Placing Health in Welfare Policy: A HIAP Approach in Ontario Canada
Mots-clés :
social assistance, policy analysis, health-in-all-policies, social determinants of healthRésumé
Increasingly, the relationship between social factors and health has been reflected in social policy. Through a focus on social determinants of health (SDOH), there has been a shift towards health promotion. However, there is little understanding of how extensively considerations of health impacts have been taken up in social policy. Such understanding would identify where more attention to SDOH could better address the needs of those most at risk for poor health. The purpose of this paper is to explore how SDOH are considered within Ontario’s Social Assistance government policies and reflections on Ontario’s Social Assistance (SA) Program through a health-promotion lens.
This examination will facilitate a proposal on how Ontario’s social assistance program can be aligned with a Health-in-all-Policies (HiaP) approach to strengthen health outcomes within SA. A policy analysis was conducted on publicly available Ontario social assistance program documents. Twenty-two documents were analysed using the principles of interpretative description. Four main themes emerged: 1) a health-enabling social assistance system improves population health outcomes; 2) overlooking the role of social determinants of health produces health inequities 3) protecting and promoting health is a central goal; and 4) a cross ministerial approach to health outcomes is desirable. These four themes were checked against the HiaP checklist (developed for this paper and presented in table 2) to ensure the themes that emerged from this study themes that emerged aligned with the HiaP features identified in the checklist established. Findings reflect the extent to which this approach is adopted in social assistance policy and highlight the need for a deliberate and integrated strategy to address SDOH and improve health equity through social policy.
Résumé
La relation entre les facteurs sociaux et la santé se reflète de plus en plus dans la politique sociale. Grâce à l’accent mis sur les déterminants sociaux de la santé (DSS), un basculement vers la promotion de la santé s’est produit. Pourtant, il est difficile de déterminer le degré d’implication de la prise en compte des impacts sur la santé dans la politique sociale. Une telle compréhension permettrait d’identifier comment donner plus d’attention aux DSS afin de mieux répondre aux besoins des plus vulnérables. Le but de cet exposé est d’évaluer comment sont considérés les DSS au sein des politiques gouvernementales sur l’aide sociale de l’Ontario et des réflexions sur le programme d’aide sociale (AS) de l’Ontario dans l’optique de la promotion de la santé. Cette analyse rendra possible un projet par lequel le programme d’aide sociale de l’Ontario s’accordera avec l’approche de la Santé dans toutes les politique (SdTP) pour renforcer les résultats sur la santé au sein de l’AS. Une analyse politique a été effectuée sur les documents publics en lien au programme d’aide sociale de l’Ontario. Vingt-trois documents ont été analysés en utilisant une approche interprétative. Quatre principaux thèmes revenaient : un système d’assistance sociale favorisant la santé améliore les résultats sur la santé de la population ; négliger le rôle des déterminants sociaux de la santé créé des inégalités en matière de santé ; protéger et promouvoir la santé sont des objectifs clés ; et une approche interministérielle sur les résultats sur la santé est encouragée. Ces thèmes ont été vérifiés selon la liste SdTP, un outil développé dans le cadre de cet article afin de s’assurer que les thèmes correspondant aux caractéristiques établies d’une approche SdTP. Les résultats illustrent à quel point cette approche est utilisée dans la politique d’aide sociale et soulignent aussi le besoin d’une stratégie réfléchie et cohérente afin de répondre aux DSS et d’améliorer l’égalité de la santé à travers la politique sociale.
Mots clés: assistance sociale ; analyse des politiques ; santé dans toutes les politiques ; déterminants sociaux de la santé
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