Health Equity

Scarborough Health Network (SHN) is Improving Population Health, Health Equity and System Integration.

What is Health Equity

Health Equity is the absence of health inequities between different socioeconomic groups and is aligned with the ideas of fairness, social justice and human rights. Health Equity aims to reduce or eliminate socially constructed health inequalities that lead to differential health outcomes for different social groups and ensure quality care.

Health Equity at SHN

SHN is Canada’s leading hospital in advancing health equity, serving one of the most diverse communities in the country.

To drive change in health equity forward, we are working with our partners in the community to remove access barriers to quality health care – the physical and intangible things that stand in the way of people getting the help they need. Through actions on social determinants of health, SHN is ensuring the populations we serve reach their full potential through:

Education

SHN is a leader in providing education and knowledge exchange opportunities not only to our staff, but out in the community, creating change by empowering the voices of Scarborough with awareness and knowledge about the social determinants of health. This education is key to reducing health disparities and promoting better health outcomes.

We bring together health care professionals, staff, volunteers, community advocates and local champions to share their expertise and personal experiences. Our education programs set us apart:

Health Equity Certificate Program

In alignment with our strategic direction, SHN has launched the Health Equity Certificate Program in Fall of 2019. This ground-breaking course is shifting the health care landscape through real, hands-on interaction with the industry and its decision-makers.

The sessions will be held over a two-year period with 3-4 sessions each year. Participants will have the opportunity to apply theories and strategies learned in real time by working on an issue relevant to their practice that addresses inequities in Scarborough.

We have participants engage in strategies that will reduce health disparities and promote health. The program will leave participants with a strong understanding of the social determinants of health and how to address them.

Stand Up for Health Training

We invite SHN leaders to participate in Stand Up for Health, an immersive simulation that gives participants a better understanding and appreciation of the social determinants of health through experiential learning. In this training, participants are placed in the role of Canadians living in poverty and must interact, make choices, and solve challenges within their given set of circumstances. In the second half of the training, participants will have a facilitated discussion on challenges faced by marginalized Canadians as well as on public policy that leads to a healthy and equitable society.

Health Equity Rounds

Dr. Shah, Family Physician and SHN’s Director of Global Health, Diversity and Health Equity and Kristy Macdonell, SHN’s Manager of Health Equity, Patient and Community Engagement, will lead you through a quick-hitting, action-packed learning experience that discusses how the social determinants of health matter. This has a specific focus on how income affects health and the importance of income equity. It will provide resources, tools and practical strategies for taking action so that change can be developed.

Empowerment

We build capacity to ensure our patients are empowered to take action through advocacy and gain control over decisions regarding their own care. Equipped with knowledge, they are able to identify the barriers to accessing the care they need and have the tools to overcome them.

Engagement

We work with our Patient and Family Advisors (PFAs) and Community Advisory Council (CAC) and collaborate with our community partner organizations – including diverse, cross-sectoral stakeholders – to help develop services and interventions that advance health equity efforts, creating healthy and vibrant communities.

Excellence

SHN promotes employee diversity, inclusion and equity to foster creativity and innovation, thereby driving our excellence from all dimensions. To support an inclusive and equitable workplace where employees feel empowered to share their experiences and diverse perspectives, we have created supports training and staff development on best practices to address health equity issues.

We provide inclusive and equitable quality care, ensuring we deliver services that meet the needs of the diverse population we serve by providing:

Evidence

Join us in the action as we uncover new understandings of our societal structure and the influence it has over our population’s health. We dig in to generate up-to-date, equity-related data to better understand unmet needs of patients accessing healthcare, and use research evidence to design and implement inclusive practices and interventions.

A look at Scarborough's Population Health

Bringing together communities of leaders, professionals, staff, volunteers and community members, what motivates us is fostering a culture that works towards improving population health and health equity. Through educational opportunities, programming, and other initiatives we are empowering individuals like you to take action through advocacy, addressing barriers the people of Scarborough face when they need help from the health care system.
0
%
of children live in low income families
0
%
of households are headed by a lone parent
0
%
are unemployed (as a % of labour force)
0
%
have no high school education
0
%
of the population are visible minorities
0
% +
speak a language other than English or French as their first language (mother tongue)
0
%
are new immigrants
0
%
are seniors (65 years and over)

Data source – Census 2016, Statistics Canada

Additional related services

Patient Demographic Data Collection

In order to improve our care, SHN is is collecting patient demographic data to better understand the unique needs of our patients and improve the programs and services we provide.

