Small steps towards a big problem: Addressing the social determinants of health at the community level

David Phipps (ResearchImpact, York) wrote the following guest blog post for “Health Policiesabout a new initiative with UWYR that is focused on community solutions for community health challenges arising from the social determinants of health.

Health isn’t a problem.  Not being healthy is a wicked problem.  Wicked problems are persistent social problems characterized (among other things) by:

  • Lack of clarity on all stakeholders associated with the problem
  • Lack of clarity on the causes of the problems
  • Lack of clarity on end points and outcomes
  • Interventions change the nature of the wicked problem challenging evaluation

Social determinants of health (SDOH) are wicked problems.
There is an increasing amount of attention paid to SDOH at the international, national and local levels:

  • International: The World Health Organization recently released the technical paper for the World Conference on Social Determinants of Health to be held in Rio de Janeiro in October 2011.
  • National: National Collaborating Centre for Determinants of Health (NCCDH) is one of six NCCs funded by the Public Health Agency of Canada (PHAC). In 2010 it released an environmental scan of the role of public health agencies in supporting policy responses to social determinants of health in Canada.
  • Local: On June 22 York Region’s Human Services Planning Board release their report, Making Ends Meet which identifies poverty and income insecurity as the single human service priority for York Region.  Health indicators and outcomes are included in the planning.

But how do you tackle such large, wicked problems.  According to WHO Commission on Social Determinants of Health, all you need to do is:

  1. Improve living conditions
  2. Tackle inequitable distribution of power, money and resources
  3. Measure and understand the problem and assess the impact of action.

I’ll get right on that. I’ll also get right on solving the upstream political issues underlying SDOH that were pointed out in a previous Healthy Policies blog.
NOT (and therein lies the problem – where do you start with a wicked problem like SDOH?)
In York Region we are taking small steps to address this wicked problem.  At our Knowledge Mobilization Expo on June 15 we announced a small grant of $93,000 from the Canadian Institutes of Health Research to take our expertise in knowledge mobilization and focus it on community solutions to community health challenges. Using Making Ends Meet as a call to action, we shall hire a knowledge broker to work in the community.  Based at UWYR the knowledge broker will work with citizens, citizen groups and agencies to identify community health challenges (all of which will be SDOH). S/he will then broker relationships with community health providers and researchers/grad students from York University to co-create social innovations aimed at improving the health of York Region citizens.  One neighbourhood at a time. In this partnership the university is in a supporting role, supporting community solutions to community health challenges.  This helps us address some of the needs identified at a recent community/university forum on SDOH.
One such innovation we supported previously was the heat registry of the Parkdale Activity and Recreation Centre. The PARC Heat Registry received continuing funding and was able to renew Canada’s first heat registry thanks, in part, to evidence collected by a York University Knowledge Moilization Intern. The heat registry tracks and provides services to poor and vulnerable populations at risk of heat exposure on hot summer days. The heat registry has now been emulated by Toronto Public Health and has been expanded across Toronto’s most at risk communities.
Innovations such as this will not address the underlying causes of poverty and social exclusion but the innovations will allow communities to develop health policies and health services that address those local health inequities that arise from them. They are band aids.  We will not be raising people out of poverty but we will be addressing the health needs arising from poverty.
Poverty and the health inequities that arise from poverty are wicked problems.  In York Region we are harnessing the knowledge and experience of the community, linking it to knowledge and experience in the university (=knowledge mobilization) and developing community solutions (=social innovations) to community health challenges.
They are small steps but if you’re the one in the community taking them, they are important to you.