National Collaborating Centre for Determinants of Health. (2010). Integrating social determinants of health and health equity into Canadian public health practice: Environmental Scan 2010. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University. Retrieved from www.nccdh.ca/supportfiles/Environmental-Scan-2010.pdf
Public health interest and action on health determinants to reduce health inequities is reflected throughout public health’s history including major public health concepts and reports of recent decades (e.g., Ottawa Charter, Reports on Health of Canadians, population health approach, etc.). Explicit expectations for action on health determinants are increasingly embedded within defining parameters of practice such as core public health program and accreditation standards.
Despite public health’s more distant and recent history, public health action on broader health determinants is not widespread and may even be viewed as ‘new’. Either the application of foundational concepts was never universally institutionalized throughout public health or enough time has passed and pressures exerted upon the public health sector that they have been lost. Even within early adopter organizations, action on determinants of health is still at a relatively early stage of implementation versus having been institutionalized throughout. A number of pervasive challenges are barriers to more widespread action. These include: the lack of clarity regarding what public health should or could do; a limited evidence base; preoccupation with behaviour and lifestyle approaches; bureaucratic organizational characteristics; limitations in organizational capacity; the need for leadership; more effective communication; and supportive political environments.
There are also a number of opportunities for achieving success. First, there is the past experience of successively addressing major society-wide challenges (e.g., sanitarians, tobacco control). Increasing evidence to informaction will result from the Institute for Population and Public Health’s (IPPH-CIHR) strategic focus on health equity–related research. Several public health organizations are taking action on health determinants and will thereby add to existing knowledge (i.e., ‘learn by doing’). As evidenced by the interest in this environmental scan, there is considerable and widespread interest in action on health determinants within the public health community. There is also evidence of interest from many sectors across society.