Learn more about coming to the hospital

Global Community Resource Centre (GCRC)

GCRC is an interactive “one-stop” hub that empowers patients, providers and the overall community with the right information and resources to obtain optimal health. Find out about educational opportunities, access to community resources, and our efforts to reduce health disparities and improving population health through social innovation and research.

Learn more

Interpretation Services

Scarborough Health Network (SHN) offers free interpretation services for our patients.

SHN is committed to providing the best health care for our patients, which includes quality patient and family centred care and improved health outcomes.  Removing barriers to communication is one of the ways in which we can achieve these goals and offer our patients dignity in speaking for themselves. Understanding their concerns, symptoms, and fears is essential to ensuring their safety and privacy.

Ask for an interpreter if:

  • You are deaf, deafened or hard of hearing
  • English is not your first language

Full-time interpreters for Tamil and for Mandarin and Cantonese are available to assist with communication between hospital staff, physicians and patients.

The hospital also has telephone interpretation available 24/7 in more than 200 languages. The phones are located in all clinical areas, including patient registration.

If you require interpretation services, please inform the unit or clinic before arriving for your appointment or let your health care provider know when you get to the hospital.

Contact us

Seemi Khan

Health Equity Lead, Health Equity, Patient and Community Engagement

Social Determinants of Health

Social determinants of health are the interrelated social, political, and economic factors that create the conditions, in which people live, learn, work and play. The intersection of the social determinants of health causes these conditions to shift and change over time and across the life span, impacting health of individuals, groups and communities in different ways. To address health disparities effectively and achieve health equity, it requires taking action on the social determinants of health as this has the potential to improve health outcomes at the level of individuals, communities and populations.

Income and Social Status

Social determinant of health icon: Income and Social Status

Income is the most important social determinant of health, as it can directly inhibit access to food, shelter and clothing. When overall living conditions are low, individuals often suffer from poor diet, exercise and psychological health, which can increase the likelihood of substance abuse. A Canadian study on men found that those living in the wealthiest 20% of neighbourhoods lived on average 4 years longer than those living in the poorest 20% of neighbourhoods (Ramirez, Baker & Metzler, 2007; Mikkonen & Raphael, 2010). When looking at income and income distribution as a social determinant of health, it is important to observe how health is related to actual income, and how the ways in which income is distributed affects the overall health of a population.

Employment and Working Conditions

Social determinant of health icon: Employment and working conditions

Employment status and working conditions have significant effects on health status and outcomes amongst populations involved. People with low incomes are associated with poorer health as they are less likely to afford adequate housing and quality food. Work conditions can also significantly influence people’s health and emotional wellbeing. People with high stressful jobs are more prone to high blood pressure, cardiovascular diseases and mental health problems, including depression and anxiety. High stressful jobs are associated with lower income and lower education and are more common among racialized populations, especially women.

Education and Literacy

Social determinant of health icon: Education and literacy

Those who have obtained a higher level of education are often times healthier than those with little or no education. A high level of education is directly correlated to higher income and job security. With high income and job security, individuals have greater access to resources which can benefit their health. Lack of education is not the main factor in poor health, but it does create a barrier by hindering one’s ability to receive proper health care and be knowledgeable of one’s health.

Childhood Experiences

Social determinant of health icon: Childhood Experiences

Early childhood experiences have a long-lasting impact on the social, biological and psychological health and well-being. Healthy childhood development is greatly influenced by inclusive, nurturing environments and the accessibility of social economic resources (Ramirez, Baker & Metzler, 2007; Mikkonen & Raphael, 2010). Research has shown that children living under conditions of material and social deprivation are more prone to negative health outcomes across the entire life course. In Canada, 15% of Canadian children live in poverty (Mikkonen & Raphael, 2010).  Access to affordable and high-quality regulated childcare services is fundamental to healthy childhood development. Yet only 17% of Canadian families have access to regulated childcare (Mikkonen & Raphael, 2010).

Physical Environments

Social determinant of health icon: Physical Environments

Housing is one of the most fundamental determinants of health and well-being. The availability of economic resources is a key determinant in housing security. Health and housing are directly connected with other intersecting factors including affordability, stability, neighbourhood and quality. Lack of adequate and affordable housing pose a significant risk of developing health complications especially for marginalized groups who endure social economic inequalities (i.e. indigenous, immigrants, disabled and elderly). In recent years, rent has increased beyond the cost of living in Canadian major cities where more than 30% of earned income is spent on rent (Ramirez, Baker & Metzler, 2007; Mikkonen & Raphael, 2010).

