There is substantial evidence that social and economic factors - such as poverty, lack of education, precarious working conditions, and racial discrimination to name a few - play a profound role in creating access barriers to healthcare services and contribute to poor health outcomes.1 These factors, widely recognized as the social determinants of health, are shaped by the unequal distribution of resources and power based on social identity and location. Ultimately, social determinants of health form the foundation for the widening health disparities experienced by structurally underserved communities worldwide.2,3 In Canada, for example, people with lower income have shorter life expectancies4; and racialized populations experience higher rates of chronic diseases (e.g., hypertension and diabetes) and medical racism with negative impacts on mental and physical health.5,6
The COVID-19 pandemic has shone a spotlight on the structural drivers of health inequities and has emphasized the importance of understanding the relationship between social conditions and health outcomes. It cannot be denied that the virus is a shared enemy threatening the safety and well-being of the entire world. The health burdens, experiences, and outcomes, however, are not the same for everyone. This public health crisis has reinforced and exacerbated long existing inequities and chronic disinvestment in public health, which has resulted in certain communities (e.g., Black and Indigenous communities, low-income residents, individuals experiencing homelessness, immigrants and refugees, and essential workers) to be disproportionately impacted by higher rates of COVID-19 infection, hospitalization, and mortality.5
For our issue on Social Determinants of Health, UTMJ invited Professor Arjumand Siddiqi, Canada Research Chair in Population Health Equity, and Falan Bennett, MPH Candidate at the Dalla Lana School of Public Health, to reflect on social inequalities perpetuated further during the COVID-19 pandemic. They discuss the role racism and capitalism have played in differential health outcomes for communities in Canada and provide solutions that prioritize health equity over economic benefits.
UTMJ also had the privilege to interview a number of highly respected leaders in the fields of healthcare advocacy and policy, primary care, and global health. Interviewees shared their insights into leadership strategies and the impact social determinants of health, further exacerbated by the COVID-19 pandemic, has had on patient wellbeing and our society as a whole. Dr. Allan Grill, the Chief of Family Medicine at Markham Stouffville Hospital shared his insights into developing a strategy for the Long-term Care facilities in Markham, Ontario at the beginning of the COVID-19 pandemic. Dr. Danielle Martin, the Executive Vice-President and Chief Medical Executive of Women's College Hospital, discussed her career trajectory towards becoming a leader in healthcare policy and provided advice on how individual physicians can mitigate the impact of social determinants of health on their patients. Next, UTMJ spoke with Dr. James Owen, a family physician at St Michael's Hospital, whose practice focuses on HIV primary care and prevention, 2SLGBTQIA+ health, and the care of vulnerable populations. In his interview, he discusses how the COVID-19 pandemic has impacted the way physicians connect with their patients and the important role patients can play in healthcare policy design and implementation. Another interviewee was Dr. Kwame McKenzie, CEO of the Wellesley Institute, Professor of Psychiatry at the University of Toronto, and the Director of Health Equity at the Centre for Addiction and Mental Health. With his interview, the focuses on the fallout we expect from the COVID-19 pandemic, especially its impact on mental health outcomes and urges for a proactive strategy to provide essential healthcare services for mental wellbeing. Finally, the UTMJ also interviewed Dr. Rachel Spitzer, paediatric and adolescent gynaecologist at Mount Sinai Hospital, who discusses the impact social determinants of health and the COVID-19 pandemic has had on this unique patient population.
The UTMJ takes pride in supporting manuscript submission by trainees all over the world. In this issue, Emily Snook from the Department of Medicine, University of Toronto and Kelly Perlman from the Douglas Mental Health Institute, McGill University received the first prize trainee submission award. Their co-authored paper, entitled “A systematic meta-review of predictors of adverse effect development in response to antidepressant medications,” reviewed genetic and non-genetic factors that contribute to antidepressant induced adverse effects, which may help with clinical decision making regarding optimal antidepressant therapy for patients.
This is the second issue of the University of Toronto Medical Journal’s 98th volume. We would like to sincerely thank our dedicated editorial team for all the hard work that went into preparing this issue, and their continued efforts in the upcoming issue. We are grateful for the patrons and faculty that continue to support the University of Toronto Medical Journal and the authors that have allowed us to showcase their important work and provided insight into the role social determinants play in influencing health outcomes. We hope that you find this issue informative and thought-provoking.
- Social determinants of health and health inequalities [Internet]. Canada: Government of Canada; c2020 [cited 2021 March 31]. Health. Available from: https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html.
- National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on Community-Based Solutions to Promote Health Equity in the United States. Te Root Causes of Health Inequity. In: Communities in Action: Pathways to Health Equity. Baciu A, Negussie Y, Geller A, et al., editors. Washington (DC): National Academies Press (US); 2017.
- Mikkonen J, Raphael D. Social Determinants of Health: Te Canadian Facts. Toronto: York University School of Health Policy and Management; 2010.
- Bushnik T, Tjepkema M, Martel L. Socioeconomic disparities in life and health expectancy among the household population in Canada [Internet]. Canada: Statistics Canada; c2020 [cited 2021 March 31]. Available from: https://www150.statcan.gc.ca/n1/pub/82-003-x/2020001/article/00001-eng.htm.
- Ontario Agency for Health Protection and Promotion (Public health Ontario). COVID-19 – What we know so far about... social determinants of health. Toronto, ON: Queen’s Printer for Ontario; 2020
- Gore D, Kothari A. Social determinants of health in Canada: Are healthy living initiatives there yet? A policy analysis. International Journal for Equity in Health. 2012;11(1), 41.