1. Researching the extent to which the government ministries of Ontario address social determinants of health Social determinants of health: Is it really everyone’s business? Masters of Public Health students: Christine Chan and Nicoda Foster cchan.global@gmailcchan.global@gmail nicoda.foster@gmail.comnicoda.foster@gmail.com September 27, 2012 Health Promotion Ontario Conference

2. Presentation outline 1. Research focus 2. Research methodology 3. Key factors determining whether Ministries recognized and adopted a determinants approach 4. Reflections 5. Q & A

3. Research focus To what extent do the government ministries of Ontario recognize and address the social determinants of health?

4. Research focus A determinants approach by all government ministries of Ontario would create society-level improvements towards an environment that supports good health and wellbeing.

5. Research methodology June – August 2012: data collection September 2012: data analysis Largely unstructured interviews Two core questions asked of every Ministries: (i) How does the work of your Ministry impact health? (ii) To what extent does the work of your Ministry impact on the social determinants of health?

6. Research methodology

7. Ministries which responded (R), Ministries which did not respond (NR) Ministry for Aboriginal Affairs (NR) Ministry of Agriculture, Food and Rural Affairs (R) Ministry of the Attorney General (NR) Ministry of the Children and Youth Services (R) Ministry of Citizenship and Immigration (R) Ministry of Community and Social Services (NR) Ministry of Community Safety and Correctional Services (R) Ministry of Consumer Services (R) Ministry of Economic Development and Innovation (R) Ministry of Education (R) Ministry of Energy (R) Ministry of the Environment (R) Ministry of Finance (R) Ministry of Government Services (R) Ministry of Health and Long Term Care (R) Ministry of Infrastructure (NR) Ministry of Intergovernmental Affairs (R) Ministry of Labour (NR) Ministry of Municipal Affairs and Housing (NR) Ministry of Natural Resources (R) Ministry of Northern Development and Mines (R) Ministry of Tourism, Culture and Sport (R) Ministry of Transportation (R)

8. Data Analysis The following categories were used to analyze the data collected: Policy instrument (Schneider and Ingram, 1990) Authority Symbolic Incentives Capacity building Learning Main factor influencing whether a social determinants approach was taken Extent of collaboration for health purposes Ways of resolving potential conflicts with other Ministries

9. FactorDescription Political climate Political direction of the party in power, which is largely influenced by the ideological perspective which informs its doctrine. Champions The need for influential and knowledgeable individuals to lead and support the uptake of SDOH or health equity related activities. Legislation Although all Ministries must adhere to legislative requirements, legislation is the prime driver for some ministries, and for such ministries, legislation is an important lever by which to steer them towards another way of working. Mandate driven Strict adherence to the mandate set out for the Ministry without a broad interpretation or with avoidance of deviation. Policy Processes The government Ministries of Ontario usually engage in a horizontal decision making process which involves engaging all relevant Ministries in the review and critique of proposed policies and decisions that could have a broader impact following implementation. Capacity building tools The use of tools as a vehicle to orientate a Ministry towards a determinants approach. Moral imperativeThe conviction that the determinants of health is, from a moral perspective, the correct thing to do.

10. Political Climate A factor for most Ministries. Examples: - MOHLTC - Ministry of Community Safety and Correctional Services - Ministry of the Environment

11. Champions Within Ministries. Examples: - Ministry of Health Promotion and Sport - Ministry of Tourism, Culture and Sport - Ministry of Children and Youth Services

12. Legislation Prime driver for some ministries. Examples: - Ministry of Community Safety and Correctional Services - Ministry of Energy

13. Mandate-driven If it’s not in some Ministries’ mandate, the likelihood of them doing it is low. Examples: - Ministry of Economic Development and Innovation - Ministry of Community Safety and Correctional Services

14. Policy processes Horizontal policy development processes Examples: - MOHLTC - Ministry of the Environment - Ministry of Children and Youth Services - Ministry of Agriculture, Food and Rural Affairs - Ministry of Finance - Ministry of Northern Development and Mines

15. Capacity building tools Only mentioned by: Ministry of the Environment Ministry of Children and Youth Services MOHLTC HEIA. CART.

16. Moral imperative Paying attention to the social determinants of health is the right thing to do. Examples: Ministry of Children and Youth Services Ministry of the Environment

17. Reflections Capacity building tools Capacity tools that provide information or training assume that barriers to desired behavior consist of lack of resources rather than incentives. Schneider and Ingram (1990: p. 517)

18. Reflections Horizontal policy processes Key Sets foundation for a concerted coordinated effort that a determinants approach requires Intersectoral meetings alone are not enough

19. Reflections Health is: Still largely perceived as healthcare and Largely the responsibility of health agencies

20. Reflections Parallels with Environment Environment has done a great job linking itself to collective wellbeing and sustainability Health can learn from this and build on this Partner with them

21. Need for renewed understanding by non-health agencies All Ministries contribute to the social determinants of health. This simple recognition would take a long way towards building a sense of collective responsibility towards health.

22. Conclusion Despite indirect impacts…not everyone considers health their business. Preliminary findings only. More to be done…

23. Questions?