An environmental scan is a forward-looking instrument of discovery that is used to synthesize knowledge, inform decision making, and support organizational and system change.
The environmental scanning process has its roots in the business sector. However, environmental scans have been used in the health and public health sectors for many years.
The NCCDH has regularly engaged in environmental scanning since 2010. Past scans are an important contribution to the collective knowledge base on public health and health equity action. They directly inform NCCDH projects and larger strategic planning for NCCDH and other valued partners.
Past NCCDH environmental scans and related materials are available in our Resource Library:
Building a culture of equity in Canadian public health: An environmental scan (2018)
Boosting momentum: Applying knowledge to advance health equity (2014)
The NCCDH is currently engaged in an environmental scan to identify opportunities to support, lead and influence transformative public health action to address the structural and social determinants of health.
The current environmental scan explores the following questions:
What is the current context and experience of the Canadian public health community (at all levels) related to addressing the structural and social determinants of health?
What knowledge gaps exist about public health roles and action to address the structural and social determinants of health?
What are the roles for the NCCDH to support public health action to address the structural and social determinants of health?
To engage with the Canadian public health community, the NCCDH will use a tailored, multi-component approach, including a scoping review of the literature (completed), an online survey (completed) and a variety of strategic conversations (in progress). An analysis of the information gathered will be shared with the public health community, including partners and collaborators.
|
We want to hear from Canadian public health practitioners, researchers, decision makers, policymakers and partners/collaborators at all levels. How are you taking action, and how can we better support your work? Share your ideas and perspectives in our national environmental scan. |
|
If you would like to hear about further opportunities for engagement in this project and other NCCDH initiatives, sign up for our mailing list. |
The COVID-19 pandemic has highlighted existing system gaps and exacerbated health inequities experienced by various equity-deserving groups. Throughout the pandemic, certain groups have experienced disproportionately high rates of infection and poorer health outcomes related to COVID-19.
The “Equity in Action” project aims to minimize the gap by collecting and sharing stories of interventions that have successfully promoted health equity in pandemic planning, response, and recovery. Public health practitioners across Canada, recognizing the importance of the social and structural determinants of health, have implemented interventions to promote equitable pandemic responses. This repository of positive narratives can facilitate learning and connection among Public Health Practitioners in Canada and guide equity-based planning through pandemic recovery and beyond. It is critical to lift the voices of community leaders as a source of evidence to help guide and promote equity-driven interventions in health promotion, disease prevention and future emergency preparedness planning.
Thank you to all who told their story, their organizations, and partners who took time to reflect on and share their stories of how they took action to advance health equity. Project coordination and story writing by Caralyn Vossen, Knowledge Translation Coordinator.
If you’d like to share your story of equity in action, please email [email protected].
Please cite an Equity in Action story as follows: National Collaborating Centre for Determinants of Health. (Publishing date: Year, Month, Day of Individual Story). Equity in Action Story Title. Equity in Action. www.nccdh.ca/learn/equity-in-action
To learn more about regional responses in your province or territory, please visit the respective website for your area’s health authority.
As the COVID-19 pandemic continues to evolve at a rapid pace across the world, equity and solidarity need to be beacons in a values-driven global response. Our societal responses must be infused with the knowledge that COVID-19 will swiftly follow and amplify lines of existing inequities. For this reason, our decisions and actions must consistently place equity at the core.
The NCCDH is responding to COVID-19 by identifying the differential impacts of COVID-19 and amplifying equity-informed responses. We are doing so through the following activities:
1. Hosting Community Conversations (Virtually)
2. Translating knowledge and evidence to support decision-making
3. Maintaining a Resource Hub on COVID-19
4. Participating in knowledge and research partnerships
We will be updating this page with resources related to health equity and the social determinants of health that are of relevance to Canadian public health. These resources are related to various structural, social, political, cultural and Indigenous determinants of health.
You can search the NCCDH Hub for resources by topic or type using the search bar on the right hand side.
Click here to be notified when new resources are added to this collection.
National Collaborating Centre for Environmental Health: Environmental health resources for the COVID-19 pandemic
National Collaborating Centre for Healthy Public Policy: Public health ethics and COVID-19: Selected resources
National Collaborating Centre for Indigenous Health: Information specific to First Nations, Inuit and Métis peoples and communities
National Collaborating Centre for Infectious Diseases: Podcast: Infectious questions: What health professionals need to know about 2019-nCoV and COVID-19
National Collaborating Centre for Methods and Tools: Rapid evidence reviews on COVID-19
The second release in our Let’s Talk series, Let's Talk: Public health roles for improving health equity, offers public health organizations a framework for reflection and action.
The public health roles speak to four categories of action that can guide an organization’s efforts to reduce disparities in health. They are a health equity framework that can help you set priorities and make decisions:
Role 1: Assess and report
Role 2: Modify and orient interventions
Role 3: Partner with other sectors
Role 4: Participate in policy development and advocacy
Assess and report on a) the existence and impact of health inequities, and b) effective strategies to reduce these inequities.
Assess and report includes public health surveillance activities, specifically “the ongoing systematic collection, analysis, interpretation and dissemination of health data for the planning, implementation and evaluation of public health action” (Choi, 2012). It also includes assessing and reporting effective strategies to reduce inequities.
Four of the promising practices, identified to guide local public health practice to reduce social inequities in health, are related to assessment and reporting: purposeful reporting, health equity target setting, equity-focused health impact assessment and contributing to the evidence base.
Highlights from projects
Population health status reporting: The learning together series
Population health status reporting is a vital tool for addressing the social determinants of health and advancing health equity. The way that health data is collected, analyzed and shared shapes our perceptions of population health and influences our ability to act. Public health practitioners and organizations from across Canada have identified the need for resources, tools and collaborative learning on population health status reporting. In 2012, we hosted a national learning circle of practitioners and academics engaged in knowledge exchange and synthesis. Capital Health (Halifax) served as an applied practice site, as they integrated a health equity lens into their first population health status report. Evidence and knowledge gathered over the learning circle process were disseminated to our audience through nine synthesis documents, four videos and numerous events.
Equity-integrated population health status reporting: Action framework
The NCCDH, with contributions from each of the National Collaborating Centres for Public Health, has completed a Population Health Status Reporting – Toolkit Project. This resource presents an accessible action framework for people who are creating community health status reports, as well as people interested in learning how to use PHSR to drive action on improving health equity.
