1RR3_course manual 2023

HTHSCI 1RR3 FALL 2023 Course Manual 1 HTHSCI 1RR3 Introduction to the Social Determinants of Health Fall 2023

HTHSCI 1RR3 FALL 2023 Course Manual 2 Table of Contents Introduction to the Social Determinants of Health ...................................................................................... 3 Course Description ........................................................................................................................................ 3 Learning Outcomes . .................................................................................................................................. … 3 Learning Resources ....................................................................................................................................... 4 Learning Sequence ........................................................................................................................................ 4 Overview of Learning Activities .................................................................................................................... 4 Suggestions for Success ................................................................................................................................ 4 Evaluation Measures ..................................................................................................................................... 5 In Class test #1 (30%) .................................................................................................................................... 5 In Class test 2 (30%) ...................................................................................................................................... 5 Final Exam (40%) ........................................................................................................................................... 5 UNIT 1: COURSE INTRODUCTION TO THE SOCIAL DETERMINANTS OF HEALTH .......................................... 6 UNIT 2: THE CANADIAN HEALTH CARE SYSTEM ............................................................................................ 8 UNIT 3: INCOME AND HEALTH .................................................................................................................... 10 UNIT 4: WORK AND HEALTH ....................................................................................................................... 11 UNIT 5: EDUCATION AND HEALTH .............................................................................................................. 12 UNIT 6: FOOD, HOUSING AND HEALTH ...................................................................................................... 15 UNIT 7: GENDER AND HEALTH .................................................................................................................... 17 UNIT 8: RACIALIZED COMMUNITIES AND HEALTH ..................................................................................... 19 UNIT 9: INDIGENOUS COMMUNITIES AND HEALTH .................................................................................. 20 UNIT 10: THE PHYSICAL ENVIRONMENT AND HEALTH ............................................................................... 23 UNIT 11: CALL TO ACTION: POLICY, SOCIAL JUSTICE, ADVOCACY & THE SDoH .......................................... 25

HTHSCI 1RR3 FALL 2023 Course Manual 4 For example, case scenarios in other courses, IK02 community engagement and citizenship, professional practice courses, 3CN3 nursing practice with the community and 3IH3 that focuses on indigenous policy and nursing practice. Required Textbook Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2 nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. The publication is freely available at http://www.thecanadianfacts.org/ In preparation for our first class . See also - Let's Start a Conversation About Health...and Not Talk About Health Care at All (2013). https://www.youtube.com/watch?v=QboVEEJPNX0 includes captions (5 mins) Review – the course documents – manual, outline, weekly required resources: online readings and media (see each unit for details) and planned evaluation measures. Learning Sequence Please refer to the up-to-date learning sequence posted in Avenue to Learn. Overview of Learning Activities Learners will engage in independent preparation (e.g., readings and media files) before each weekly lecture. This is not just homework – it is central to the educational approach that learners are credited with the equivalent of three hours of learning time , made up of two hours of class time and one for other required preparation such as viewing required media files. In-class time is in a large-group setting lecture/presentation with some interactive elements, like discussions about relevant media stories (e.g., news stories and social media posts). The idea behind this approach is to help learners do basic cognitive work before class, leaving higher levels of cognitive work like applying and understanding to take place in class. In other words, our aim is to get you to move beyond simply memorizing the SDoH – we want you to engage and wrestle with these challenging and sometimes uncomfortable concepts! Check stories in the press and in newscasts; what issues are being discussed in local, provincial, and federal elections. Suggestions for Success • Complete required learning prior to each in-class session • Attend all in-class sessions and be prepared to critically engage – dive deeper into the material and walk in someone else’s shoes .

