In the realm of health care, a resounding truth has emerged: the path to a resilient and sustainable health system lies not solely within the confines of clinics and hospitals, but in the grand tapestry of social determinants of health (SDoH) that shape our lives. These are the social, economic, and structural factors that influence our health such as income, employment, and education.
Fifty per cent of our overall health and well-being is attributed to the SDoH, which are embedded in our day-to-day lives. This truth, etched in the annals of research and experience, illuminates a critical shift that must transpire in our approach to health.
The journey from individual behavior to systemic transformation, from a narrow biomedical focus to a panoramic embrace of societal factors, is the cornerstone of ushering in an era of health equity and reducing disparities.
For decades, federal and provincial governments have employed different strategies, invested large sums of money, and leveraged evolving medical technology to address biomedical factors while mostly neglecting holistic health. The nut that these levels of governments have been trying to crack doesn’t solve the underlying goal: cultivating and maintaining a healthy population.
What is the source of this misguided approach? Perhaps research on the impact of the SDoH has only recently entered the government lexicon. Or it could be a willful ignorance to address health through a more complicated cross-sectoral approach. Whatever the rationale for the patchwork of health policy that has been developed to date, it is evident that a fragmented approach can no longer suffice. What we need is a comprehensive, whole-of-society, and whole-of-government strategy to address these SDoH and cultivate a resilient and thriving population.
What are these two approaches that call for a broader response? As Zhang and Ran have written that the whole-of-government approach is “an umbrella term describing a group of responses to the problem of increased fragmentation of the public sector and an imperative to increase integration, coordination and capacity.”
The whole-of-society approach is derived from the whole-of-government approach because wicked problems, such as obesity and pandemic preparedness, usually require more than the whole-of-government approach. It must also involve many social stakeholders, particularly citizens.
The common rationale for these approaches is twofold. First, there is the recognition that health is highly dependent on sectors beyond health care and is greatly influenced by the SDoH. Second, to address the multidimensional challenges inherent to the SDoH, there is the technical need to overcome siloed work—to work across disciplines in order to increase policy coherence and effectiveness.
It may appear to be difficult to employ such an approach, considering our federalist system, which divides responsibilities between federal and provincial/territorial lines. However, the whole-of-society and whole-of-government approaches have been referred to when discussing Indigenous Truth and Reconciliation, Canada’s commitment to the Sustainable Development Goals, and the country’s emergency management approach. Currently, these types of approaches will be imperative to addressing multiple national crises, including our health care system, as well as housing.
None of this is to disparage the efforts by federal and provincial governments to scale innovating primary care models, advance team-based care, incorporate digital/virtual health solutions, and expand the scope of practice of various allied health professionals. On the contrary, these are important components to complement the gamut of strategies that all stakeholders should have to address the SDoH.
The call to action is clear: it is time to recalibrate our health care paradigm, transcending the singular focus on individual choices to the broader canvas of structural redesign.
A comprehensive strategy that dismantles systemic barriers and orchestrates the symphony of social factors is essential.
The contours of this strategy sweep across the landscape of population health, recognizing that health outcomes are not mere products of personal choices, but intricate factors woven from socioeconomic conditions, access to resources, and the nuanced fabric of social and environmental determinants.