Modify and orient interventions and services to help reduce inequities, with an understanding of the unique needs of populations that experience marginalization.
It is essential for public health programs to reach populations that experience marginalization. Programs and services must be planned, implemented and evaluated with a consideration of equity.
Three of the promising practices, identified to guide local public health practice to reduce social inequities in health, are related to modify and orient: targeting with universalism, equity-focused health impact assessment, and early childhood development.
Highlights from projects
Let’s Talk: Universal and targeted approaches to health equity
This document within our Let’s Talk series explores targeted, universal and blended approaches to public health interventions. In this document, a number of conceptual examples are given to help clarify the theory.
Learning from practice: Targeting within universalism at Capital Health
Real-world examples have been documented in the Learning from Practice series to help public health staff better understand how targeted and universal approaches can be blended to achieve better population health outcomes.
Partner with other government and community organizations to identify ways to improve health outcomes for populations that experience marginalization.
Because most of the social determinants of health lie outside of the health sector, working with multiple partners - including government, community organizations, communities, and specific populations - is an essential part of public health practice, especially considering that differences in our health are influenced by economic and societal factors.
Two promising practices, identified to guide local public health practice to reduce social inequities in health, are related to partner with other sectors: intersectoral action and community engagement.
Highlights from projects
Assessing the impact and effectiveness of intersectoral action on the social determinants of health
In 2012, we released an expedited systematic review as part of our effort to explore “what works” to improve health equity through action on the social determinants of health. This review examines the question, “What is the impact and effectiveness of intersectoral action as a public health practice for health equity through action on the social determinants of health?”
In 2013, this reference guide that describes 16 community engagement frameworks was created as public health practitioners are increasingly using community engagement strategies.
Additional case examples that highlight the role of partnering with other sectors and the community.
Lead, support and participate with other organizations in policy analysis and development, and in advocacy for improvements in health determinants and inequities.
Participating in policy development and advocacy is a key role for public health to improve health equity because policies that promote health improve conditions where people live, work and play.
Three of the promising practices, identified to guide local public health practice to reduce social inequities in health, are related to policy development and advocacy: health equity target setting, intersectoral action and community engagement.
The NCCPH program has an NCC that is fully focused on healthy public policy. Because of this, the NCCDH doesn’t emphasize this role. At the NCCDH we partner with the National Collaborating Centre for Healthy Public Policy (NCCHPP) and other NCCs on resources that look at policy development and advocacy with a view that critically considers the social determinants of health and health equity. Visit the NCCHPP for more resources related to policy development and advocacy.
Highlights from projects
This resource is a joint NCCDH and NCCHPP document that offers analysis of various tools including the capacity og each to create policy recommendations.
Health Equity Tools for Policy Change
This powerpoint presentation was given by NCCDH staff to a gathering of 400 people at THRIVE! These tools as described from Alberta, Australia and the European Union, have been used widely to improve the equity outcome of policies and programs.
In addition to partnering with our funder, the Public Health Agency of Canada; our host, St. Francis Xavier University; and our five sister centres, the National Collaborating Centres for Public Health, the NCCDH has collaborated with a number of organizations in Canada over the past year.
The NCCDH has partnered/collaborated with the following organizations to lead an initiative, product or event.
Canadian Institute for Health Information (CIHI)
Alberta Health Services and Alberta Education, Government of Alberta
Alliance for Healthier Communities (formerly the Association of Ontario Health Centres)
Association of Ontario Midwives
Government of the Northwest Territory, Aboriginal Health & Community Wellness Division
Ontario Public Health Association
Provincial Health Services Authority (British Columbia)
Public Health Ontario
Aboriginal Service, Centre for Addiction & Mental Health (Ontario)
City of Vancouver (British Columbia)
Dalla Lana School of Public Health, University of Toronto (Ontario)
Direction de santé publique de la capitale Nationale (Quebec)
Middlesex London Health Unit (Ontario)
Native Canadian Centre of Toronto (Ontario)
Ottawa Public Health (Ontario)
Peterborough Public Health (Ontario)
Interior Health (British Columbia)
Soul of the Mother (Ontario)
Public Health Sudbury and Districts (Ontario)
Toronto Central Local Health Integration Network (LHIN) (Ontario)
Toronto Indigenous Health Advisory Circle (TIHAC) (Ontario)
Toronto Public Health (Ontario)
Wellesley Institute (Ontario)
Western University (Ontario)
The NCCDH has been invited to contribute to initiatives, products or events led by the following other organizations.
Institute of Population and Public Health, Canadian Institutes for Health Research
Ministry of Mental Health and Addictions, Government of British Columbia
BC Centre for Disease Control
Centre for Urban Health Solutions, St. Michael’s Hospital (Ontario)
La Chaire de recherche du Canada Approches communautaires et inégalités de santé, Department of Social and Preventive Medicine, University of Montreal (Quebec)
Collaborative community laboratory on substance use and harm reduction or “Co/Lab” (University of Victoria’s Canadian Institute for Substance Use Research) (British Columbia)
Multisectoral Urban Systems for Health & Equity in Canadian Cities (MUSE) (Canada)
RentSafe (Ontario)
SPARK: Screening for Poverty And Related social determinants and intervening to improve Knowledge of and links to resources (SPARK) Study (Ontario)
Queen’s University (Ontario)
University of Victoria (British Columbia)
Université de Montréal (Quebec)
Information and Informed Consent Form - SDH PHN Survey
At the National Collaborating Centre for Determinants of Health (NCCDH), we provide the Canadian public health community with knowledge and resources to take action on the social determinants of health, to close the difference in health across the social gradient.
We work with the public health field to move knowledge into action—in practice, in policy and in decision making—to achieve societal improvements that result in health for all.
Progress has been made, however racism continues to profoundly impact health and wellbeing both directly and through other social determinants of health. We recognize that racial equity makes us all stronger and healthier.
As a knowledge translation organization, we acknowledge the role racism plays in shaping who we are, what we know and how we come to know it. The National Collaborating Centre for Determinants of Health is committed to weaving racial equity into all aspects of our work. This includes more consistent application of different ways of knowing and drawing from a more diverse pool of knowledge generators as we develop resources and organize learning activities and broadening and developing a more diverse network. We are shifting our internal practices and organizational culture and embedding racial equity into every day decisions and practices. We are committed to building a multi-racial team equipped to steward racial equity.
