Getting to the Root of the Problem: Health Promotion Strategies to Address the Social Determinants of Health

Abstract

COMMENTARY It is increasingly acknowledged in Canada and around the world that to combat chronic diseases it is necessary to address the social determinants of health (SDH). 1,2 However, definitions and conceptualizations of the SDH are continually evolving and may lead to confusing and at times conflicting messages to public health practitioners. Even more challenging is finding a clear way to meaningfully impact the SDH. We evaluated healthy living initiatives in British Columbia and Ontario to examine program approaches to the SDH and health inequities. 3 Analysis pointed to different ways of approaching the SDH, two of which we classified as environment-based and structure-based initiatives. This paper aims to elaborate on these classifications and make the case for structure-based initiatives, based on a discussion of their implications for health outcomes and health equity. We will first define environment-based and structure-based initiatives, followed by an argument statement, a discussion of each initiative type, and finally conclusions and recommendations.

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“…That we found intermediary determinants to be most frequently considered reflects a previous review of health promotion strategies that incorporated the social determinants of health framework [105]. While these determinants do not independently address equity, they remain important [18].…”

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“…In these countries, government prevention efforts are often focused on individual behaviors related to chronic diseases and not on the socioeconomic and cultural factors that lead to such behaviors and, ultimately, to the development of diseases (Baum & Fisher, 2011; Gore & Kothari, 2013). …”

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“…From an SDH standpoint, the social environment has a profound impact on human health. For example, chronic diseases cannot be fully understood without considering the social environment contributing to their existence [ 21 ]. As an important epigenetic influence, the social environment alters gene expression and disease occurrence.…”

“…Public health functions exert influence through interventions or policies that have both upstream (structural) and downstream (environmental) factors [ 21 ]. Within these factors, public health functions exert their influence on NCD rates.…”