Housing instability has detrimental effects on an individual’s health. People experiencing homelessness – the most severe form of housing insecurity, face substantially higher morbidity in terms of physical and mental health than the general population. The mortality rate among the homeless population is 8-10 times higher than the general population (Ramirez, Baker & Metzler, 2007; Mikkonen & Raphael, 2010). Families living in low-income neighbourhoods are more likely to develop health complications as they are less likely to afford healthy food choices. Substandard housing conditions, predominantly in low income households, pose a significant health risk due to an increased exposure to lead, poor heating, vermin, and overcrowding. More public investment in affordable housing will reduce health inequities and improve overall quality of life.

Social Supports and Coping Skills

Social determinant of health icon: Social supports and coping skills

Social safety network is a range of services provided by the government to protect the health of citizens during various changes in their life. Life changes include normal transitions (such as having children and seeking housing) and unexpected events (such as accidents, experiencing a loss, developing an illness). As these life changes can be predicators of experiencing poverty, developed nations including Canada, offer services as protection from entering such state. Disability benefits, unemployment insurance, family allowances, retirement plans and more fall under services that act as a social safety net for citizens. Canada however, falls on the lower end in terms of spending on public social safety services including early childhood education, unemployment benefits, services for disabilities and more. Only 17.8% of Canada’s GDP are spent towards public expenditures (Ramirez, Baker & Metzler, 2007; Mikkonen & Raphael, 2010).

Basic security and protection is essential for a well-functioning social safety net. Canadians not only need financial benefits, but also should have access to counselling, employment training and community services in order to experience overall well-being and prevent health-threatening impacts.

Healthy Behaviours

Social determinant of health icon: Healthy Behaviours

Many factors including Lifestyle and health behaviours such as smoking, physical activity, sleeping habits, coping with stress and food choices have significant influence on health outcomes.

Other behaviours affecting overall state of health include health literacy on nutritious food and preventative health practices such as regular medical checkups and screening for cancer and other chronic diseases.

There is a growing recognition on the link between health behaviours and socioeconomic environment in which people live. For instance, people living in low income neighbourhoods have a high prevalence of unhealthy behaviours due to limited access to affordable and healthy food resources, which in turn predisposes them to chronic illnesses such as diabetes and obesity.

Access to Health Services

Social determinant of health icon: Access to health services

According to the Canada Health Act, all Canadian citizens should have access to health services without experiencing financial barriers. The concept of the act was to ensure all residents can access health care on equal terms and conditions regardless of their age, income, health status. Nonetheless, Canadians that fall under the bottom 33% of income earners have difficulty accessing services (Ramirez, Baker & Metzler, 2007; Mikkonen & Raphael, 2010). They experience barriers in accessing a specialist, to provide care on weekends or evenings, and immediate physicians care.

Additionally, these Canadians find Medicare coverage to act as a barrier to reaching their full health potential. To elaborate, Medicare covers only 70% of the total healthcare costs not including drug costs, nursing costs and homecare; resulting in Canadians covering these costs with private insurance or through out-of-pocket spending (Ramirez, Baker & Metzler, 2007; Mikkonen & Raphael, 2010). Due to the lack of full coverage, low income earners are unable to fill their prescription and pay the medical bills.

Biology and Genetic Endowment

Social determinant of health icon: Biology and Genetic Endowment

Our biological make up and genetic endowment serve as a fundamental determinant of health. Genetic endowment refers to the inherited predisposition to a wide range of individual responses that impact health. For example, sickle cell disease is inherited when both parents carry the sickle cell gene. While socio-economic and environmental factors are major determinants of health, genetic and biology factors predispose individuals to health challenges.

Gender

Social determinant of health icon: Gender

Many factors including Lifestyle and health behaviours such as smoking, physical activity, sleeping habits, coping with stress and food choices have significant influence on health outcomes.

Other behaviours affecting overall state of health include health literacy on nutritious food and preventative health practices such as regular medical checkups and screening for cancer and other chronic diseases.

There is a growing recognition on the link between health behaviours and socioeconomic environment in which people live. For instance, people living in low income neighbourhoods have a high prevalence of unhealthy behaviours due to limited access to affordable and healthy food resources, which in turn predisposes them to chronic illnesses such as diabetes and obesity.

Gender specific differences attributed to socially constructed roles have implications on the social determinants of health between men and women. Significant inequities disproportionately disadvantage women and have adverse effect on their health. Women carry more responsibilities for raising children and household duties. In addition, women have limited access to resources, power and decision making, are more likely to engage in precarious employment and experience more workplace discrimination as compared to men. Although Canada has made progress in mitigating poverty, single mothers endure higher poverty due to lack of affordable childcare and the gender pay gap and therefore face major challenges in meeting their health care needs. On the other hand, men are subject to the health effects of gender as they are more likely than women to perform risky activities.

