We know that health is influenced by much more than just the healthcare system. The Determinants of Health Model lists many of the factors that affect health. We refer to these factors as the Social Determinants of Health. Social determinants affect the conditions and circumstances in which individuals and communities live, learn, work, and play. It is also important to note that the Social Determinants of Health interact across the life span, and can affect families over the life course and across generations.
Determinants of Health Model
Source: Dahlgreen, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Future Studies.
Using a health equity lens is foundational to providing quality care and improving the health of residents in Grey and Bruce. To support the application of a health equity lens at the individual and systems level, a health equity resource tool was developed. The tool was developed collaboratively with system leaders, service providers and community stakeholders across sectors and agencies within Grey Bruce.
Click on each section of the wheel to learn more about the social determinants of health that contribute to the health of individuals and communities. The Health Equity tool guides you in planning and implementing your programs, services, and activities to be more equitable by considering the specific needs of populations.
Need more information or support, but aren’t sure where to start? Visit https://211ontario.ca or call 211 to learn more about programs and services available in the County of Bruce, Grey County and across the province.
The Health Equity tool is here to guide you in making your programs, services, and activities better for all who access them. Hover over each population name for resources to help you understand and serve that group better, as well as find local agencies focused on doing the same.
Need support but aren’t sure where to start? Visit https://211ontario.ca/ or call 211 to learn more about programs and services available in Bruce County, Grey County, and across the province.
Learn More:
Create Health Equity for People with Disability
Resources in Grey County & Bruce County:
Community Living: Owen Sound and District
Canadian Mental Health Association Grey Bruce
Ontario Disability Support Program
Grey Bruce Health Stats: Municipal Profiles
Indigenous Equity (IND-Equity) and inequities are distinct from those experienced by non-Indigenous peoples. Factors such as colonization and the decimation of culture underlie health experiences of many Indigenous peoples.
Health Inequalities and Social Determinants of Aboriginal People’s Health
Aboriginal Relationship and Cultural Competency Courses
M’Wikwedong Native Cultural Resource Centre
Southwest Ontario Aboriginal Health Access Centre
Chippewas of Nawash Unceded First Nation
Great Lakes Metis Council
Saugeen First Nation
Southwest Ontario Aboriginal Health Access Centre: Indigenous Cultural Safety Program
Bringing Reconciliation to Healthcare in Canada: Wise Practices for Healthcare Leaders (April 2018)
Centre for Wise Practices in Indigenous Health
Diversity Snapshot: Youth
Community Foundation Grey Bruce: Vital Focus on Youth Report (2019)
Keystone Child, Youth & Family Services
WES for Youth Online
The Grey Bruce We C.A.R.E Project
Launch Pad Hanover: Youth Activity and Technology Centre
Grey Bruce Health Stats: Children and Youth
One’s proficiency in reading, writing, and solving problems has a significant impact on capacity to make decisions related to health. Use plain language written at an appropriate literacy level to make client and public resources more accessible.
The Office of Literacy and Essential Skills
Connect through The HealthLine
Literacy and Basic Skills at Georgian College
Adult Learning Centres
Launch Pad Hanover: Skills Development and Employment Training Programs
Health Equity for Immigrants and Refugees: Driving Policy Action
Grey Bruce Local Immigration Partnership
Newcomer Information Bruce Grey
Settlement Services Grey Bruce
Welcoming Communities Grey Bruce
Making Rural Communities Home: A Newcomer Integration Toolkit
Service Provider Training Manual: How to Support Newcomers in Grey Bruce
Council on Aging Grey Bruce Owen Sound
Seniors Income Supports: Guaranteed Income Supplement
Trillium Drug Plan (TDP): intended for Ontario residents who have high prescription drug costs in relation to their net household income.