We are committed to sharing our experiences with others, learning from the work of others and maintaining transparency as we learn and grow.
Our work is supported by an internal workgroup and an external advisory group.
For an overview of this process, please read the following blog posts by NCCDH management:
To peruse items in our Resource Library relating to anti-racist, click here and/or decolonizing action in public health, click here.
To view NCCDH events and webinars relating to anti-racist and/or decolonizing action in public health, click here for a webinar titled: Whiteness and health equity, or click here for a webinar titled: Can understanding Whiteness improve anti-racism activities in health?.
Photo credit: Markus Spiske
To access the PHESC on-demand webinar series, click here.
The Public Health Training for Equitable Systems Change (PHESC) project is an exciting collaboration between the NCCDH, the University of Toronto, the NCCs for Methods and Tools and Healthy Public Policy, the Alliance for Healthier Communities, the Ontario Public Health Association, Public Health Ontario and the Wellesley Institute.
Funded by a grant from the Ministry of Health and Long-Term Care, the purpose of the project is to design and create a comprehensive training plan to improve knowledge, skills and performance of Ontario’s public health workforce while integrating a health equity approach.
Guided by the Ontario Health Equity Guideline, 2018, the NCCDH has developed an interactive and participatory training program for all public health staff, professionals and leaders in Ontario. The NCCDH will be offering a series of webinars (click here to register), in-person workshops, practice tools and resources in order to support Ontario Public Health Units operationalizing the health equity requirements of the Ontario Public Health Standards.
To learn about the on-demand webinars in this series, click here.
For more information contact the NCCDH ([email protected]).
Photo credit: PHESC
The NCCDH has launched a 20-month participatory initiative to test ways to develop organizational capacity to advance health equity (project overview). The project, called the Organizational Capacity for Health Equity Action Initiative (OCI), is using an international learning circle, working in tandem with two practice sites to learn what frameworks, strategies and organizational conditions are most useful and effective to develop and sustain Canadian public health organizational capacity for health equity action.
We are currently working with two organizations, each with a focus on a specific public health challenge of interest to multiple programs. The sites represent different organizational models (e.g., health unit, department within health authority) and differing contexts (e.g., rural and urban, and geography/population size served by department). The practice sites will engage in exchange and co-learning among the other sites involved.
For more information, please review the sections below or contact us.
|
|
Practice sites serve as the heart of this project, and each is supported by an NCCDH knowledge translation specialist. The sites are designing and implementing organizational enhancement projects that are working towards organizational-level change. Learn more about the participating site projects below.
| Site name | Project description |
|---|---|
|
Interior Health (BC)
|
Implementing a health equity lens in opioid overdose surveillance and reporting
The project aims to support the implementation of a health equity lens in the reporting, monitoring and surveillance practices related to the overdose crisis, guided by the Equity-integrated PHSR (EI-PHSR) action framework. |
|
Ottawa Public Health (ON)
|
Client and community engagement
OPH will develop a departmental client and community engagement framework and an engagement policy that incorporate a health equity/SDOH perspective. |
Based on participatory learning and using resulting resources, at the end of the initiative, public health practitioners and organizations will be able to:
The initiative is led and facilitated by the NCCDH in collaboration with participants. The NCCDH serves as the convenor and provides direct support to the practice sites
The initiative will bring together both reviewed literature and emerging knowledge arising through research currently under way
Targeted evidence drawn from the published and a grey literature base will include organizational change/capacity methodology, as well as health equity theory, methods and tools — especially those aimed at organizational-level change. Experiential evidence, primarily from the practice sites, will be incorporated into the project’s evidence identification and assessment.
This project uses a learning circle to integrate evidence, expert opinion and practice-based innovation and learning. The learning circle is composed of practitioners and researchers, including representatives from practice sites.
Learning circle members will identify key health equity organizational capacity issues and challenges and will study these issues throughout the course of the initiative. The circle meets every two months.
Each meeting is a facilitated discussion on a specific theme. The discussion is supported by an evidence backgrounder. At the end of each meeting, the learning circle conversation will be synthesized, shared with circle members and translated in summary form.
Learn more about learning circles.
Evaluation is expected to incorporate:
Do you work in public health? Are you responsible for supporting your organization’s work on the social determinants of health and health equity? If you answered yes to both questions:
Join a network of other professionals who are committed to amplifying their public health equity practice.
The Health Equity Collaborative Network is a network of practitioners and researchers who share practices and experience, build relationships for information exchange and support, build capacity, advance knowledge of effectiveness, and share other information related to the social determinants of health and health equity.
The objectives of the Health Equity Collaborative Network are to support public health practice on the social determinants of health and health equity. Specifically, to:
Members of the network meet on a quarterly basis via teleconference/webinar.
Is the Network for me?
Network members:
To join the network please contact Rebecca Cheff, Knowledge Translation Specialist.
All information on this website is copyrighted by us or other contributors. Users of this website are granted a limited licence to use (display or print) the information for personal, non-commercial use only, provided the information is not modified and all copyright and other proprietary notices are retained. Any other use is strictly prohibited without our permission and the permission of the applicable rights' holders. None of the information may be otherwise reproduced, reverse engineered, republished, or re-disseminated in any manner or form without our prior written consent. Nothing contained herein shall be construed as conferring any right in any copyright in any of the information provided on the website or imply that a licence has been granted in respect of any trademarks, service marks, or trade names displayed.
The NCCDH eNewsletter is sent monthly to our mailing list of individuals across the country who work in or are interested in public health and keeping up with the latest in the field. It outlines recent NCCDH resources, upcoming news and events, as well as highlights important health equity work by other organizations.
The Let’s Talk Series is a collection of resources designed to promote discussion and understanding of how key concepts in health equity apply in public health practice. Each resource contains discussion questions to spark dialogue, reflection, and action to address the social determinants of health.
The Glossary of Essential Health Equity Terms is intended to enhance effective communication and action on the social and structural determinants of health and health equity. Having consistent terminology and understanding of concepts allows for greater clarity on points of influence and impact for action on health equity. In 2022, NCCDH undertook a project to evolve and expand the 2014 version of the Glossary of Essential Health Equity Terms. Within this project, 33 terms were identified through consultation with public health practitioners and other key informants across Canada. Descriptions for each term were developed through an extensive review of existing glossaries from other sources, academic and grey literature. These were validated via survey feedback from public health colleagues across Canada.
