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Appendix A – Glossary of Terms and Abbreviations

Terms

Unless otherwise indicated, these terms are drawn from Health Disparities Task Group of the Federal/ Provincial/Territorial Advisory Committee on Population Health and Health Security 2004, Reducing Health Disparities-Roles of the Health Sector: Discussion Paper, Federal/Provincial/ Territorial Advisory Committee on Population Health and Health Security, Ottawa.

Determinants of health: the range of personal, social, economic and environmental factors that determine the health status of individuals or popu-lations (WHO, Health Promotion Glossary, 1998). The determinants of health can be grouped into seven broad categories: socio-economic environment; physical environments; early childhood development; personal health practices; individual capacity and coping skills; biology and genetic endowment; and health services.

Disadvantaged populations: populations that share a characteristic associated with a high risk of adverse health outcomes (e.g., Aboriginal peoples, single mothers in poverty, women, homeless people, refugees). One approach to assisting disadvantaged populations is to use specific strategies targeted at that particular population. This is distinct from approaches aimed at reducing the range of underlying determinants of health that affect health (e.g. income, education).

Health care: the programs, services, procedures, therapies and interventions that treat and care for individuals with diseases, injuries and disabilities. Health care is the largest subset of the health sector.

Health disparities: differences in health status that occur among population groups defined by specific characteristics. For policy purposes, the most useful characteristics are those consistently associated with the largest variations in health status. The most prominent factors in Canada are socio-economic status (SES), Aboriginal identity, gender, and geographic location.

Health inequality: “...is the generic term used to designate differences, variations, and disparities in the health achievements and risk factors of individuals and groups...that need not imply moral judgment...[and may result from] a personal choice that would not necessarily evoke moral concern” (Kawachi, Subramanian & Almeida-Filho 2002, p. 647). Some inequalities reflect random variations (i.e., unexplained causes), while others result from individual biology, the consequences of personal choices, social organisation, economic opportunity, or access to health care. Public policy addresses health inequalities attributable to modifiable factors, especially those that are perceived as inequitable.

Health inequity: “...refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice....The crux of the distinction between equality and equity is that the identification of health inequities entails normative judgment premised upon (a) one’s theories of justice; (b) one’s theories of society; and (c) one’s reasoning underlying the genesis of health inequalities. Because identifying health inequities involves normative judgment, science alone cannot determine which inequalities are also inequitable, nor what proportion of an observed inequality is unjust or unfair” (Kawachi, Subramanian & Almeida 2002, pp. 647-648).

Health sector: the policies, laws, resources, programs and services that fall under the jurisdiction of health ministries. This sector encompasses health promotion and preventive health, public health, community health services such as home care, drugs and devices, mental health, long-term residential care, hospitals, and the services generally provided by health care professionals (doctors, nurses, therapists, pharmacists, etc.).

Population health: Population health is both a description and a concept that underlies the discussion of health disparities. “Population health strategy focuses on factors that enhance the health and well-being of the overall population. It is concerned with the living and working environments that affect people’s health, the conditions that enable and support people in making healthy choices, and the services that promote and maintain health” (Federal/Provincial/ Territorial Advisory Committee on Population Health 1994). It is concerned with collective, rather than individual health status and risk factors, as well as policies and strategies that address non-medical determinants affecting health throughout the life course.

Primary health care: The World Health Organisation defines primary health care as “the principal vehicle for the delivery of health care at the most local level of a country’s health system. It is essential health care, made accessible at a cost the country and community can afford, with methods that are practical, scientifically sound and socially acceptable. Everyone in the community should have access to it, and everyone should be involved in it. Besides an appropriate treatment of common diseases and injuries, provision of essential drugs, maternal and child health, and prevention and control of locally endemic diseases and immunization, it should also include at least education of the community on prevalent health problems and methods of preventing them, promotion of proper nutrition, safe water and sanitation.”

Public health: “Public health is the combination of science, practical skills, and values directed to the maintenance and improvement of the health of all the people. It is a set of efforts organised by society to protect, promote, and restore the people’s health through collective and social action. ...Public health activities change with changing technology and values, but the goal remains the same – to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the populations” (Last 1994).

This broad definition is closely aligned with the definition of “population health”, and should be distinguished from the definition of the five core “public health” programs and services aimed at primary prevention: population health assessment, surveillance, disease prevention, health protection, and health promotion. These programs and services are provided by health departments, regional health authorities, and local units.

Socio-economic status (SES): a term that describes the position of an individual group in a population or society, reflecting the overall hierarchy. The most frequently used indicators of SES are income, education and occupational categories. The conceptual cousin of this term is class, which originated in social theories that attempt to explain rather than simply describe the structure and functioning of society. To be consistent with previous national documents on health status and their determinants, SES is used and is intended to be interpreted broadly.

Appendix B – The World Health Organisation Commission on the Social Determinants of Health

The Commission on Social Determinants of Health (Commission) was launched in March 2005 and will complete its initial work in May 2008. It is chaired by Sir Michael Marmot of the University College, London and has twenty Commissioners. The Commission brings together leading scientists and practitioners to provide evidence on policies that improve health by addressing the social conditions which people live and work. It collaborates with countries to support policy change and monitor results.

Main Goals of the Commission:

  • To support policy change in countries by promoting models and practices that effectively address the social determinants of health.

  • To support countries in placing health as a shared goal to which many government departments and sectors of society contribute.

  • To help build a sustainable global movement for action on health equity and social deter-minants, linking governments, international organizations, research institutions, civil society and communities.

Appendix C – The Health Systems Knowledge Network

The Health Systems Knowledge Network was appointed by the WHO Commission on the Social Determinants of Health from September 2005 to March 2007. It was made up of 14 policy-makers, academics and members of civil society from all around the world, each with his or her own area of expertise. The network engaged with other components of the Commission (see http://www.who.int/social_determinants/map/en) and also commissioned a number of systematic reviews and case studies (see www.wits.ac.za/chp/).

The Centre for Health Policy led the consortium appointed as the organisational hub of the network. The other consortium partners were EQUINET, a Regional network in east and southern Africa devoted to promoting health equity (www.equinetafrica.org) , and the Health Policy Unit of the London School of Hygiene in the United Kingdom (www.lshtm.ac.uk/hpu) . The Commission itself is a global strategic mechanism to improve equity in health and health care through action on the social determinants of health at global, regional and country level.

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