Grey Bruce Health Stats: Older Adults
Ontario Seniors Dental Care Program Information
Preventing Falls in Older Adults
Beaver Valley Outreach: Seniors Centre Without Walls (telephone-based activities and information for seniors or anyone experiencing isolation)
Financial Resources for End of Life: United Way Bruce Grey
Racial Equity Tools
Health Equity and Racialized Groups: A Literature Review, 2011
National Collaborating Centre for Determinants of Health, Let’s Talk: Racism and health equity
Grey Bruce Health Stats: Immigration and Ethnocultural Diversity
The Huron County Healthy Rural Policy Lens
Pierre’s Story: The Many Costs of Rural Living (video)
Bruce & Grey Community Information
Equity and Inclusion for People Living in Poverty
Income and Health
Income and Health in Grey Bruce
Bruce Grey Poverty Task Force
United Way of Bruce Grey
Bruce Grey Poverty Task Force: Income Security
Financial and Employment Assistance: Caseworkers in Grey County and Bruce County are available to provide information about what program or benefit may best suit an individual and/or family needs.
Ontario Works
Federal Government Financial Supports
Grey Bruce Health Stats: Income
Grey Bruce Health Stats: Labour
Ukrainian Newcomers
211 Ontario Newcomers
Arden Language Centre (provides ESL training and occasional assistance with interpretation)
Out On The Shelf: Guelph’s Queer Library and Resource Centre
Re:searching for LGBTQ2S+ Health!
Rainbow Health Ontario
Health Equity Impact Assessment: LGBT2SQ Populations Supplement (Ministry of Health and Long Term Care and Rainbow Health Ontario)
Out on the Shelf: Everything LGBTQ+ in Grey Bruce, Guelph, Dufferin and Wellington County
Check out Grey Bruce Pride on Facebook or email greybruceprideinfo@gmail.com
Southwest Health Line
Visit Kincardine Pride on Facebook and Twitter
M’Wikwedong Indigenous Friendship Centre, Advocacy Project for Two Spirit and Indigenous LGBTQQIA+ People
Southeast Grey Community Health Centre: LGBTQ+Connection
Pflag Canada, Owen Sound - Email owensoundon@pflagcanada.ca
Counting Women In: A Toolkit for Rural Action on Poverty
The Ontario Women’s Health Equity Report
Gender and health are also about boys and men (The Lancet)
The Women’s Centre
Women’s House Serving Grey Bruce
STOP Sexual Violence Survey Grey Bruce
Violence Prevention Grey Bruce: Working Together Protocol
Education can lead to better health. An individual’s level of education is correlated with other social determinants of health such as employment, working conditions, level of income and social status. Individuals with a higher education have increased literacy and better access to economic and social resources. More skills and resources support achievement of healthier lifestyles.
Bruce Grey Catholic District School Board 2022-2024 Equity Action Plan
Mental Health and Well-Being - Bluewater District School Board (bwdsb.on.ca)
Grey Bruce Health Stats: Education
Resources for Adults:
Adult Education – Bluewater District School Board, Grey & Bruce Counties
Adult and Continuing Education - Bruce-Grey Catholic District School Board (bgcdsb.org)
Adult Learning – Upper Grand District School Board, in-person support available in Dundalk
Adult Learning Centre
Georgian College
Fanshaw College – Huron/Bruce Regional Sites
Better Jobs Ontario (formerly Second Career) - Georgian College
Ontario Colleges & Universities – many virtual programs now available
Resources for Youth:
Launch Pad
Newcomer Information Bruce Grey: select “Education” on the “explore” section.
Employment support programs often have courses and programs available to support people’s learning goals, call 2-1-1 for information about various employment services or visit https://www.newcomersbrucegrey.ca/ and select “Employment” on the “explore” section of the page.
Safe and affordable housing is an absolute necessity for living a healthy life. The presence of mould, poor heating, inadequate ventilation, pests and overcrowding are all determinants of adverse health outcomes.
For many communities, homelessness is an increasing public concern. Most people do not choose to be homeless. There are many causes of homelessness including but not limited to; systemic or societal barriers, a lack of affordable and appropriate housing, financial or mental challenges and/or racism and discrimination.