Recognizing that language is influenced by context and culture, we undertook separate development processes for the English and French glossaries, which are complementary but are not direct translations of each other. This process was extremely powerful and enlightening for both the developers of this glossary and for those who provided feedback, revealing new understandings of concepts and resulting in a higher quality of both the English and French versions. You can access the French glossary here.
Terms are organized into four groupings – Core Concepts, Roots of Health, Relative Influences, and Interventions & Strategies. Each grouping includes a number of related terms. Each term has a drop down option to reveal the description and related resources to support further understanding and application of the concept.
Following the initial 2022 project, NCCDH continues to update and add descriptions to this glossary based on our ongoing work. This page is updated regularly to reflect the NCCDH’s current understanding of these terms.
Last updated December 2024
We’d love to hear from you! Did you find the term you were looking for? If you have any comments or feedback on the glossary, e-mail us at [email protected].
Initial development (2022): Thank you to the public health professionals who provided feedback through the initial user survey, validation, and focus testing phases. It is this guidance from the field that resulted in the 33 initial terms selected and descriptions written.
Research, writing, and conceptualization of the 2022 version by Dianne Oickle, Knowledge Translation Specialist. Developmental work, internal scoping and external partner consultations by Claire O’Gorman, formerly with NCCDH. The Glossary is continually reviewed and updated.
Updates to the glossary are supported by NCCDH staff in collaboration with public health professionals and key partners. Internal guidance and review by Claire Betker, Scientific Director.
Webpage and project coordination by Caralyn Vossen, Knowledge Translation Coordinator. Thank you to our partner RÉFIPS (Réseau francophone international pour la promotion de la santé) in the development of the French version of the glossary Glossaire des principaux concepts liés à l’équité en santé.
Please cite information contained in the document as follows: National Collaborating Centre for Determinants of Health. (n.d.). Glossary of essential health equity terms. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
ISBN: 978-1-989241-84-4
Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada through funding for the NCCDH. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
St. Francis Xavier University
2400 Mount Saint Bernard
Camden Hall, 2nd Floor
PO Box 5000
Antigonish, Nova Scotia, Canada, B2G 2W5
Email: [email protected]
We would like to begin by acknowledging that we are in Mi’kma’ki, the ancestral and unceded territory of the Mi’kmaq People. This territory is covered by the “Treaties of Peace and Friendship” which Mi’kmaq and Wolastoqiyik (Maliseet) peoples first signed with the British Crown in 1725. The treaties do not deal with surrender of lands and resources but in fact recognize Mi’kmaq and Wolastoqiyik (Maliseet) title and established the rules for what was to be an ongoing relationship between nations.
We acknowledge this land not only in thanks to the Indigenous communities who have held relationship with this land for generations but also in recognition of the historical and on-going legacy of colonialism.
Out of respect for the important work of reconciliation, we encourage you to contact us if you can suggest a way improve upon our statement above.
Established in 2005 and funded through the Public Health Agency of Canada, the National Collaborating Centres (NCCs) for Public Health produce information to help public health professionals improve their response to public health threats, chronic disease and injury, infectious diseases and health inequities. The NCCs are located across Canada, and each focuses on a different public health priority.
The six centres are:
The National Collaborating Centre for Determinants of Health is proud to work closely with the other National Collaborating Centres for Public Health on several joint projects and initiatives.
With other NCCs, we have:
To learn more about the NCCPH program click here.
Effective communication is an important overarching factor to drive action about population level health differences that are avoidable, and therefore considered unfair.
Public health practitioners have an important role in communicating that where people live, work, play and learn has an effect on their opportunities to be healthy. Public health practitioners need to be enabled to understand and talk about how differences in health that are influenced by social and economic factors.
One of the promising practices, identified to guide local public health practice to reduce social inequities in health, is related to communication: social marketing.
Highlights from projects
Our Let’s Talk documents promote understanding of key concepts and contains questions to spark discussions. Two in this series especially focuses on terminology and how we use language: Let’s talk: Health equity and Let’s talk: Population and the Power of Language.
Glossary of Essential Health Equity Terms
The Glossary of Essential Health Equity Terms is intended to enhance effective communication and action on the social and structural determinants of health and health equity. Having consistent terminology and understanding of concepts allows for greater clarity on points of influence and impact for action on health equity.
Other resources on public health communication strategies.
Leadership is needed to build the capacity of public health practitioners, organizations and the field in general to improve the conditions where we live, work and play, and, ultimately, the health of our society.
In the 2008, the Chief Public Health Officer's report of Canada's strong, visionary leadership and shared as a common characteristic of jurisdictions That-have stepped ahead in health equity work. Leadership emerged as central to health equity work in our 2010 Environmental Scan: Integrating social determinants of health and health equity into Canadian public health practice and is a domain in the 2012 Core Competencies for Public Health in Canada.
One of the promising practices identified to help public health practice at the local level reduce social inequities in health, is related to leadership and capacity: Competencies and organizational standards.
Highlights from projects
What Contributes to successful public health leadership for health equity? An appreciative inquiry
To identify the factors and conditions that effectively influence public health leadership to address the social determinants of health and health equity, we conducted appreciative inquiry interviews with 14 public health leaders. The postponement summarizes the findings and provides examples from Canadian public health practice.
Public Health Speaks: Organizational standards as a promising practice for health equity
In 2013, we explored the use of "organizational standards" to make social inequities in public health priority. This resource is a summary of four interviews with Canadian public health experts reflecting on their experiences using "standards" to support organizational frameworks and renewal processes.
To help managers and practitioners in the field find the right race for their professional development, we conducted a scan for online courses, in English and French, that were designed to increase participants' knowledge and skills in working towards health equity through the social determinants. We also completed a brief assessment of each course for quality and relevance, resulting and recommended in 12 courses. To learn more about the methods for this work, click here.
Public health leadership for action on health equity: A literature review
A scoping literature review and a qualitative synthesis of literature about effective public health leadership, and enablers and barriers to leadership capacity regarding health equity.
Leadership for Equity Series of Case Studies
At the NCCDH, to advance social determinants of health and health equity through public health practice and policy, we
Our strategic priorities are significantly informed by our Advisory Board; the 2010 and 2013 pan-Canadian environmental scans, and 10 promising practices to guide local public health practice to reduce inequities in health.
