Social Determinants of Health and Health Equity for Children:

Developing a lesson plan in Sudbury

Geneviève Projean, Social Determinants of Health Public Health Nurse

Dana Wilson, Health Equity Manager

March 22, 2018

DISCLOSURE OF COMMERCIAL SUPPORT

• None of the presenters at this session have received financial support or in-kind support from a commercial sponsor.

• None of the presenters have potential conflicts of interest to declare.

Presentation Outline

• Awareness of the Social Determinants of Health

• Health Equity Communications

• Development of Lesson Plan Pilot Study

• Partnership with Laurentian University’s Faculty of Education

Awareness of the Social Determinants of Health

Importance of the Social Determinants of Health• Core social and economic factors that influence the

health of individuals and communities

• Influence “the extent to which a person possesses the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment” (Raphael, 2016, p.3)

• Public Health Agency of Canada (2011) recognizes 12 key determinants

Evidence from Sudbury and Area

Related Evidence in Ontario

• Kenney and Moore (2013), in a study of secondary school aged youth in Kingston, Ontario revealed a similar trend, with lifestyle choices most commonly associated with health.

• Shankardass, Lofters, Kirst, & Quinonez (2012) found that 53-64% of Ontarians were aware of health inequalities based upon income.

Ontario Public Health Standards - Health EquityFour requirements:

1. Assess and report

2. Modify and orient interventions to decrease health inequities

3. Engage in community and multi-sectoral collaboration with LHIN(s) and other relevant stakeholders

4. Lead, support, and participate

Mandated Health Equity Standard Program Outcomes:

That the general public, Local Health Integration Networks (LHINs), and other partners have:

• Increased awareness of local health inequities

• Increased awareness of the causes of health inequities

Increased support (by everyone) for actions that decrease health inequities

Public Health Sudbury & Districts Health Equity Communications

Short-term Outcomes Intermediate Outcomes Long-term Outcomes

Increased community

readiness for health

equity action

awareness of SDOH

and their impact on health

awareness of local

inequities in health and

wealth

awareness of realities

of priority populations

Increased community

capacity for health

equity action

engagement with

community partners to

identify health equity

actions

collaboration with

community partners and

the public in taking

health equity actions

Increased health equity

action

equity focused

decision making and civic

engagement

participation in

compassionate activities

and community

involvement

health equity

Communication Initiatives

Youth Taking Action on Health Equity

Development of Lesson Plan

• Established partnership with Laurentian University’s Faculty of Education to pilot lesson plan materials with education students during their school placements in elementary schools

• Our Heath Equity Team developed a three-module lesson plan for junior elementary school students (grades 4-6)

Development of Lesson Plan

• Reviewed key Ministry of Education documents: Ontario’s Well-Being Strategy for Education Discussion Document

Well-being in Our Schools, Strength in our Society Engagement Paper

Achieving Excellence: A Renewed Vision for Education in Ontario

Ontario’s Education Equity Action Plan

Foundations for a Healthy School

• Incorporated / adapted materials from Grade 5 Puzzle activity

Saskatoon Health Region

Public Health Nutritious Food Basket data 2016

Legislative Assembly of Ontario, Discovery Portal

Lesson Plan Goals

1. Create awareness among students and adult influencers (i.e., education students) about the social determinants of health and health equity

2. Encourage students to identify possible actions or solutions in their communities that can promote health equity

Lesson Plan Document Includes:

• Background Information for Teacher Candidates Low Awareness about the Social

Determinants of Health Alignment with the Ministry of Education Sensitivity of Materials

• Curriculum Expectations

• Lesson Plans Health and Poverty The Social Determinants of Health

and Health Equity Health Equity in Action

Activity C: Introducing Poverty and Budget Exercise

Activity J: Puzzle Activity on Health Equity Action

• First puzzle piece: One thing you can do tomorrow to make a difference in our community

• Second puzzle piece: One thing you can do next monthto make a difference…

• Third puzzle piece: One thing you can do in the next yearto make a difference… (Activity L)

Sensitivity of Materials

• Highly likely that education students will encounter children living in poverty during their placements and future careers

• Education students needs to be aware of the potential impacts lesson plan may have on students living in poverty since they will have firsthand experience with these issues

Current Status of Pilot Study

• 64 education students were introduced to project during their regularly scheduled courses in October 2017

• Can use any/all of the 13 turnkey activities during their in-school placements

• Evaluation includes voluntary online survey and option of focus group interview

Next Steps

• Identify opportunities to continue piloting the lesson plan with the education students

