Regional Differences in Social Determinants of Health – Ontario vs British Columbia

Co-authored with Erin Brennan

Government of Canada defines determinants of health as (Government of Canada, 2018):

  • Income and social status

  • Employment and working conditions

  • Education and literacy

  • Childhood experiences

  • Physical environments

  • Social supports and coping skills

  • Healthy behaviours

  • Access to health services

  • Biology and genetic endowment

  • Gender

  • Culture



The determinants of healthcare are described to understand what the health inequalities are for a specific population. Ontario is a very dispersed population ranging from rural communities in northern Ontario to very dense urban areas in the Greater Toronto Area (GTA). Health inequalities are very different for both areas.

Within the GTA 28.5% of the population are new immigrants compared to 20.6% nationally (Ontario Population, 2015). Therefore, Public Health Ontario has to ensure that programs in the GTA can reach a variety of different cultures and ethnic backgrounds (Ontario Population, 2015).

The GTA is a very dense population with a high amount of pollution from major highways and industry. 28% of Ontario residents live near major highways and a high volume of GTA residents commute into Toronto every day. Close vicinity to highways as well as commuting on a daily basis exposes individuals to Traffic Related Air Pollution (TRAP). Exposure to pollutants causing TRAP can cause the onset or worsen symptoms of asthma (TRAP, 2016). The Board of Health of the City of Toronto has requested that Public Health Ontario conduct air quality tests near buildings with vulnerable populations such as; schools, day care centers and long term care facilities.

Accessibility to health care for most in the GTA is not an issue as there is a high volume of centers offering a multitude of health services. However, within the Toronto area there is a high volume of homeless individuals that do not seek the medical treatment they require (i.e. mental illness, addictions or tuberculosis.) There is a new program being implemented called the Shelter Health Services Pilot that will aid in providing better access to healthcare for the homeless population.

However, for Northern Ontario communities access to healthcare is very limited due to the low density population and large area. Northern Ontario communities that exist within the North East LHIN and North West LHIN have a decreased life span and more likely to have a premature death due to mental illness or other ailments. Both of these areas house only 6% of the Ontario population (Health in the North, 2017). Primary care providers have a harder time accessing their patients due to the large are and decreased density of the population. Recent initiatives have been put in place by the province to decrease the health inequalities for these patients.

  • Ontario Telemedicine Network

  • Allows patients to reach specialists or primary care providers to avoid travelling long distances to large urban centers.

  • Mobile health units

  • Travel to different community to provide specific services to areas that do not offer them

  • Mammography, eye exam, diabetes checkups and chronic obstructive pulmonary disease check ups are the programs offered through these mobile health units.

  • Northern Travel Grant

  • Offers funding to patients and one companion to urban centers for specialized treatments that are not offered in their communities.

In Northern Communities there is a high volume of indigenous communities. Current research is being implemented to provide guidance to public health units to develop processes to effectively communicate to First Nations and Metis communities in a respectful and beneficial manner to provide a better healthcare service (Talking Together, 2018). As of now, public health units have little guidance on how to communicate with First Nations and Metis communities.  However, now northern health care providers are asked to complete cultural competency training to improve the healthcare relationship with Indigenous communities (Talking Together, 2018).


British Columbia:

Similarly to Ontario, British Columbia has a dispersed population, with density centered in the lower mainland. Like Ontario, British Columbia has identified specific populations who experience poorer health than other British Columbians (PHSA, 2011). The Provincial Health Services Authority (PHSA) identifies those populations as those: living in poverty, with mental health or substance abuse, aboriginal peoples, immigrants, and refugees (PHSA, 2011).  However, unlike Ontario, British Columbia has prioritizes Aboriginal Health; with particularly attention on the well-being of infants, children, and families. This mostly targets rural populations, and those living on reserve. Aboriginal populations overall rank lower on education, and higher in unemployment compared to non-aboriginal Canadians (NCCAH, 2013). By focusing on the youngest sector of the population, several indigenous-specific determinants of health can be addressed such as Education and Literacy, and Employment and Working Conditions.  This may be a long-term approach, but one that should improve several determinants for the target population.


Another priority in BC is chronic disease prevention (PHSA, 2011). The province has prioritized the populations named above in attempts to reduce health inequities.  Decreasing chronic disease within these populations, would not only improve the health of British Columbians overall, it is estimated that it would reduce costs associated with health inequities by up to $2.6 billion (PHSA, 2011, Health Officers Council of BC, 2008).  As the PHSA states, that while “Inequities generally exist along two major gradients: socioeconomic status and geographic status (i.e. urban vs. rural location)…inequities also appear along other gradients such as ethnicity, gender, age, and disabilities” (2011). Disentangling health inequities from other factors such as cultural traditions, social behaviours, and economic barriers is a challenging task that would take carefully developed programs, target to unique populations.  We believe this is why the province has chosen to focus on providing affordable housing, improving food and income security, and promoting early childhood development (PHSA, 2011). We see this as an approach that blankets several priority populations at once. Programs such as Strong Start, inclusive Friendship Centres (previously Aboriginal Friendship Centres), and vigorous political focus on Affordable Housing, do not require specific application to individual groups or cultures, but address chronic disease prevention by reducing health inequities for all populations accessing the service.




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Health Officers Council of BC. (2008). Health inequities in British Columbia: Discussion paper. Vancouver, BC: Public Health Association of BC.

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Provincial Health Services Authority, (2011). Towards Reducing Health Inequities: A Health System Approach to Chronic Disease Prevention. A Discussion Paper. Vancouver, BC: Population & Public Health, Provincial Health Services Authority. Retrieved from

Reducing Health Risks From Traffic Related Air Pollution (TRAP) in Toronto. 2017. Retrieved from.


Relationship building with First Nations and public health: Exploring principles and practices for engagement to improve community health. 2018. Retrieved from.

Talking Together To Improve Health: Review of the Literature. 2017. Retrieved from.


Toronto Shelter Users to Have Better Access to Health Services: Province and City Providing More Support for People that are Homeless. 2018. Retrieved from.


Traffic related Air pollution: Avoiding the Trap Zone. 2016. Retrieved from.

Vision mission, Mandate and Values. 2016. Retrieved from.

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