In this part of our website, we profile our projects in relation to public health roles that we promote to improve health equity. All of these roles come from our 2010 environmental scan; four primary roles are explained further in our Let’s talk: Roles for improving health equity. Our projects are organized under the most aligned role, although we recognize that many projects cross-cut two or more roles.
In each section of this part of the website, we briefly describe the role, highlights from several related projects, summaries of projects in development, and direct you to published resources, events, blogs and Health Equity Clicks: Community conversations.
This list is an evolving scan of public health and health organizations that are taking action on the social determinants of health and advancing health equity.
Health Equity Clicks: Organizations will be of interest to public health practitioners and researchers across the country, and is designed to:
This list of organizations builds on the 2010 NCCDH Environmental Scan Integrating Social Determinants of Health and Health Equity into Canadian Public Health Practice. In 2012, the Canadian Institute for Health Information - Canadian Population Health Initiative (CIHI-CPHI) shared an internal catalogue describing organizations that generate population health-related knowledge with NCCDH. This catalogue, created in January 2011 and updated in January 2012, has been used to support this online resource by identifying new Canadian and international organizations.
Organizations were identified from:
The list of organizations is non-comprehensive as Canadian contributions to the social determinants of health and health equity are continuously evolving and progressing. We welcome your input, comments, corrections, updates, and additions. We encourage you to help us strengthen this resource by emailing us your suggestions. We will update this list on a bi-annual basis based on feedback received with the goal of making it as useful as possible to practitioners and researchers in the field.
We will be in touch soon to address you suggestions, concerns and questions. Thanks for your time.
Integrating health equity and the social determinants of health into Canadian public health practice.
At the National Collaborating Centre for Determinants of Health (NCCDH), we provide the Canadian public health community with knowledge and resources to take action on the social determinants of health, to close the gap between those who are most and least healthy.
We work with the public health field to move knowledge into action—in practice, in policy and in decision making—to achieve societal improvements that result in health for all.
We are one of six national collaborating centres funded through a Public Health Agency of Canada program.
We are hosted at St. Francis Xavier University (StFX) in Antigonish, Nova Scotia (Mi’kma’ki).
StFX has a rich history in social justice beginning in the 1920s with the Antigonish Movement. The Movement began, led by Father Jimmy Thompkins and Dr. Moses Coady, as a local community-based movement in response to poverty affecting disadvantaged groups in Eastern Canada. StFX quickly created an Extension Department to teach and use these community actions and adult education methods. After World War II, the Coady International Institute was founded to continue this work with an international audience. The Institute is well respected worldwide as a centre for leadership education about community-based development. Situating the NCCDH here furthers StFX’s deep commitment to applying knowledge to social change.
We would like to acknowledge this sacred land on which the NCCDH operates. We acknowledge that we are located in Mi’kma’ki, the ancestral and unceded territory of the Mi’kmaq People. This territory is covered by the “Treaties of Peace and Friendship” which Mi’kmaq and Wolastoqiyik (Maliseet) peoples first signed with the British Crown in 1725. The treaties did not deal with surrender of lands and resources but in fact recognized Mi’kmaq and Wolastoqiyik (Maliseet) title and established the rules for what was to be an ongoing relationship between nations. We acknowledge this land in thanks to the Mi’kmaq people who have held relationship with this land for generations and to recognize the historical and ongoing reality of colonialism.
Out of respect for the important work of reconciliation, we encourage you to contact us if you can suggest a way improve upon our statement above.
Public health organizations and practitioners address determinants of health through multiple means. Based on the findings of our 2010 environmental scan, the NCCDH decided on a focused knowledge translation analysis of current interventions that have a basis of success, starting with ten practices identified as ‘promising’ by the Sudbury and District Health Unit.
To find out more about these promising practices we conducted an expedited systematic review about intersectoral action as a public health strategy to address the social determinants of health.
We are currently
Our Advisory Board provides advice to our Scientific Director to inform and influence our work. The Board members bring a pan-Canadian perspective, and act as a liaison between our Centre and public health practitioners, students, researchers, policy makers and community groups. Members are practitioners and academics from most Canadian provinces and territories who come from a range of expertise, backgrounds and networks.
Population health status reporting is a vital tool for addressing the social determinants of health and advancing health equity. The way that health data is collected and shared shapes our perceptions of population health and influences our ability to support action. Public health practitioners and organizations from across Canada have identified the need for resources, tools, and collaborative learning on this topic.
The National Collaborating Centre for Determinants of Health is working to enhance reporting by supporting an initiative that engages in collaborating learning, synthesis and reflection. Through a series of discussions, demonstrations, and presentations the NCCDH is hosting a learning circle. Our learning circle includes managers, directors, researchers, epidemiologists, and medical officers of health from across Canada. The learning circle provides advice and new skills to support Capital Health in Halifax as they work to integrate a health equity lens into their first population health status report for 2013.
To learn more...
-Download syntheses of key topics from the The Learning Together Series, available in our Resource Library
-Visit our new YouTube channel, to watch four new videos on population health status reporting
-Read related blog posts
-Start a discussion about population health status reporting in Health Equity Clicks, our online community. You can also read through a past discussion called "What are the best indicators for assessing and supporting health equity in the delivery of public health programs and services?"
One of four videos available on our YouTube Channel: Integrating health equity into population health status reporting - The role of public health
The National Collaborating Centre for Determinants of Health is committed to maintaining confidentiality and personal privacy. The collection, use, disclosure, and retention of personal information must comply-with the privacy policy of our host organization, St. Francis Xavier University. This policy is attached below, and available at http://www.stfx.ca/privacy/personal-information/
1. Personal Information: Collection, Use and Disclosure
1.1 Purpose
On November 23, 2000, the Nova Scotia Freedom of Information & Protection of Privacy Act, (hereafter FOIPOP), was amended to include all records in the care and custody of Nova Scotian universities. As of this date university records are considered public records. The FIOPOP Act ensures that public bodies, including universities, are accountable to the public, that the public has a right to have access to records, the right to the adjustment of personal information about themselves, and the right to question the unauthorized collection, use, or disclosure of personal information. St. Francis Xavier University is committed to the appropriate collection, use, and disclosure of general and personal information in accordance with the FOIPOP Act.
1.2 Scope and Responsibility
Many St. FX employees are required to collect, use, and disclose general and personal information during their employment with the University. These are required to have an understanding of the FOIPOP Act and its Implications, especially in regard to the collection, use, and disclosure of personal information. These policies apply to all St. FX employees. Disciplinary action may result if these policies arent followed.
