In our pursuit of well-being, it's undeniable that the healthcare system plays an essential role. Yet, extensive research underscores the profound impact of social determinants on our ability to lead healthy lives. In his 2015 book, "The Health Gap," Michael Marmot explains how the conditions surrounding our lives, from the circumstances of our birth to the places we grow, live, work, and age, have a profound influence on health disparities across our lifetime. Marmot stresses that it's not merely poverty, but the far-reaching inequities that truly drive ill health. Regrettably, this concept finds validation within my own hometown.
At the heart of Hamilton, Ontario, you'll find one of Canada's most advanced healthcare centers—a hub that provides comprehensive acute care services, including tertiary and quaternary care for those grappling with cardiac issues, neuro-trauma, and stroke. However, the residents of Hamilton's core, who reside close to this medical marvel, experience significantly shorter and less healthy lives compared to their counterparts in other parts of the city (DeLuca and Kanaroglou, 2015). This grim reality was shared with Hamiltonians in 2010 when the local newspaper ran a series of articles under the banner of "Code Red."
“Code Red” combined straightforward statistics with compelling narratives from community members and stakeholders. Its aim was to spotlight the profound challenges faced by those living in Hamilton's core. The series initiated a much-needed conversation within the community regarding health disparities, with a specific emphasis on the social determinants of health. This was a significant milestone because, despite the evidence indicating that social and structural factors are pivotal in shaping health outcomes, public opinion has long held onto the misconception that health is primarily a product of individual choices and behaviors (Churchill. E., et al., 2021). Initiatives like the "Code Red" series are essential for reshaping the misconceptions to achieve an informed public.
Most importantly, the “Code Red” series generated a collection of initiatives by the municipal government, educational institutions, and the city's healthcare systems. For example, Hamilton Health Sciences introduced the "Hospital 2 Home" program, a groundbreaking initiative that identifies individuals who frequently utilize the Emergency Department and selected interventions to improve their overall health and well-being. These interventions were focused on social determinants of health such as securing housing, establishing food security, and organizing social connections, achieved through community home visits.
While the various initiatives showed promise and garnered some success, a subsequent follow-up series titled "Code Red: Ten Years Later" highlighted the imperative for continued efforts to rectify equity issues for those living in Hamilton's core. Despite only modest improvements, now is not the time to waver, but rather an opportunity to deepen our commitment. We must persevere, keep these vital conversations and actions alive, and continually strive for improvement in the pursuit of a healthier, more equitable future for all residents of Hamilton.
Churchill, E., et al. (2021). Effectiveness of Narrative Messaging Styles about the Social Determinants of Health and Health Inequities in Ontario, Canada. International Journal of Environmental Research and Public Health, 18, 1-13.
Deluca, P., Buist, S., Johnston, N. (2012). The Core Red Project: Engaging Communities in Health System Change in Hamilton, Ontario. Social Indicators Research, 108, 317-327. https://www.zotero.org/dlaforce1d/items/IY9J7K9U/attachment/BEBM9C8D/reader
Deluca, P., Kanaroglou, P. (2015). Code Red: Explaining Average Age of Death in the City of Hamilton. AIMS Public Health, 2(4), 730-745. https://www.zotero.org/dlaforce1d/items/ZBVWD3VU/attachment/ARVC73S2/reader
Let’s Learn Public Health. (2017, June 25). What Makes Us Healthy? Understanding the Social Determinant of Health. [Video]. YouTube. https://www.youtube.com/watch?v=8PH4JYfF4Ns
Marmot, M. (2015). The Health Gap. Bloomsbury Publishing.
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