Social Determinants of Health

Transcription

1 Social Determinants of Health Issues, challenges & opportunities in Haliburton Mark Skinner, Department of Geography, Trent University Ann MacLeod, Trent-Fleming School of Nursing 3 March 2010 Introduction Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity... (World Health Organization, 1946) What are social determinants of health? Why should we care about rural health? What do we know about SDH in Haliburton? What are the key issues, challenges & opportunities?

2 What determines health? Why is Jason in the hospital? Because he has a bad infection in his leg. But why does he have an infection? Because he has a cut on his leg and it got infected. But why does he have a cut on his leg? Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on. But why was he playing in a junk yard? Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them. But why does he live in that neighbourhood? Because his parents can't afford a nicer place to live. But why can't his parents afford a nicer place to live? Because his Dad is unemployed and his Mom is sick. But why is his Dad unemployed? Because he doesn't have much education and he can't find a job. But why...? Toward a healthy future ( determinants of health Health is determined by complex interactions between social and economic factors, the physical environment and individual behaviour Public Health Agency of Canada Income and social status Social support networks Education and literacy Employment conditions Social environments Physical environments Personal health practices Health child development Biology/genetic endowment Health services Gender Culture

3 social determinants of health The conditions in which people are born, grow, live, work, play and age, including the health system Responsible for health inequalities the unfair and avoidable differences within and between countries 2008 WHO Commission on SDH ( where is rural in SDH research? Prevailing SDH theories are urban-based Major exception is determinants research in Canada: - NETHRN-BC collaboration on rural health - PHAC and CIHI quantitative findings (national) - Qualitative studies of age-friendly communities; rural women; employment, gender, health services and social environments; rural change, culture and pride; voluntarism; etc.

4 Importance of rural health Nowhere is the need to debunk assumptions about health care more acute than in regards to Canada s rural people and places Rural Canadians are older, poorer and sicker than their urban counterparts Longstanding gap in health services and professionals New challenges of rapidly aging rural population rural health as a field of study Rural medicine & health services Nursing & community health Human health resources Rural health Related health & social sciences Gerontology & ageing studies Rural health geography

5 rural health in reality key question: what is rural? No consensus on rural, remote, northern, etc. Technical versus social approaches A Canadian definition You know that you are rural if there is no Starbucks or Second Cup you know that you are remote if there is no Tim Hortons Roger Pitblado, CJNR, 2002

6 what about the bush-rural Rural health research in Haliburton

7 community-university partnership Community Care Haliburton County Haliburton Highlands Family Health Team Haliburton Kawartha Pine Ridge District Health Unit Haliburton Highlands Mental Health Services Ontario Early Years Point in Time Centre for Children, Youth and Parents SIRCH Community Services and Consulting Trent University Geography Department Trent/Fleming School of Nursing U-links Centre for Community-Based Research Funded by Haliburton County Development Corporation project objectives & design Problem: Concern for gap in providing context-specific health and social services in Haliburton Goal: to examine and adapt the SDH approach to support community capacity-building in Haliburton Objectives: 1. To understand the challenges and assets of rural health and social service providers relevant to their planning and service delivery to address social determinants of health 2. To understand the availability and applicability of data accessible to rural health and social service providers to guide program delivery directed to improve determinants of health

8 specific research questions 1. What data is available and where are the gaps in data availability to support decision making at a local level to support action to address rural social determinants of health? 2. What are the social determinants of health challenges that rural health and social service providers encounter with their clients? 3. What programs and services are provided locally in a rural areas to address key social determinant of health issues? 4. How do challenges experienced by health and social service providers guide adaptation of the social determinants of health to reflect a rural context? multi-phase methodology 1 Grey Literature Review 2 Key-informant interviews 3 Care recipients survey 4 Secondary analysis reports 5 Next steps

9 findings: review highlights Above average number of people over 65 years old Below average proportion of immigrants Above average proportion of lone-parent families Above average reliance on government sources of income Above average proportion of income spent on housing (rental) Above average unemployment rate and proportion of people without sort of post-secondary education Above average rates of heart disease, obesity, smoking, suicide and infant mortality findings: gaps in knowledge Gaps in knowledge of social determinants Further local data is particularly needed: - How lower income, rural single women manage housing and income insecurity - Impact of geographic isolation on social inclusion and exclusion - What food insecurity looks like in rural areas - Local secondary school and post secondary graduation and retention rates and contributing factors - Transportation challenges and solutions - Perceptions of safety in bush rural communities - Mediating factors to rural resilience

10 findings: key determinants findings: key challenges Employment and working conditions: the seasonal nature of employment often means job insecurity Income and social status: higher percentage of lower income families and low paying jobs Social environments: isolation issues because they live where cheap housing is ; many lack transportation into town"; "safety is an issue because police can t respond quickly Education and literacy: lack of education causes a low paying job - this is a cycle

11 findings: strategies for unmet SDH discussion: key issues Funding: program cutbacks; higher rural cost per capita; urban modes of service delivery Planning challenges: access to local data; shifting gov t priorities; regional planning framework Community assets: volunteerism; partnerships; local groups; U-Links Centre for CBR; etc Future research: women; transportation; homeless; safety; seasonal employment; isolation; physical environment; etc.

12 further analysis: student reports 8 secondary analysis projects completed by 15 students in GEOG 3820 Geography of Health & Health Care 1. Income and social status 2. Housing 3. Education and Literacy 4. Social support networks 5. Personal health practices and Coping skills 6. Healthy child development 7. Women and poverty 8. Food security further analysis: recommendations Income and social status: purchase data from Statistics Canada Housing: create profile of housing & homelessness in Haliburton Education and Literacy: support for teacher recruitment/retention Social support networks: focus on informal support networks Personal health practices: seasonal elements of mental health Healthy child development: focus on child health and safety Women and poverty: gender as key social determinant Food security: feasibility of food programs

13 next steps for SDH project Use lessons from Haliburton to developing a Social Determinants of Rural Health framework Potential for further research (eg, Trent honours thesis project on rural homelessness) Opportunities for continuing the partnership: - Community university partnership grants (academic) - Provincial health ministry grants (for providers) - Community-based education through U-Links Outcomes from SDH workshop? (earlier today) Concluding comments Successful example of a community-university project to address rural health gaps The big question remains: how can rural communities whose formal partnerships and informal networks often thrive, contribute to local responses in an era of demographic aging and provincial government withdrawal? Nowhere is the need to debunk assumptions about health care more acute than in regards to Canada s rural people and places

14 further information Acknowledgements: Beth Archibald, Mary-Lou Mills, Heather Reid, Jenny Perrott, Morgan Yates, Haliburton community Available report: Social Determinants of Health in Haliburton County ( Mark Skinner Ann MacLeod thank you