1.3 Definition
According to the FOIPOP Act personal information is defined as:
2. Policies
2.1 Collection
Personal information is not permitted to be collected unless the information directly relates to University activities or is necessary for the enactment of a University program or activity. Personal information is not permitted to be collected, used, or disclosed for the personal or benefit of University employees.
2.2 Use
Personal information must only be collected for the purpose for which that information was obtained or compiled, or for a use compatible with that purpose.
2.3 Security
All University records are to be housed and maintained in a secure location to prohibit unauthorized access, use, or disclosure. All records (regardless of media) are to be kept in secure enclosures (i.e. locked filing cabinets or password protected automated systems, etc.) To protect the confidentiality of the records, all reasonable measures should be undertaken. Only those University employees who require access to the information are to be granted admittance to it. Confidential records are to be identified as such and are not to be filed with general records. One person shoulds be designated for each office/department and will have the ultimate responsibility for the records.
2.4 Correction of Errors and / or omissions
An individual may make application to have errors or omissions corrected in relation to personal information about them. Upon making a request the University will correct and annotate information with an amendment, when satisfactory documentary evidence is provided to support the correction.
2.5 Disclosure
StFX employees may disclose personal information within the University (i.e. from office to office) if the information is necessary to perform necessary University activities. Individuals are to be notified upon collection of the information that personal information may be shared within the University for work related matters but not to outside third parties without written consent, or upon exemptions in the FOIPOP Act. University personnel may release personal information about any individual; if the individual has consented in writing to its disclosure, for a use compatible with the original purpose for which it was obtained or compiled, for the purposes of complying with a subpoena, warrant, or summons; for the collecting of a debt owed to the University, or for the making of a payment to the University, to the representative of the bargaining agent authorized in writing by the employee, to an officer/employee of the University when it is necessary for the performance of duties, for the protection of the health or safety of University personnel, for the necessary requirements of University operation or law enforcement, so that the next of kin/friend of an injured, ill or deceased individual may be contacted, and/or if the President of the University (or prescribed representation) determines that compelling circumstances exist that affect anyone's health or safety.
2.6 Disclosure for research purpose
St. Francis Xavier University may disclose personal information for a research purpose, including statistical research. This information is only permitted if the research cannot reasonably be undertaken unless that information is made available in individually identifiable form. This can only be undertaken if any record linkage is not harmful to the individuals that information is about and that the benefits derived will be clearly in the public interest, the President of the University (or prescribed representative) has approved conditions relating to the security and confidentiality and the removal or destruction of individual identifiers, the prohibition of any subsequent use/disclosure of that information in individually identifiable form without the express authorization of the University, and the person to whom that information is disclosed has signed an agreement complying with approved conditions regarding that act and with the University's policies.
Our health is determined to a large extent by the conditions of everyday life, and by the systems put in place to promote health, prevent disease, and support us when we get sick. The ‘social determinants of health’ (SDH) is a name given to the many social conditions that interact to influence our health and well-being, the circumstances in which people are born, grow up, live, work and age.
The World Health Organization (WHO) Commission on the Social Determinants of Health wrote in their final report that the “unequal distribution of health-damaging experiences is not in any sense a ‘natural phenomenon but is the result of a toxic combination of poor social policies and programs, unfair economic arrangements, and bad politics.”
The WHO Commission proposes three overarching recommendations for action to improve the SDH, including:
Explore key historical documents and resources to learn more about the social determinants of health.
We are dedicated to facilitating knowledge exchange between and among public health practitioners, researchers, and decision makers working to advance health equity. To help keep track of exchange opportunities related to public health, the social determinants of health, and health equity, we have created an Workshops & Events section. As in the Resource Library, we have categorized each event so that they are easy to browse by topic or by type.
Our resource library contains more than 350 resources. The library is evolving, as we continue to add resources that are relevant, geared to practice, and either recently published or foundational to current health equity thinking in public health. To suggest a new resource or to learn more about our resource selection process, please contact us.
The right-hand side bar offers two options to search this library:
We also have curated reading lists available.
In 2010, we conducted an environmental scan to learn more about the needs of public health professionals in their efforts to integrate knowledge on the social determinants of health into their work. Respondents from across Canada agreed that public health leaders and organizations play a vital role in advancing health equity.
In his first Report on the State of Public Health in Canada, David Butler-Jones, Canada’s Chief Public Health Officer, said
“high-level leadership in all sectors – health and otherwise – is crucial to reducing health inequalities.”
But what factors enable public health leadership? And how are these factors different across Canada? Our aim is to analyze and translate knowledge about public health leadership to help leaders improve and mitigate the effects of social determinants of health and advance health equity. Our intent is to identify effective practices, describe enablers and barriers that influence leadership, and identify tools and strategies to support leaders.
We will do this by means of:
Recordings of past webinars are linked from the event page listed below, and can also be found on our YouTube channel. Webinars are typically available in the language in which they were delivered.
Please note that events appear in Eastern Standard Time, and titles reflect the primary language of delivery.
Our work is related to the social determinants of health and/or health equity, and we focus specifically on public health organizations and practitioners.
Each of our current initiatives is informed by the results of a pan-Canadian environmental scan, Integrating Social Determinants of Health and Health Equity into Canadian Public Health Practice.
Visit the following pages for more information:
In this section you will find background information on the social determinants of health, a listing of resources produced by the NCCDH, as well as a collection of resources we are calling our Resource Library. The resource library is not comprehensive and will evolve over time.
We will continue to ensure that additions to our resource library are relevant and evidence-informed, and your feedback is welcome. To suggest a new resource or to learn more about our resource selection process, please contact us.
These terms represent how health is shaped and determined by structural and social forces environments that surround individuals, families, groups, and communities.
Health is more than the absence of disease. Health is the physical, spiritual, mental, emotional, environmental, social, cultural and economic wellness of the individual, family and community. Individuals and groups define health differently depending on their values, culture, experiences and world view. Health is not an endpoint; rather, it is considered a resource for everyday living to support people to live dignified and fulfilling lives, despite the presence or absence of disease.