Programs and Services in Grey County & Bruce County:
Community Connection/211 Central East Ontario
Safe n’ Sound Grey Bruce
Grey County: Housing Programs and Services
Bruce County: Housing Services
YMCA Housing Services
Indigenous Support Housing Program
Grey Bruce Community Legal Clinic (Help with legal problems that affect housing)
United Way of Bruce Grey: Programs
Resources:
Bruce Grey Poverty Task Force: Housing
Homelessness Media Kit (United Way Bruce Grey)
Focus on Housing Report (communityfoundationgreybruce.com)
About Affordable Housing in Canada (cmhc-schl.gc.ca)
RentSafe
Home Takeover
Grey Bruce Health Stats: Housing
Bruce County Affordable Housing Development Toolkit
Community Safety and Well-being Plan for Municipalities of Bruce & Grey: Priority Area of Action - Housing and Homelessness
Provincial Strategy to Combat Homelessness
12 Dimensions of Indigenous Homelessness
Definition of Indigenous Homelessness in Canada
Ontario Non-Profit Housing Corporation
Prescribing medications and lifestyle changes for our patients who suffer from income deficiency isn’t enough; we need to start prescribing healthy incomes. The Star - Basic Income, Just What the Doctor Ordered
A living wage is the hourly wage a worker needs to earn to cover their family's basic everyday needs: food, housing, utilities, childcare and transportation. A living wage is not the same as the minimum wage, which is the lowest wage rate an employer can pay an employee. The 2022 calculation of a living wage for Bruce Grey has been determined to be $20.70. Income and deductions from government taxes and transfers are included in the living wage calculation.
According to the low-income measures, after tax (LIM-AT), a household has low income if its adjusted after-tax income is less than half of the median adjusted after-tax income of all households in Canada. For private households, the low-income rate in Grey Bruce is 22.8%. This translates to 12.1% of people in Grey County and 10.7% people in Bruce County who belong to low-income households (based on LIM-AT) – Census Data (2021).
Basic income improves living standards and lifts many Canadians out of poverty. A universal basic income is a “government policy that guarantees a regular income to all Canadians to help them live a basic and dignified life”. With a basic income, individuals have improved access to opportunities for health, work, education and leisure (Canadian Index of Wellbeing, 2016).
Poverty is a risk factor for many health conditions. Poverty: A Clinical Tool for Primary Care Providers directs providers to use key questions to find out more about their patients, their employment, living situation, social supports and the benefits they receive. The tool includes links to key government and community resources to support positive interventions. Add Page 2 of the Poverty Tool to your computer screen as a reminder when connecting with patients and families about benefits, resources and services.
Accessing government benefits is often very complex and can pose challenges for people with low incomes. Some people may also experience language, literacy, digital, mobility, cognitive, disability and/or mental health barriers which add to these challenges. Benefits are often administered by different government agencies (e.g., housing, social services, CRA), making it difficult to browse benefits all in one place. As a result, people with low incomes may feel frustration and isolation as they are unable to navigate successfully (Prosper Canada, 2022).
The Benefits wayfinder is an online tool that simplifies the search for government benefits for people seeking ways to boost their incomes and/or reduce their expenses. The tool provides information and resources from federal, provincial, and territorial governments, and content is regularly updated. Frontline service providers can use the tool to help clients identify benefits that can help boost their incomes and improve their quality of life (Prosper Canada, 2022).
If a client has a modest income and a simple tax situation, volunteers in Grey Bruce can do a tax return for free! Free Income Tax Clinics in Grey Bruce 2022
Financial Literacy Program/United Way Bruce Grey
Turning Over Stones Resource
Free Income Tax Clinics in Grey Bruce 2022
Community Income Tax Grey Bruce Infographic 2022
Income and Income Distribution (The Canadian Facts, 2020)
Basic Income Postcard_Poverty is not complex; life is
Basic Income Postcard_Impact on Health and Well-Being
Basic Income Postcard_Impact on Indigenous Communities
Basic Income Postcard_Income and time poverty
Canadian Index of Wellbeing: Bruce and Grey County Community Wellbeing Survey (2018)
A patient’s ability to understand and participate in their own health care is critical. Yet, many Ontarians do not have access to care in a language that they understand. >The Right to Language Accessibility in Ontario’s Health Care System
The Hub is an online portal, through which vulnerable newcomers, sponsors, service providers, volunteers, and the public can access information and resources to support the social and economic integration of newcomers. The Hub provides information in 25 of the most common languages in the Region.
