In Manitoba, there are two main documents that guide the province in the relation to the social determinants of health (SHoD). The first is the Chief Provincial Public Health Officer Position Statement on Health Equity published by Manitoba Health, Seniors and Active Living. Health equity is defined as meaning “that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socio-economic status or other socially determined circumstance” (Manitoba Health, Seniors and Active Living, 2018). There are 3 key points in this position statement. It recognizes that some populations including Indigenous peoples, newcomers and refugees, visible minorities, people living in poverty, persons with disabilities, and people experiencing long term unemployment and homelessness experience a greater burden of poor health outcomes and shorter life expectancy (Manitoba Health, Seniors and Active Living, 2018). First Nations, Metis and Inuit peoples face significant health gaps due to traumatic experiences related to racism and colonization (Manitoba Health, Seniors and Active Living, 2018). The SDoH, identified as “the conditions in which people are born, grow, live, work and age – such as housing, food, income, natural and built environments, social safety net and social inclusion”, are unequally distributed among population groups (Manitoba Health, Seniors and Active Living, 2018).
The second document is the Winnipeg Regional Health Authority (WRHA) Health Equity Position Statement. In this statement, health equity is described as “the ability for people to be able to reach their full potential and not be disadvantaged from attaining it because of their social and economic status, social class, racism, ethnicity, religion, age, disability, gender, gender identity, sexual orientation or other socially determined circumstance” (Winnipeg Regional Health Authority, n.d.). There are 3 key points in this position statement. The WRHA recognizes that larger health gaps exist in Winnipeg due to unfair, unjust and modifiable social circumstances. Colonization has had an ongoing negative and tragic impact on all aspects of Indigenous peoples’ health and well-being. Ethnic groups who have experienced marginalization or oppression are more likely to have poorer health outcomes (Winnipeg Regional Health Authority, n.d.).
The province of British Columbia has several documents relating to the SDoH. The first is the B.C. Social Determinants of Health Standards document which is still in the development stage. The Standards would aim to “provide consistency and guidance for social determinants of health information data collection within British Columbia’s health care community” (British Columbia Government, n.d.). The intent of the Standards will be to assist health care providers to identify, capture, maintain, identify and understand the SDoH and relate them to the potential inequities and negative impacts on people and populations (British Columbia Government, n.d.). The Standard will capture data for each electronic health record and collect an individual’s lifetime health history and care records which could be shared in health care domains such as hospitals, doctor’s offices and pharmacy systems, in order to advance equitable healthcare (British Columbia Government, n.d.).
The second document is the British Columbia Nurses’ Union Position Statement on Social Determinants of Health. The B.C. Nurse’s Union believes that socioeconomic factors are the foundation of health and when these conditions are improved population health improves. Key points of this paper identify ways to create a healthier province including eliminating/alleviating poverty, ensuring safe housing, and supporting publicly funded services such as healthcare, social services and education (British Columbia Nurses Union, 2019). The paper states that British Columbians, by and large, are healthy people, living longer than the Canadian average; however, there are considerable variations in their health status. A major point of discussion is around income and its impact on population health. The paper states that distribution of wealth in the province is uneven and largely due to unjust government policies (British Columbia Nurses Union, 2019). B.C. has historically had one of the lowest minimum wages in the country making it difficult for some people to meet their daily needs. The income gap is growing and the populations experiencing the most disparities are First Nations people, new immigrants, single mothers, those with disabilities, and the elderly (especially women). Its population also experiences very high rates of homelessness. It is well known that this province has some of the highest housing prices in the country, particularly in Vancouver.
There are several similarities and differences between Manitoba and British Columbia in their priorities related to the SDoH. Both provinces identify certain groups as being more marginalized such as First Nations people and new immigrants. Manitoba has the largest population of First Nations and Metis people of any province in Canada (Government of Canada, 2020) and places significant emphasis on recognizing the disparities among its First Nation peoples. Similar to B.C., many First Nations communities do not have access to clean drinking water and some communities have been under boil water advisories for years. For example, Shoal Lake First Nation just recently had its 24-year boil water advisory lifted with the opening of a new treatment plant. While both provinces struggle with homelessness, B.C. experiences a much larger homeless population. Housing prices across Canada have risen exponentially over recent years. Manitoba has a relatively low cost of housing in comparison to B.C. in general, and to Vancouver specifically. With regards to the SDoH, most provincial documents do a good job of defining the SDoH and recognizing their impact on population health but that’s where it ends. The province of British Columbia is very progressive in its approach to set about standardizing definitions and terminology for the multiple domains of the SDoH and capturing this information in an individual’s electronic medical record. Every time a health care provider reviews a client’s EMR, they would be reminded to consider the impact of the SDoH on that individual’s health. This approach takes the SDoH and turns them into a functional piece of usable information. Finally, both provinces assert that it is the responsibility of government to develop and adopt good public policy in order to promote positive health outcomes, reduce health inequities, and strengthen its response to the social determinants of health.
Resources:
British Columbia Government. (n.d.). B.C. social determinants of health standards.
British Columbia Nurses Union. (2019). Position-statement-social-determinants-of-health [PDF].
Government of Canada. (n.d.) Achieving clean drinking water in First Nations Communities.
https://www.sac-isc.gc.ca/eng/1614385724108/1614385746844
Government of Canada (2020). Annual Report to Parliament 2020. https://www.sac-isc.gc.ca/eng/1602010609492/1602010631711
Manitoba Health, Seniors and Active Living (2018). Chief Provincial Public Health Officer Position Statement on Health Equity.
Winnipeg Regional Health Authority (n.d.). WRHA Health Equity Position Statement.
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