Population health is the health status of an entire population that results from interrelated factors including policy, primary care, public health, social and environmental factors and the distribution of inequities.1 The three main components of population health are health outcomes, determinants and policies.2 Population health strategies use diverse forms of knowledge and evidence to develop policies and interventions that improve the health and well-being of an entire population rather than of individuals.2
Health equity means that all people (individuals, groups and communities) have fair access to, and can act on, opportunities to reach their full health potential and are not disadvantaged by social, economic and environmental conditions,3 including socially constructed factors such as race, gender, sexuality, religion and social status.4 Achieving health equity requires acknowledging that some people have unequal starting places, and different strategies and resources are needed to correct the imbalance and make health possible.5 Health equity is achieved when disparities in health status between groups due to social and structural factors are reduced or eliminated.
Health inequity refers to differences in health associated with structural and social disadvantage that are systemic, modifiable, avoidable and unfair.4 Health inequities are rooted in social, economic and environmental conditions4 and power imbalances,3 putting groups who already experience disadvantage at further risk of poor health outcomes.6
Health disparity is a measurable difference in health outcomes between groups, communities and populations who experience relative advantage and disadvantage due to structural and social determinants of health.37 A disparity that exists across socioeconomic categories occurs when disadvantaged groups experience worse health outcomes and greater health risks than advantaged groups. Reduced health disparities between groups are evidence of progress toward reaching health equity.7
When used, the term health disparity should be clearly distinguished as the measure to indicate the level of health inequity.
Power is the ability to achieve a purpose, such as advancing health equity. There are many types of power (e.g., political, economic, expert, institutional, community, and worker power) and many ways of conceiving of power (e.g., power over, power to, power with, and power within). Communities, institutions, and people who hold more power also experience advantage , which reinforces inequity, and use their power to maintain the status quo. Changing the written and unwritten rules that create and maintain patterns of advantage and disadvantage between socially defined groups (the structural determinants of health) requires redistributing power. Public health can share the power it has and redistribute power to communities that have been marginalized by systems of oppression. Public health can also act to build power in those communities and work to limit the power of those who benefit from the status quo. 8
These concepts name the structural and social forces that are at the root of population, public, community, and individual health outcomes.
Determinants of health refer to the factors that influence the health of individuals, communities and populations. Determinants of health include individual characteristics (e.g., behaviours, biology, genetics, lifestyle) and social, economic and physical environments, in addition to health care.24 While it is often used synonymously with social determinants of health, the term determinants of health is a broader concept that is not specific to the social justice roots of health inequities. It is important to specify social determinants of health and/or structural determinants of health in order to draw attention to root causes and solutions in public health equity work.
The interrelated non medical conditions of daily life in which people are born, grow up, live, work, play, learn, and age. These conditions have economic, political, and ecological dimensions. Some examples include:
The structural, social, and ecological determinants of health are recognized as being inextricably linked. 10 11
(Updated 2024)
The ecological determinants of health are the conditions that enable life on earth. They include oxygen, water, food, fuel and natural systems that recycle and detoxify many forms of wastes; an ozone layer that protects from the sun’s UV radiation; the natural resources used to build and operate civilizations; and a reasonably stable and habitable climate. The ecological determinants of health both interact with and feedback on the structural and social determinants of health. 10
The written and unwritten rules that create, maintain, or eliminate patterns of durable and hierarchical patterns of advantage among socially constructed groups. Structural determinants manifest current power relationships. Structural determinants take the form of values, beliefs, world views, culture and norms; governance; laws, policies, regulations and budgets; and institutional practices.
Structural determinants work through oppressive systems (e.g. capitalism, colonialism, racism, ableism, cis-heteronormativity, sexism, anthropocentrism) and related ideologies.
Conceptually, the structural determinants of health include the economic, commercial, and political determinants of health. They interact with the social and ecological determinants, driving patterns of advantage that show up in the conditions of daily life (e.g. the advantages experienced White, cisgender and/or non-disabled people). The structural determinants of health are sometimes referred to as the structural determinants – or structural drivers – of health inequities. 10 11
(Updated 2024)
Intersectionality considers how systems of oppression (e.g., racism, classism, sexism, homophobia) interact to influence relative advantage and disadvantage at individual and structural levels.511 An intersectional orientation recognizes that the experience of multiple forms of discrimination and disadvantage has a cumulative negative effect that is greater than the sum of the parts.12 The intersectional nature of oppression and privilege means that people may have privilege in one or more forms even if they experience oppression in other domains.13
Racism is the race-based allocation of value, resources, opportunities and status14151617 in cultural, political, institutional, economic and social forms.1415 Racism is subtle, 1415 reinforced by White supremacy and normalized by dominant White culture and practices.18 Racism differs from prejudice, hatred or discrimination in that it requires one racial group to have systematic power and superiority over other racialized groups.5 Racism intersects with other systems of oppression (e.g., homophobia, sexism, classism, Islamophobia), which affects decision-making power, cultural and symbolic images, and distribution of material resources (e.g., income and wealth).19
Marginalization occurs when people are excluded based on social identities such as race, gender, sexuality and social class as well as the inequitable distribution of social, economic, physical and psychological resources.20 Individuals and communities are marginalized by, live in marginalized conditions or are forced into marginalization rather than being labelled as marginalized people/populations/groups.
Vulnerability occurs when people are exposed to multiple layers of marginalization, including barriers to social, economic, political and environmental resources21 that overlap to increase the risk of poor health.22 Individuals and communities are vulnerable to, live in vulnerable conditions or are forced into vulnerability rather than being labelled as vulnerable people/populations/groups.
These conditions describe the relative ways to consider both approaches to and outcomes of the roots of health.
Advantage refers to having enough opportunities and resources (social, political, economic) and therefore not being at risk of exposure to health-damaging factors.8
Disadvantage refers to having not enough opportunities and resources (social, political, economic) and therefore being at risk of exposure to health-damaging factors.8
Groups and populations with higher socioeconomic status (advantaged) have greater access to resources and services, allowing them to be healthier than those with lower socioeconomic status and less access (disadvantaged), a pattern that exists at every level of the socioeconomic spectrum.823
Health inequities are reduced when power and resources are shifted to address the needs of those who are disadvantaged due to inadequate resources and supports8 and the inequitable distribution of the structural and social determinants of health.