• Identify opportunities for future collaboration and/or piloting of materials with our four local school boards in Sudbury

• Explore the possibility of translating the lesson plan in French

Conclusion• New mandate for public health to focus on awareness

of the social determinants of health and health inequities among public, LHINs, partners

• Local and provincial challenges of raising awareness

• Children and youth are a key target and are our future leaders

• Collaboration with key sectors is essential (e.g., Post-secondary institutions, local school boards, Ministry of Education)

References• Institute for Social Research, York University. (2013). 2013 RRFSS cycles 13-15 (Jan-Dec), combined data from: Simcoe

Muskoka District; Haliburton, Kawartha, Pine Ridge; Niagara Region; Middlesex-London; York Region; Sudbury District; Halton Region, Hamilton; Grey Bruce; Lambton; Leeds, Grenville and Lanark; Chatham-Kent & 2013 RRFSS cycles 14-15 (May-Dec), combined data from Durham Region and Brant.

• Kenney, K. & Moore, S. (2013). Canadian Adolescent perceptions and knowledge about the social determinants of health: an observational study of Kingston, Ontario youth. Biomed Central Public Health, 13:781.

• Ministry of Education. (2014). Achieving Excellence-A Renewed Vision for Education in Ontario. [published 2014; cited August 24 2017]. Available from: http://www.edu.gov.on.ca/eng/about/renewedVision.pdf

• Ministry of Education. Foundations for a Healthy School – Promoting well-being is part of Ontario’s Achieving Excellence vision. [published 2014; cited July 17 2017]. Available from http://www.edu.gov.on.ca/eng/healthyschools/resourceF4HS.pdf

• Ministry of Education. (2017). Ontario’s Education Equity Action Plan. [published September 2017; cited September 12 2017]. Available from: http://www.edu.gov.on.ca/eng/about/education_equity_plan_en.pdf

• Ministry of Education. Ontario’s Well-Being Strategy for Education – Discussion Document [published May 2016; cited July 17 2017]. Available from http://www.edu.gov.on.ca/eng/about/WBDiscussionDocument.pdf

• Ministry of Education. Well-Being in Our Schools, Strength in Our Society – Engagement Paper [published 2016; cited August 24 2017]. Available from http://www.edu.gov.on.ca/eng/about/wellbeingpdfs_nov2016e/wellbeing_engagement_e.pdf

• Ministry of Health and Long-term Care. (2017). Ontario Public Health Standards: Requirements for programs, services, and accountability.

References• National Collaborating Centre for Determinants of Health. (2013). Let’s Talk: Public health roles for improving

health equity. Retrieved from: http://nccdh.ca/images/uploads/PHR_EN_Final.pdf

• Public Health Agency of Canada. (2011). What determines Health. Retrieved from: https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

• Raphael, D. (2016). Social Determinants of Health, 3rd ed. Toronto: Canadian Scholars’ Press Inc.

• Raphael, D. & Sayani, A. (2017). Assuming policy Responsibility for health equity: Local public health action in Ontario, Canada. Health Promotion International, 1-12.

• Shankardass, K., Lofters, A., Kirst, M., & Quinonez, C. (2012). Public awareness of income-related health inequalities in Ontario, Canada. International Journal for Equity in Health, 11:26.

• Sudbury and District Health Unit. (2009). The Most Important Things You Need to Know About Your Health May Not Be as Obvious as You Think. Retrieved from: https://www.sdhu.com/health-topics-programs/health-equity/health-equity-resources

• Sudbury & District Health Unit. (2011). Let’s Start a Conversation About Health… and Not Talk About Health Care at All. Retrieved from: https://www.sdhu.com/health-topics-programs/health-equity/health-equity-resources

• Sudbury & District Health Unit. (2012). 10 Promising Practices: Health Equity. Retrieved from: https://www.sdhu.com/health-topics-programs/health-equity/10-promising-practices-health-equity

• Sudbury & District Health Unit. (2016). You Can Create Change! Retrieved from: https://www.sdhu.com/health-topics-programs/health-equity/you-can-create-change

• Sudbury & District Health Unit. (2017). Lesson Plan for Junior Elementary Students (Grades 4-6): Youth Taking Action on Health Equity.

Thank you! Questions?

Dana Wilson

Health Equity Manager

Health Equity Team

wilsond@phds.ca

705.522.9200, ext. 498

Geneviève Projean

Social Determinant of Health Public Health Nurse

Health Equity Team

projeang@phsd.ca

705.522.9200, ext. 506

With support from Sherry Price, Project Officer, Health Equity Team