Evidence also shows that experiences of prejudice, discrimination and homophobia against LGBTQ+ Canadians have harmful and lasting effects on health, including mental health.

Culture

Social determinant of health icon: Culture

Studies show that in Canada, visible minorities including recent immigrants and refugees, black and Indigenous populations face racism and discrimination regularly due to societal dominant perceptions and values. For instance, immigrants subjected to Islamophobia and racist attitudes experience humiliation and social isolation due to their perceived status as cultural outsiders. These experiences have a profound impact on their mental health and overall wellbeing.

Linguistic barriers and lack of culturally appropriate services impede access to healthcare among members of the ethnic minorities and their effects are even more visible in mental health care

Race

Social determinant of health icon: Race

Racialized groups including Black, recent immigrants and Indigenous people are among the most marginalized people in Canada who may face additional health risks attributed to everyday experiences of racism. Different manifestations of racism that impact personal well-being and mental health include: institutional racism-discrimination within employment practices, healthcare, education and criminal justice, personally mediated racism-microaggressions that can be dehumanizing and alienating and internalized racism-refers to when those stigmatized consciously or unconsciously accept dominant societal racist stereotypes, views and biases. This can result in self-doubt or hatred of their respective racial group.

Tools and Resources

To ensure that we are taking initiative in addressing the social determinants of health, it is important that we are aware of resources and tools that exist in our community. Through using these tools and resources, we can help our community receive the support they need outside of the health care environment to improve their health status.

COVID-19 Resources

COVID Resources in Various Languages

Centre for Disease Control and Prevention

https://wwwn.cdc.gov/Pubs/other-languages?Sort=Lang%3A%3Aasc&Page=2

COVID-19 Social Care Guidance

This Social Care Guidance tool is developed to guide primary care providers in supporting vulnerable patients

Learn more

Free Dental Services

Toronto Public Health Free Dental Clinics

https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/dental-and-oral-health-services/dental-clinics/

Urban Dental Clinic

Many Canadians earn low incomes and have no access to dental insurance or government social-assistance programs. Established in 2005, the Urban Dental is served by volunteer dentists and hygienists who provide emergency dental care to uninsured low-income adults. Services provided are emergency examinations, x-rays, prescriptions, extractions, fillings and cleanings.

https://www.healthequity.ca/urban-dental-clinic/

General Health Websites

Link to Health Canada website Link to MedlinePlus website

Health Topics

AIDS/HIV
Canadian Aids Society Catie
Aids.org Ontario Aids Network
ALS
als411 ALS Association (U.S.)
ALS Society of Canada ALS Society of Ontario
Walk for ALS
Alzheimers
Alzheimers Society of Toronto Alzheimers Society of Ontario
Alzheimer’s Association

Breastfeeding
La Leche League Canada Public Health Agency of Canada
Toronto Public Health Health Canada – Infant Feeding
Breastfeeding.com World Health Organization (WHO)
National Women’s Health Information Centre

Cancer
Canadian Cancer Society Ovarian Cancer Canada
Colon Cancer Canada Cancer Care Ontario
Cancer View Canada National Cancer Institute (U.S.)
Community Information
Agincourt Community Services Aisling Discoveries
Canadian Hearing Society (CHS) Canadian National Institute for the Blind (CNIB)
Carefirst Seniors Support Services Catholic Cross Cultural Services
Chinese Family Services of Ontario CICS – Centre for Information and Community Service
Community Care Access Centre (Scarborough) East Metro Youth Services
East Scarborough Storefront Mennonite New Life Centre of Toronto
Hong Fook Mental Health Association Phillips Lifeline
Polycultural Immigrant and Community Services Ontario Breast Screening Program
Settlement Assistance and Family Support Services Scarborough Centre for Healthy Communities
Tropicana Community Services Taibu Community Health Centre
Tamil Eelam Society of Canada TransCare Community Services
Yee Hong Centre for Geriatrics Warden Woods Community Centre
Cord Blood
Explore Stem Cells Insception Cord Blood Program
Stem Cell Information Stem Cell Network

Heart
Heart and Stroke Foundation of Ontario Heart Month
Canadian Cardiovascular Society
Canadian Heart Failure Network

