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What is the relevance of SDG 3 to a high-income country like Canada? And how do we truly implement a universal development agenda? These were just some of the themes discussed at the Canadian Public Health Association’s annual conference in Toronto from June 13th to 16th. SDSN Manager Lauren Barredo participated, describing the UN processed to set the goals, targets, and indicators, and sharing opportunities for Canada to lead on implementing SDG 3.

20160614_195708Fellow panelists included Kira Fortune, Acting Chief of the Special Program on Sustainable Development and Health Equity at the Pan American Health Organization, Alessandra Guedes, Regional Advisor on Family Violence for the Pan American Health Organization, and Dionne Patz, Public Health Policy and Program Advisor in the Office of the Assistant Director at the Pan American Health Organization. Their panel focused on the transition from the Millennium Development Goals to the Sustainable Development Goals, and how it will affect Canada’s health sector. Several opportunities were identified given the broader agenda of the SDGs. For example, the SDGs emphasize health systems strengthening and the need for all countries to implement universal health coverage (UHC). Canada’s national health system has largely been a great success; while inequalities in access to care remain, for the most part Canadians have access to affordable, high-quality care. Canada therefore has many lessons to share with other countries as they expand coverage, and an opportunity to reduce inequalities nationally over the next 15 years. In addition, the SDGs offer an opportunity to strengthen data and information systems for healthcare, to support improved programs and outcomes nationally, as well as increase the ease of reporting. Here too Canada is ahead of many countries, with Statistics Canada making a large amount of health data publically available online while still protecting privacy. Canada could offer capacity building and technical assistance to other countries aiming to develop similar data portals, and the data collection and analysis infrastructures that support them.

afcd77d6cea67301fd8025f6a16205aePerhaps the most important aspect of the SDGs is their interdisciplinary nature. While SDG 3 focuses on health systems and diseases, several other SDGs touch on the environmental and social determinants of health. SDG 6 covers clean water and sanitation, important environmental determinants of health. Polluted drinking water is responsible for over half a million under-age-five deaths from diarrhea each year. Kira Fortune explained that the SDGs offer the health sector an opportunity to push for a “health in all policies” approach, where ministries of health work with other ministries to ensure all programs and initiatives reap possible health benefits.

The broader conference touched on a number of topics at the nexus of the determinants of health and the SDGs. In a plenary presentation, Alessandra Guedes shared some alarming statistics on links between domestic violence and community health. One in three women experience partner violence or sexual violence by a non-partner in their lifetime. Survivors are roughly twice as likely to experience depression or have an alcohol use disorder, and are 16% more likely to deliver a low birth weight baby. Therefore, domestic violence has implications for society as a whole, and even future generations. These issues are handled by multiple SDGs: 3 (health), 6 (gender equality), 10 (inequality), and 16 (peace, justice, and governance), and therefore the SDGs offer a framework to bring about real change.

The conference also devoted a lot of attention to inequalities in health outcomes across different social groupings, including income, race, ethnicity, age, gender, and disability. In a plenary on the racialization of Canadian society and health equity, Ingrid Waldron of Dalhousie University described some of the ways that race and racism affect health. For example, racism causes stress, and chronic stress affects cortisol levels and can cause poor health. Race also shapes the way patients are diagnosed and treated, for example black men are more likely to be diagnosed with schizophrenia, and black women are less likely to be diagnosed with depression. She recommended looking at the social determinants of health through a lens of inequality, and finding policies that can address inequality in a sensitive way. David McKeown of the Toronto Department of Public Health suggested that since health professionals already recognize and understand some of the social determinants of health, there is a good foundation to begin a deeper conversation and implement further solutions. Charlotte Loppie of the University of Victoria called on those present to think about the kinds of privilege they benefit from, and how it can be used to improve the system, support others, bring new voices to the table, and reduce inequality.

The SDSN is currently partnering with the Pan American Health Organization to develop online course materials to help public health practitioners better understand and address the social and environmental determinants of health described above. To achieve the SDGs, health workers need to be able to both recognize these factors, and partner effectively with other ministries to improve health outcomes. For example, treating diarrheal disease at a health facility can save the life of a child, but in the long term a ministry of health needs to be able to work with sanitation departments, water authorities, community groups, and other actors to identify problems and address the main causes. Stay tuned for more information on our upcoming online course that will examine these themes in detail!

For more information on the CPHA conference event, please visit http://www.cpha.ca/en/conferences/conf2016.aspx.