HTHSCI 1RR3 FALL 2023 Course Manual 5 Evaluation Measures (see learning sequence for dates and times) 1. Online Test 1 - 30% (Units, 1, 2 and 3) See Learning sequence for date and time. 2. Online Test 2 - 30% (Content focus on units 4, 5, and 6 with some questions from Units 1, 2 and 3). See Learning sequence for date and time. 3. Final Exam – 40% (During Final Exam Period- Dec. 8 to Dec. 21, 2023) (Units 7, 8, 9, 10 and 11 with some questions from units 4, 5, and 6) Note. virtual proctoring software may be utilized in this course for all on-line evaluation measures. This software may require you to turn on your video camera, present identification, monitor and record your computer activities, and lock down your browser during the exam. This software may be required to be installed before the exam begins. • All evaluation measures will cover the required readings, media files, and lecture content. • The majority of the evaluation measures will consist of questions evaluating knowledge and comprehension about the course content. Some questions will focus on integration and application of learning (e.g., case-based scenarios). On-Line Tests 1 &2 (30% each) • Tests 1 will consist of 40 and test 2 will have 50 multiple-choice questions. Both tests will be completed outside of class time – see learning sequence for details. Final Exam (40%) • Most of the final exam will consist of questions evaluating understanding, integration of learning, and application of knowledge. These questions will be like those used for the earlier tests and will include scenario-based questions similar in format to those in the Nursing Certification Licensure Examination (NCLEX). • The final exam will consist of approximately 80 multiple-choice questions and 10 scenario-based questions . • The date and time of the final exam will be determined by the Registrar's Office and will take place during the normal exam period for Term 1 (December 8 to December 21, 2023). The instructor reserves the right to modify elements of the course and will notify students appropriately, either in class or on Avenue to Learn (McMaster Undergraduate Course Management Policy, 2014).

HTHSCI 1RR3 FALL 2023 Course Manual 7 RECOMMENDED: National Collaborating Centre for Determinants of Health (2022). Mind the disruption podcasts. First series of Fall 2022 https://nccdh.ca/learn/podcast/ RNAO Summary on Social Determinants of health brochure with application to a case. https://rnao.ca/sites/rnao-ca/files/rnao_sdh_brochure_2013.pdf CRITICAL THINKING QUESTIONS: 1. Reflect on the degree of familiarity you had with the idea of living and working conditions as primary determinants of health prior to today. When you thought of health and its determinants what did you think of? 2. Can you think of examples from the news in which the social determinants have affected somebody’s health (or the health of a population)?

HTHSCI 1RR3 FALL 2023 Course Manual 8 UNIT 2: THE CANADIAN HEALTH CARE SYSTEM Guest lecturer: Dr James McKinley (1 hour) & faculty led (50 minutes) AIMS: Upon completion of this unit, learners will understand the structure and function of the health care system in Canada, alignment with primary health care (PHC), and the role of politics and ideology in determining health service priorities as they influence the health of Canadians. KEY CONCEPTS: Role of nurses, other professions, and citizens in determining health, federal/provincial/territorial/municipal roles in health, universality, Primary Health Care (PHC) KEY TERMS: Health care financing, federal social transfers, jurisdiction, availability, accessibility, portability, comprehensiveness, private funding (paid for out of your own pocket or private insurance), public funding (paid for out of tax revenues) REQUIRED READINGS: Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2 nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 12: Health Systems) Canadian Institute of Health Information (2023). Primary Health Care defined - web page. https://www.cihi.ca/en/topics/primary- care#:~:text=This%20type%20of%20care%20typically,end%2Dof%2Dlife%20care Health Canada (2023). Canada health act annual report 2021-2022. https://www.canada.ca/content/dam/hc-sc/documents/services/publications/health-system- services/canada-health-act-annual-report-2020-2021/canada-health-act-annual-report-2021- 2022-eng.pdf see CHAPTER ONE - Pages 5 through 19 Ontario (2023). Apply for OHIP and get a health card. Published first April, 2017 https://www.ontario.ca/page/apply-ohip-and-get-health-card#section-2 World Health Organisation (2023). [Factsheet] Universal health coverage (UHC). https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) Government of Canada. (2023). Provincial and Territorial Drug Benefit Programs. Lists those with Pharmacare and those with drug benefit plans. https://www.canada.ca/en/health- canada/services/health-care-system/pharmaceuticals/access-insurance-coverage-prescription- medicines/provincial-territorial-public-drug-benefit-programs.html

