Jennifer Butler, B.Sc.(Pharm)

Determining Health: What Our Governments Choose to Prioritize

Thank you to Amber Bacic for her collaboration and assistance in acquiring resources from her home province of British Columbia. 

Determinants of health are an important concept when looking to study or understand the health of an individual or a population. So how do our governments consider them in policymaking and the administration of our healthcare systems? I was recently tasked with taking a look at the resources that discuss this concept both at a federal and a provincial level. I was then challenged to compare my provincial resources with those of another province. 

A National View

As defined by the Public Health Agency of Canada (PHAC), determinants of health are “the broad range of personal, social, economic and environmental factors that determine individual and population health”. They include:

  1. Income and social status,
  2. Employment and working conditions,
  3. Education and literacy,
  4. Childhood experiences,
  5. Physical environments,
  6. Social supports and coping skills,
  7. Healthy behaviours,
  8. Access to health services,
  9. Biology and genetic endowment,
  10. Gender,
  11. Culture, and
  12. Race / Racism (PHAC, 2001).

This definition is provided on a Government of Canada web page titled “Social determinants of health and health inequities”. On this page, PHAC provides a brief explanation and examples of the social determinants of health (SDHs), such as income, education, employment, racism, etc. They go on to explain how SDHs contribute to health inequity in Canada, and provide a curated list of resources on reducing health inequities (PHAC, 2001).

A Manitoba Lens

While, it does not appear that Manitoba Health or the Manitoba Government formally acknowledge the determinants of health on their website, Chief Provincial Public Health Officer Dr. Brent Roussin used his 2022 report on the health status of Manitobans to discuss the impact of the SDHs in the province. In chapter 2 of his report, he states that four SDHs are driving the health disparities of Manitobans: racism, stigma, colonialism and residential schools and the trauma they inflicted on the survivors, their families and their communities (Roussin, 2022). 

In a 2022 report on improving mental health and community wellness, the Manitoba Government identifies several key priorities. The priorities specifically addressing SDHs include improving access to services, as well as creating and improving social services and supports. Furthermore, the report emphasizes that all initiatives must be undertaken in collaboration with Indigenous partners and communities (Government of Manitoba, 2022).

Shared Health, the Manitoban health authority, has a page on their website dedicated to “disrupting racism”, which provides learning resources, surveys, data and more (Shared Health, n.d.). 

The Southern Chiefs’ Organization (SCO) is a political entity that represents the 32 Anishinaabe and Dakota Nations in southern Manitoba. One of their priorities is establishing a self-determined, decolonized healthcare system for their communities (SCO, n.d.). In a 2024 report responding to Indigenous health legislation, SCO states that decolonization, proposed as Canada relinquishing control of the lands, people and culture of the Nations represented by SCO, is required in order to address what they refer to as colonial or Western determinants of health caused by conditions of poverty. This will allow them to implement a holistic approach based on First Nations determinants of health. According to this report, Western determinants of health are the societal influences on health, defined as physical and mental wellbeing. Whereas First Nations health “encompasses everything from physical, mental, emotional and spiritual well-being to the preservation of the land, culture and language” (SCO, 2024). 

So How About British Columbia?

In 2024, the BC Ministry of Health published a detailed framework outlining their long-term strategy to improve the health of all people of BC and promote health equity. Within this framework, they establish several priorities, all of which they plan to address looking through a lens of Truth, Rights and Reconciliation, anti-racism and health equity, and system capacity.  Priorities laid out in this report that specifically address SDHs are: reducing unfair disadvantages faced by pregnant people, children and families; acknowledging, understanding and reducing the impact of climate change on health; preventing and reducing harm from psychoactive substance use; and improving the mental health and wellness of the population, including by cultivating connection to the land, language, place and community (BC Ministry of Health, 2024). 

An Interprovincial Comparison

Overall, compared to the Manitoba Government, the BC Government provides a more detailed, in depth view of how they prioritize determinants of health in improving the health of their province’s population. Where the BC Ministry of Health framework is a forward-thinking roadmap, the report from Dr. Roussin provided a retrospective view on the health of Manitobans, with recommendations for establishing priorities (Roussin, 2022). The Mental Health and Community Wellness report published by the Manitoba Government provides a high-level perspective on addressing SDHs, such as establishing goals of improving access and providing social services (Government of Manitoba, 2022). Comparatively, the BC Ministry of Health framework is well-rounded and describes their priorities with a greater level of detail, such as providing details on how they will reduce disadvantages for pregnant people or address the impact of climate change on health (BC Ministry of Health, 2024). 

That being said, there is some overlap between the two provinces’ specific priorities for addressing determinants of health. Both prioritize addressing racism broadly, as well as anti-Indigenous racism and colonialism. However, Manitoba places a much stronger emphasis on anti-Indigenous racism, whereas British Columbia’s focus is more distributed across multiple areas. This distinction likely reflects the demographic differences between the two provinces—according to the 2021 Census, 18.1% of Manitoba’s population is Indigenous, compared to 5.9% in British Columbia (Government of Canada; Indigenous Services Canada, 2023). 

References

BC Ministry of Health. (2024). British Colombia’s Population and Public Helath Framework: Strengthening Public Health. BC Ministry of Health. https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/public-health/pph-framework/bc_population_and_public_health_framework.pdf

Government of Canada; Indigenous Services Canada. (2023). An update on the socio-economic gaps between Indigenous Peoples and the non-Indigenous population in Canada: Highlights from the 2021 Census [Report]. https://www.sac-isc.gc.ca/eng/1690909773300/1690909797208

Government of Manitoba. (2022). A Pathway to Mental Health and Community Wellness. Government of Manitoba. https://www.gov.mb.ca/asset_library/en/mhcw/docs/roadmap.pdf

Public Health Agency of Canada. (2001, November 25). Social determinants of health and health inequalities [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Roussin, B. (2022). 2022 Manitoba Health Status Report. Government of Manitoba. https://www.gov.mb.ca/health/cppho/docs/health-status-2022.pdf

Shared Health. (n.d.). Disrupting Racism. Shared Health. Retrieved February 17, 2025, from https://sharedhealthmb.ca/about/racism-disrupted/

Southern Chiefs’ Organization. (n.d.). Southern Chiefs’ Organization Inc. Retrieved February 22, 2025, from https://scoinc.mb.ca/

Southern Chiefs’ Organization. (2024). Decolonization: Recognizing First Nation Sovereignty 2024. https://scoinc.mb.ca/wp-content/uploads/2024/11/SCO-Decolonization-Report-Nov-2024-FINAL.pdf

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