Health Equity and the Determinants of Health

What is health equity?  

Health Equity means that all people, regardless of circumstance, identity, ability, or income level have the resources and opportunity to obtain optimal health and wellness in a way that is meaningful to them. Barriers to optimal health are often far deeper than personal and lifestyle choices, and the factors that contribute to health and well-being can often be related to other factors outside of a person's control. For example, a person’s ability to access healthy and nutritious, culturally appropriate foods is bigger than personal choice, and depends on income levels, cost of food, transportation to food retailers, access to culturally appropriate foods, connections to community, and food preparation skillsets that are often shared or passed down through family and communities.

What is health inequity?

Health Inequities are health differences that are not attributable to a person's genetics or personal choices but rather factors outside of their direct control. These barriers to health and wellbeing are a product of structures around us that create differences in health that are avoidable, unfair, systematic, and unjust. These barriers often affect those in our society who have been made marginalized or vulnerable. For example, we see that health and wellness generally improves as socioeconomic status improves, creating situations where those with lower socioeconomic status have more obstacles to obtaining optimal health and wellbeing.

What are the determinants of health?

There are many factors that contribute to a person’s health and well-being. This can include biological or genetic factors, but also the environment a person lives in, their experiences, and access to services and support. Health inequities are often the result of unfair and unjust distribution of the factors needed for good health and wellbeing. These factors that affect our health outside of our direct control or genetics can be described as the social, structural or commercial determinants of health.

What are the social determinants of health?

The social determinants of health are the social and economic factors that influence people’s health. These are the living and working conditions that people experience every day. They influence the daily conditions in which people live, work, play, learn and age.

Health is much more than access to health care; it is about different opportunities to health which are influenced by social and economic factors. For example, extreme differences in income and wealth affect an individual’s ability to access resources that promote and maintain good health and well-being. Having a safe and secure place to call home, decent and safe working conditions, access to nourishing food and safe air and land, and a supportive network and community are all social determinants of health.

What are the structural determinants of health? 

The structural determinants of health are deeply embedded in the social, political, and economic structures of our society and have a profound impact on health and well-being. These are the written and unwritten rules that create, maintain, and eliminate the long-lasting patterns of advantage and disadvantage between socially constructed groups that impact health. The structural determinants of health also inequitably distribute power so that groups with more power based on current social structures maintain their power by reinforcing or modifying the unwritten or written rules. Some examples of the structural determinants of health include:

• values, beliefs, world views, culture and norms
• governance
• laws, policies, regulations and budgets
• institutional practices

What are the commercial determinants of health? 

The commercial determinants of health (CDoH) are the activities and approaches used by entities that impact health outcomes such as marketing, labour conditions and practices, policy influence, etc. These can have a negative or positive impact on health and often contribute to inequities in our society by how resources and power are distributed.

How are we taking action to improve health equity?

• Prioritizing health equity within our strategic planning process and planning
• Health Equity and Priority Populations Advisory Committee – a cross-team group of staff who come together to review equity concerns they are seeing in program work for coordinated action and and who support staff capacity building.
• Developed a Health Equity Framework to inform action across public health programming.
• Partnering with our Community – we work together with local groups and coalitions, other service providers, schools, municipalities, and people with lived experiences
• Improving programs and services with the goal of making them more accessible to those who need them most
• Participating in healthy public policy development
• Understanding and sharing information about the impacts of health inequities in our community

Interested in learning more about health equity and the determinants of health? – visit the National Collaborating Centre for Determinants of Health Website for current guidelines and research.