Menopause
Menopause and U National Women’s Health Information Centre
Mental Health
Canadian Mental Health Association, Ontario Centre for Addiction and Mental Health
Mental Health and Addiction 101 Tutorials National Institute of Mental Health (U.S.)
WomensHealthMatters.ca Workplace Mental Health Promotion
Multilingual Resources
Consumer Health Information in Many Languages Resources

Natural and Alternative Medicine
Natural Standard National Centre for Complementary and Alternative Medicine

Osteoporosis
Osteoporosis Canada International Osteoporosis Foundtion
Women’s College Hospital

Parkinson’s
Parkinson Society Canada Parkinson’s Disease Foundation (U.S.)
Parkinson’s Disease: MedlinePlus National Institute of Neurological Disorders and Stroke (U.S.)
American Parkinson Disease Association (U.S.) National Parkinson Foundation (U.S.)
Portals
Krames – St. Mike’s Women’s Health Matters
Health Gateway
Psoriasis
Psoriasis Society of Canada The National Psoriasis Foundation

Health Equity Impact Assessment Tool

Health Equity Impact Assessment (HEIA) is a practical, decision-support tool developed by the Ministry of Health and Long-Term Care (MOHLTC) to advance health equity and reduce avoidable health disparities between population groups.

Learn more

For more information, click here.

Interpretation Services

SHN is committed to providing the best health care for our patients, which includes quality patient and family centred care and improved health outcomes.  Removing barriers to communication is one of the ways in which we can achieve these goals and offer our patients dignity in speaking for themselves. Understanding their concerns, symptoms, and fears is essential to ensuring their safety and privacy.

Learn more

Local Resources

*Link to Community Resource Guide once added to library

Learn more

Mental Health Resources

Aisling Discoveries Child and Family Centre

http://aislingdiscoveries.ca

Togetherall

https://togetherall.com

Bounce Back

https://bouncebackontario.ca/

Canadian Mental Health Association (CMHA)

https://cmha.ca

East Metro Youth Services

http://emys.on.ca

East Scarborough Storefront

https://thestorefront.org

Family Services of Toronto

https://familyservicetoronto.org

Youth Link

http://youthlink.ca

OHIP-Covered Physiotherapy Services

Toronto Central Healthline

https://www.torontocentralhealthline.ca/listservices.aspx?id=11019&roegion=Scarborough

 

OHIP-Covered Physiotherapy Services

You must have a valid Ontario health card and a referral from a physician or nurse practitioner and be age 19 or younger, or age 65 or older, or any age after overnight hospitalization for a condition that requires physiotherapy, or a recipient of Ontario Works or the Ontario Disability Support Program.

Organization

Address

Contact Information

Canadian Physiotherapy Centre 2967 Sheppard Ave. E.

Toronto, ON  M1T 3J5

 

Tel: 416-493-0703
Lifemark Physiotherapy Scarborough Village – Scarborough 3481 Kingston Rd,

Toronto, ON  M1M 1R4

 

Tel: 416-266-8844
Novo Peak Health – Scottfield 60 Scottfield Dr, Lower Level Toronto, ON  M1S 5T7

 

Tel: 416-298-0474
PT Health Central Scarborough Physiotherapy 2155 Lawrence Ave. E., Suite 14

Toronto, ON  M1R 5G9

 

Tel: 416-755-0879
Scarborough North Physiotherapy Clinic 3443 Finch Ave. E., Suite 407 Toronto, ON  M1W 2S1

 

Tel: 416-499-6635
Seaver Physiotherapy 1121 Bellamy Rd N, Unit 8 Toronto, ON  M1H 3B9

 

Tel: 416-438-6792
Town Centre Rehab Clinic Scarborough 60 Brian Harrison Way, Unit 4 Toronto, ON  M1P 5J5

 

Tel: 416-296-1788
Lifemark Physiotherapy Clinic Toronto – Bathurst Street 1500 Bathurst St, Unit 6

Toronto, ON  M5P 3L3

Tel: 416-651-0824

Tel: 416-651-0040

Ontario Drug Benefit Program

Ontario Drug Benefit Program helps Ontario residents pay for prescription drugs. Please click the link below to find out who qualifies and what is covered.

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Poverty Tool

This clinical tool offers specific resources to help health care providers screen for and respond to poverty concerns in patient encounters, particularly when caring for underserved, vulnerable, and marginalized populations.

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Social Prescription

Social prescribing is a specially structured way of referring people to a range of local, non-clinical services. It complements clinical treatments and seeks to address people’s needs in a holistic way. This asset-based approach goes beyond treating illnesses. It recognizes people as not just patients with needs, but as community members with gifts to share, while supporting them to engage with and contribute back to their communities.