Grey Bruce Settlement Services
Grey Bruce Settlement Services is a collaboration between YMCA of Owen Sound Grey Bruce and Welcoming Communities Grey Bruce. The program offers a central place to help newcomers feel more connected to the community through many resources and partnerships with other local service agencies. Services are free and staff will meet with you in the community where you live, throughout Grey Bruce. Settlement Workers in Schools (SWIS) are also available to help students and family with school aged children.
The Grey Bruce Local Immigration Partnership brings together service providers, settlement agencies, community groups, employers, newcomers and other key organizations across the region to foster a welcoming and inclusive community for newcomers. The initiative is a collaboration between Grey and Bruce Counties and is funded by Immigration, Refugees and Citizenship Canada.
Interpretation Services
The 211 helpline has interpreters available in more than 170 languages. Call 211, press 1 for English and then ask for the language you want to speak in and hold while an interpreter is brought on the line.
For organizations (such as medical clinics) that need to access interpretation services for clients:
Interpreting Services, Remote Interpretation Services - MCIS Languages
Across Languages | A Voice for Every Language
R.I.O. – Remote Interpretation Ontario – Access Alliance
Grey Bruce Health Stats: Languages
Currently, diet related factors represent the top risks for morbidity and mortality in Canada. Research has shown that not meeting dietary recommendations cost Canadians billions in direct health care costs. The pandemic has made it even more clear that diet-related chronic diseases and conditions are a risk factor for infectious diseases like COVID-19.
The Grey Bruce Food Charter expresses the values of the Grey Bruce community to support a healthy, just, economically and environmentally sustainable food system. The Charter acknowledges the right of all to food. The Charter is a commitment to work together to build a vibrant, sustainable, food secure community.
Household food insecurity occurs when there is inadequate or insecure access to food due to financial constraints. This is a serious public health problem in Canada that impacts mental, social, and physical health. The 2017 Canadian Community Health Survey data revealed that 20% of households in Grey Bruce experienced food insecurity and that 21% (or approximately 1 in 5) children and youth under 17 years of age were growing up in a food insecure household in Grey Bruce. PROOF Food Insecurity Policy Research.
The pandemic has resulted in a 36% increase in seniors accessing food banks and 2-3 food bank users reported having less than $100 left after paying for housing and utilities each month. Hunger Report 2021 – Feed Ontario
Because household food insecurity results from financial constraints, it cannot be solved through charitable food provision. Income solutions are needed to respond to food insecurity – not just more food.
Many food literacy programs and emergency food supports exist in Grey Bruce including 22 food banks, 19 Good Food Box sites, and a Student Nutrition Programs in local schools. These programs do not address the root cause of the issue, poverty, but are able to provide valuable social and food skills programming. Contact 211 for the full Grey Bruce listing.
OShare (Owen Sound)
South West Health Line (extensive list of food banks in the region)
Grey Bruce Community Food Programs (COVID Response)
Food Affordability in Grey Bruce
GBHU Food Literacy Videos
Basic Income impact on Health and Wellness
Bruce Grey Poverty Task Force: Food Security
FoodBruceGrey.com
Affordability can be another barrier for some individuals and families living on low incomes. As an example, an individual might go to their local emergency department because they can’t afford health care insurance or the cost of services such as oral health and dental care.
Understanding the fair distribution of resources and responsibilities helps us to recognize the root causes of inequities, the advantages that some groups or individuals have relative to others, and the need to eliminate inequities through collaborative action.
Learn More
Canadian Nurses Association, Social Justice…A means to an end, an end in itself (2nd ed.)
