In 2013, researchers examined the capacity of municipal governments to reduce health inequities (Collins & Hayes 2013). When they examined the issue amongst municipal politicians and senior-level staff, respondents believed that higher levels of government had a greater responsibility for health; however, they felt that at the municipal level, investing in parks and recreation facilities, as well as affordable housing and recreational programs were considered health policy and planning options that were available for municipal governments.
Knowledge about the social determinants of health (SDH) varies amongst levels of government, stakeholders, and the public in general (Canadian Council on Social Determinants of Health 2014), but I argue that municipal government has a significant role to play in addressing health inequities and enhancing individual and community wellness.
The social determinants of health (SDH) are the socio-economic realities that influence health and quality of life, and these factors have an impact on community members regardless of their individual health choices.
One well known Canadian framework list fourteen SDH including: Income and Income Distribution, Education, Unemployment and Job Security, Employment and Working Conditions, Early Childhood Development, Food Insecurity, Housing, Social Exclusion, Social Safety Network, Health Services, Aboriginal Status, Gender, Race, and Disability (Mikkonen & Raphael 2010).
Collins & Hayes (2010), argue municipal governments have a role to play in addressing health inequities but more research is needed to support municipalities in understanding their role in community health, and developing new policies that are proactive, innovative, and locally responsive to residents needs.
As the Mayor in Happy Valley-Goose Bay, I believe that municipalities can and should be enabled to play a leading role in improving public health. The Town of Happy Valley-Goose Bay is an urban community located in the Canadian sub-Arctic, and home to a multicultural population, of which approximately half are Indigenous peoples.
In reviewing our recent 2017 municipal budget through a SDH lens, it is clear that there are several intersections between municipal governance and opportunities to improve residents’ living conditions. For example, municipal taxation and its impact on disposable income, tax discounts based on household income levels to address income distribution issues, investments in water quality, wellness infrastructure with new childcare spaces, and safer transportation networks – all of these decisions also directly and indirectly impact on individual health outcomes.
The municipality has also invested in wastewater treatment facilities, new playground equipment, revitalization of healthy environments such as Birch Island, the study of trail networks to encourage active transportation, adherence to development regulations, and extensive advocacy for municipal inclusion in major decision-making processes related to resources developments that have major socio-economic impacts on the community, advocacy for affordable housing and homelessness solutions, improved mental health services, and general promotion of an inclusive environment for all residents.
It is clear that municipal services, infrastructure, and representative responsibilities connect directly with creating healthy communities and there are opportunities to invest in municipalities with community and individual health in mind. Further study in this area is warranted, as the linkages between municipal decision-making and health outcomes and health enhancements are still little known. Additionally, with more understanding, there may be opportunities to divert some health expenditures to support municipal level programming aimed at pro-actively supporting health through local policies and initiatives.
There is an exciting opportunity to consider a new SDH framework (Canadian Council on Social Determinants of Health 2015) that provides guidance to municipal leaders and administrators, allowing municipal budgets to be analyzed through this SDH lens on an annual basis, and to see what decisions are made with municipal tax dollars that connect with determinants of healthy communities.
Canadian Council on Social Determinants of Health. (2015). A Review of Frameworks on the Determinants of Health. Retrieved from http://ccsdh.ca/images/uploads/Frameworks_Report_English.pdf
Canadian Council on Social Determinants of Health. (2014). Communicating the Social Determinants of Health Guidelines for Common Messaging. Retrieved from http://ccsdh.ca/images/uploads/Communicating_the_Social_Determinants_of_Health.pdf
Collins, P. A., & Hayes, M. V. (2010). The role of urban municipal governments in reducing health inequities: A meta-narrative mapping analysis. International Journal for Equity in Health, 9(1), 13. doi:10.1186/1475-9276-9-13 Retrieved from https://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-9-13
Collins, P. A. P., & Hayes, M. V. P. (2013). Examining the Capacities of Municipal Governments to Reduce Health Inequities: A Survey of Municipal Actors’ Perceptions in Metro Vancouver. Canadian Journal of Public Health, 104(4), e304-310. Retrieved from http://journal.cpha.ca/index.php/cjph/article/view/3873
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. Retrieved from http://www.thecanadianfacts.org/