living in poverty and suicide rates for First Nations communities are almost double to that of the Canadian average (sac-isc.gc.ca, 2022). Health needs to be understood as the physical, spiritual, mental, environmental, social and cultural wellness of the individual and family (SCO, 2023) . Health services offered on reserves are minimal, and usually limited to nursing stations, individuals living in these communities are flown to Winnipeg to receive needed health which is considered reasonable access as per the Canadian Health act. Some may consider this equal access to health care as they have the ability to receive required services, just not in their home communities but I would argue this is far from Equitable. In this specific example, physical environment, social supports, culture, literacy, racism- all SDH identified by the Public Health agency of Canada are not taken into consideration. What our system is neglecting to address is the impact that social well-being has on overall health(WHO, 2023). Action is required. Poor health outcomes based on poverty alone: higher stress, social isolation, food insecurities, substance abuse, worsening symptoms of mental health and inadequate housing need to be considered and addressing SDH appropriately is "fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and society" (WHO, 2023)
References
Determinants of health . (2023, October 14). Retrieved from Government of Canada : https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Equity vs Equality: What's the Difference. (2023, October 16). Retrieved from Milken Institute School of Public Health: https://onlinepublichealth.gwu.edu/resources/equity-vs-equality/
Indigenous Services Canada. (2022, April 26). Retrieved from Indigenous people in Manitoba: https://www.sac-isc.gc.ca/eng/1626886719453/1626886859809
SCO. (2023, October 16). Retrieved from Southern Chiefs Organization Inc.: https://scoinc.mb.ca/
Social determinants of health. (2023, October 15). Retrieved from World Health Organization : https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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