Privilege represents power,423 advantage and entitlement4 granted without question based on structural and social determinants of health, including race, gender, economic status and sexual orientation.4 Privilege is usually invisible to those who have it because they are not taught to recognize and address it. 423 Privilege is also known as structurally enabled or embedded advantage to reflect that it is a result of systems influence not individual characteristics.24
Oppression is “a system of supremacy and discrimination … where a socially constructed … ‘dominant group’ [holds] power, wealth, and resources … [creating] a lack of access, opportunity, safety, security, and resources for non-dominant populations".5 p8 Dominant groups include those who are White, heterosexual, English speaking, male, high income and high social status, among others. Oppression reflects current and historical processes,5 including racism, colonization and discrimination based on gender and sexual diversity, as well as denial of health services based on social status.
Assets are opportunities and resources that ensure the chances for health and well-being for an individual, group or community compared to broader society. Deficits are risk factors and risk conditions that impede the chances for health and well-being for an individual, group or community compared to broader society. Assets and deficits are created by unequal power and resource distribution at individual, group, community and societal levels.
Protective factors and conditions increase the chances of good health by enhancing our ability to cope with challenges, mitigate the effects of negative influences and reduce the likelihood of poor health. A population health equity approach focuses on building protective factors to decrease the likelihood of experiencing the negative impact of risk conditions.25 A focus on protective factors aligns with an asset-based approach to health.
Risk factors and conditions decrease the chances of good health by increasing the risk, severity and duration of disease, injury or premature death. They may be individual characteristics and behaviours as well as environmental and social factors that increase the chance of having poor health.25 Focusing on risk factors and conditions aligns with a deficit-based approach; attention to protective factors is necessary in addition to reducing risk.
Social inclusion improves participation in society of people who experience marginalization and vulnerability through equitable access to material (economic) and non-material resources required for living,27 including power and rights.
Social exclusion is when people are not able to participate in society through inequitable access to resources, capabilities, power and rights, leading to inequitable health impacts and outcomes.28
Social inclusion and exclusion are intersectional, dynamic and simultaneous social determinants of health that are relational and context specific. They depend on location as well as social and institutional structures.29 Interventions for inclusion and social justice (strength based) are different than those to address exclusion and social injustice (deficit based) — they are not opposite sides of the same coin.30
These approaches intend to indicate courses of action and levels of impact for action on the structural and social forces that determine population health equity.
Upstream interventions and strategies dismantle and change the fundamental social and economic systems (structural determinants of health) that distribute the root causes of health inequities including wealth, power and opportunities. These changes generally happen at the provincial, territorial, national and international levels. They are about changing the cause of the causes of health and health inequities.32333431
Midstream interventions and strategies reduce exposure to risk by improving material conditions or by promoting healthy behaviours. These changes generally occur where individuals who live with inequities are directed or referred to resources that support health at the regional, local, community or organizational level. Midstream approaches are about changing the root causes of health inequities. 32333431
Downstream interventions and strategies seek to address immediate needs and mitigate the negative impacts of disadvantage on health at an individual or community level through the availability of health and social services. These changes generally occur at the service or access-to-service level. Downstream strategies are about changing the effects of the causes. 32333431
Levelling up involves efforts to improve the health of groups who experience disadvantage by bringing their health closer to that of groups with advantage, thus reducing health inequities between groups.3 Levelling up is a concept closely tied to closing the gap.
Closing the health gap between the most and least advantaged involves interventions and strategies designed to improve health outcomes of groups who are experiencing disadvantage. The result is that the difference in health status and outcomes between those who are advantaged and disadvantaged (the health gap) decreases.35 Closing the gap is a concept closely tied to levelling up.
Proportionate universalism is an approach where programs and services are delivered universally but strategies include a range of responses to address different levels of disadvantage (rather than just targeting the least disadvantaged groups) 36, as well as planning for impact that is proportionate to the level of disadvantage that is experienced.37
Advocacy is a critical population health strategy for health equity that combines individual, organizational and societal actions to influence change at a systems level (across sectors and organizations). Advocacy for health equity focuses on changing factors related to the structural and social determinants of health.40 Advocacy explicitly recognizes the importance of engaging in political processes to effect desired policy changes at organizational and system levels (municipal, regional, provincial, territorial, national, international).4142
Community engagement for health equity is based on meaningful and authentic existing and ongoing relationships with communities, which is a core public health practice,44 allowing people who live with inequities to influence health system priorities45 and inform decisions about population and public health initiatives.46 Public health considers community members as partners47 rather than ‘service recipients’, recognizing that community members know best about what they need to be healthy and the solutions to address inequities.44
Decolonization means dismantling colonial power systems, including political, knowledge and social structures.48 Also known as deconstructing colonial oppression, decolonization includes active resistance and actions to restore power, land and independence to Indigenous Peoples; emphasize Indigenous knowledge; and critically assess White, Western-centric practices5 at individual, organizational and systems levels across all sectors.23
An asset- or strength-based approach promotes the skills, values, knowledge and connectedness of individuals and communities as a resource for health. An asset-based approach focuses on building protective factors to promote health and well-being by drawing on collective individual and community capacities.38
A deficit-based approach identifies problems and risk factors or conditions that increase the chances of poor health.38 This approach focuses on decreasing risk and addressing deficiencies at an individual, group or community level.
Health in all policy (HiAP) is a policy development approach that considers the population health implications of decisions and policies, including those outside of the formal health sector.49 HiAP explicitly recognizes the accountability of policy-makers for equity, health and the health impacts of any policy, including those outside of traditional health sectors.22 A HiAP approach reflects collaboration, transparency, participation and sustainability across sectors and levels of government50 and is necessary to both maximize positive health impacts and avoid harm.
Intersectoral action, also known as intersectoral collaboration, refers to various sectors of society working together toward a common goal. This approach includes government departments (e.g., health, education, environment, justice); community members; non-profit organizations and businesses.51 Relationships are key to intersectoral action and can be vertical (across organizational levels) or horizontal (within organizational levels).52 This approach is based on principles of co-development, co-ownership and co-accountability.
Movement-building includes efforts to achieve health equity by strengthening community efforts to influence broad systems change.53 Movement-building for health equity needs an inside–outside strategy, where public health builds internal capacity for health equity action (inside) as well as ongoing relationships and intentional cross-sector alliances with organizations invested in social justice (outside).54 Movement-building includes synergistic efforts to disrupt power imbalances and structural factors at the root of health inequities.55
Community organizing is the process by which people who have a common identity or purpose unite to identify shared issues, develop collective goals, and implement strategies and tactics to reach those goals.
The process of community organizing includes:
found no results.