The social determinants of health can influence lifestyle choices and behaviours. Coping with conditions such as low income, food insecurity, unsafe housing, insecure employment and discrimination can lead to high levels of stress. Individuals may adopt unhealthy coping behaviours such as smoking, overeating, alcohol and/or substance use in attempt to relieve such stress having an immediate impact on health. Your Health
Grey Bruce Health Stats: Health Behaviours
Grey Bruce Health Stats: Substance Use
Lack of transportation and limited public transportation can be a barrier limiting access to health services, jobs, social services, recreation and programming. It affects the health of many individuals including women, children and youth, disabled persons, low-income groups, and the elderly.
Movin’ Grey Bruce
Grey Transportation Route (GTR)
Health is influenced by the way that communities are planned and built, as well as by the services and resources available within them. Building relationships with and engaging priority populations is an important aspect of community engagement in order to understand their unique needs, assets, histories, and cultures.
National Collaborating Centre for Determinants of Health: Climate Change and Health Equity
Governments at all levels can influence the availability of social determinants such as housing, employment, recreational opportunities, family benefits or social assistance through policies, laws, and regulations. Healthy Public Policies
The Health Equity Tool and training video was developed by the Moving Health Equity Forward Committee, an action group of the Bruce Grey Poverty Task Force.
When designing or making changes to policies and programs, or when working with your clients, consider these 5 key questions to ensure that you are using a health equity perspective.
If you are making changes for a group or organization, consider the system perspective. If you are making changes in the work you do directly with clients, patients, or other individuals, consider the individual perspective.
System Perspective a) Are all who may be impacted engaged in the planning process? b) What are the roles of each stakeholder? c) Have we used a broad lens to ensure perspectives cross sectors/silos? d) Have we engaged patients, clients, or others who will experience the impact? Individual Perspective a) Were you included in the discussion? b) Is everyone included that you want (e.g., personally, professionally)
System Perspective a) What do the organization and community consider the critical factors for success? b) Have we completed the Health Equity Impact Assessment to identify possible negative impacts and plan for mitigation? Individual Perspective a) Have you asked the stories of people with lived experience? Do you understand what is important to those you serve? b) What is the goal that you want to achieve? What is most important to individuals you serve? c) What steps are important to getting to that goal? d) What is important to providers? Is it the same as what the individual(s) wants to achieve? e) What screening tools can be used to better understand someone’s current situation?
System Perspective a) What is the immediate impact to core agencies and system users? b) What are the ripple effects to other agencies and the community? c) Have we clearly identified the positive and negative impacts? Do we have a plan to mitigate negative impacts? Individual Perspective a) How will this affect you? b) How will this impact those immediately around you? c) What are the positive impacts that we can leverage to help you drive the change? d) What are the negative impacts and how can we reduce them?
System Perspective a) Are all the players willing to move this ahead? b) What are the barriers? c) Are there funding or other systems (political, social) that need to be overcome to make this achievable? Individual Perspective a) Is it a realistic goal or set of goals? b) Do you have what you need to achieve it? c) What things or people do you need to support you to achieve it? d) How confident are you that you can achieve your goal?
System Perspective a) What other key players do we have to engage before we can move ahead (political, funders, etc.)? b) Are there data or supportive information that we need before moving ahead? C) What does implementation look like? Individual Perspective a) What actions do you need to take to move toward your change goal(s)? b) What do you need to help you move ahead with your change goal(s)? c) Do you feel ready to work toward your change goal(s)?
Would you like a hard copy of the Health Equity Tool?
Send us an e-mail and a member of the Moving Health Equity Forward Action Group will be in touch.
The following three video modules are intended to increase awareness of health equity and build capacity for health equity-focused decision-making at all levels of health, social and community service organizations. Please Note: For optimal quality, please download the videos prior to projecting to an external device.
Video 1: Provides an introduction to health equity and the determinants of health.
Video 2: Explains the Grey Bruce Health Equity Tool and components of the tool.
Video 3: Demonstrates how to use the tool online.
The Health Equity Tool and Training Videos were developed with support from Health Link Grey Bruce through a collaborative of the Bruce Grey Poverty Task Force.
References
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