Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: a qualitative inquiry

Abstract

To date, Ontario public health units (PHUs) have generally neglected the social determinants of health (SDH) concept in favor of risk aversion and behaviorally oriented health promotion approaches. Addressing SDH and responding to the presence of health inequities is required under the Ontario Public Health Standards and is a component of provincial public health documents and reports. Nevertheless, units vary in their understanding and application of the SDH concept in their activities. The authors conducted 18 interviews with Medical Officers of Health and lead staff persons from nine Ontario PHUs, in order to better understand how these differences in addressing the SDH among health units come about. The findings suggest that differences in practice largely result from epistemological variations: conceptions of the SDH; the perceived role of public health in addressing them; and understandings concerning the validity of differing forms of evidence and expected outcomes. Drawing from Bachelard's concept of epistemological barriers and Raphael's seven discourses on the SDH, we examine the ways in which the participating units discuss and apply the SDH concepts. We argue that a substantial barrier to further action on the SDH is the internalization of discourses and traditions that treat health as individualized and depoliticized.

Taking stock of the social determinants of health: A scoping review

“…[35,62,97–98] However, as Manzano and Raphael (2010) have pointed out, these written contributions have not been accompanied by substantive action, and in fact Canada has increasingly weakened its commitments to improving the SDOH and health equity. [62] The many documents published by Canadian government organizations and scholars perhaps supports the claim that Canada is a document powerhouse that falls short in acting on the SDOH (e.g.,[15, 20, 22, 27–30, 33, 57, 62–63, 97–102]).…”

Adaptation et conditions d’utilisation d’un outil d’analyse des interventions au regard des inégalités sociales de santé

“…Comme nous l'avions déjà observé en 2010 en France, l'approche réflexive est appréciée sur le terrain parce qu'elle permet d'ouvrir le dialogue sur un sujet jugé par les répondants, complexe et sensible, tant les conceptions attachées aux ISS et aux DSS divergent entre professionnels (15). Elle est reconnue pour éclairer les pratiques quotidiennes, susciter les rapprochements et la mobilisation, offrir un espace-temps de réflexion collective privilégié dans le rythme institutionnel.…”

“…Les difficultés rencontrées en santé publique pour travailler sur les ISS seraient moins liées à un problème de connaissances sur les ISS qu'à des conceptions problématiques, construites au fil du temps et intériorisées par les professionnels, qu'ils désignent sous la notion d'obstacles épistémologiques (15,16). Pour dépasser ces obstacles à l'action, Masuda (2013) soutient la nécessité d'évoluer vers un modèle de transfert des connaissances centré sur l'équité intégrant deux conditions fondamentales : un examen critique des conditions institutionnelles dans lesquelles les connaissances sont produites ou diffusées et des pratiques professionnelles réflexives.…”

Anthropologies In and Of Evidence Making In Global Health Research and Policy

“…The ‘inclusiveness’ and ‘pragmatism’ that I and the others involved in Optimize often celebrated seemed both a genuine reflection of the people and the process in concrete terms, as well as a language that had the subtle effect of policing and containing the potentially more critical claims of the qualitative evidence we were reviewing. We know that this kind of framing and disciplining has happened in related domains, such as the careful maintenance of the discourse of the ‘social determinants of health’ in global health circles (Brassolotto 2014); Ottersen, et al 2014). …”