HTHSCI 1RR3 FALL 2023 Course Manual 10 UNIT 3: INCOME AND HEALTH AIMS: This unit will focus on understanding the link between power inequities and poverty. Learners will come to understand how power is associated with autonomy and self-determination. The relationship between income and health will be explored through examples from various marginalized/underserved populations. KEY CONCEPTS: Power, inequity, impact of low income on health of individuals and families KEY TERMS: Social gradient, income, low-income cut-off (LICO), autonomy, relative vs. absolute poverty, self-determination REQUIRED READINGS: Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2 nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 3: Income and Income Distribution; Chapter 11: Social Safety Net) Edmonton Social Planning Council (2020) Available from https://edmontonsocialplanning.ca/wp-content/uploads/2020/11/fACTsheet-Basic-Income.pdf Grey Bruce Health Unit (2021). Public health. Social determinants of health. https://www.publichealthgreybruce.on.ca/Your-Environment/Healthy-Communities/Social- Determinants-of-Health REQUIRED MEDIA FILES: Bregman, R . (2017). Poverty isn’t a lack of character , it ’ s a lack of cash. https://www.ted.com/talks/rutger_bregman_poverty_isn_t_a_lack_of_character_it_s_a_lack_ of_cash Wilkinson, R. (2011, July). How economic inequality harms societies [Video]. TED Conferences. https://www.ted.com/talks/richard_wilkinson_how_economic_inequality_harms_societies (16 minutes)

HTHSCI 1RR3 FALL 2023 Course Manual 11 RECOMMENDED: Herd, D., Kim, Y. and Carrasco, C. (2020) The social safety net for working adults. Institute for Research on Public Policy https://irpp.org/research-studies/canadas-forgotten-poor-putting-singles-living-in-deep- poverty-on-the-policy-radar/ CRITICAL THINKING QUESTIONS: 1. Why is it more difficult to study the relationships between income and health than it is to study other factors such as smoking and health? 2. Why is it challenging to increase the level of health of Canadians by focusing on the medical system alone? UNIT 4: WORK AND HEALTH AIMS: In this unit we will explore how employment impacts the health of individuals and communities. Learners will explore quality work-life balance and healthy workplaces. Power imbalances between employers and employees will be explored to identify inequities in the labor force and the impact this has on health. KEY CONCEPTS: Precarious employment, labour market transformation, work-related health KEY TERMS: Boundaryless careers, employment strain, precariat REQUIRED READINGS: Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2 nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 5: Unemployment and Job Security; Chapter 6 Employment and Working Conditions) Canadian Centre for Policy Alternatives (2021). Disproportionate Burden: Covid-19 labour market Impacts on Indigenous and racialized workers in Canada . https://policyalternatives.ca/publications/reports/disproportionate-burden

HTHSCI 1RR3 FALL 2023 Course Manual 13 UNIT 5: EDUCATION AND HEALTH AIMS In this unit we will explore the associations between education and health. Learners will explore the importance of early childhood education and how this can impact lifelong health outcomes. KEY CONCEPTS: Access to early childhood education and care, educational inequalities, long-term effects of childhood underinvestment/trauma KEY TERMS: High quality/affordable/regulated early childhood education and care, child poverty REQUIRED READINGS: Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2 nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 4: Education, Chapter 7: Early Childhood Development) Ministry of Education, Ontario (2014). Hoe does learning happen? How Does Learning Happen? Ontario’s Pedagogy for the Early Years pgs 5-10 and 13-14, Kings printer for Ontario Ministry of Education, Ontario (2021). Building on: How does learning happen? Building on How Does Learning Happen (ontario.ca) pgs 2-7. Kings printer for Ontario REQUIRED MEDIA FILES: Knowledge Centre (2018). Interview with Dr Jean Clinton: Issues hindering on issues hindering development https://www.youtube.com/watch?v=tMvLctm99q0 (4 minutes) Burke, N. (2022). Understanding ACEs. TED talk. Understanding ACEs with Dr. Nadine Burke Harris - YouTube (7 minutes) Robert Wood Johnson Foundation (2014, January 8). Education: It matters more to health than ever before [Video]. YouTube. https://www.youtube.com/watch?v=C8N4wka3wak (3 minutes) RECOMMENDED: Janki Shankar, Eugene Ip, Ernest Khalema, Jennifer Couture, Shawn Tan, Rosslynn T. Zulla, Gavin Lam. (2013). Education as a Social Determinant of Health: Issues Facing Indigenous and Visible Minority Students in Postsecondary Education in Western Canada . Int J Environ Res Public

HTHSCI 1RR3 FALL 2023 Course Manual 14 CRITICAL THINKING QUESTIONS: 1. What surprised you the most about the link between early childhood education and care and health? 2. What are the implications of limited education for individuals and families and how might subsidized day care help correct that? 4. As a nurse or student what can you do to help others attain success in education?

HTHSCI 1RR3 FALL 2023 Course Manual 16 RECOMMENDED: TED. (2013, December 3). The unexpected face of homelessness|Bee Orsini|TED Talks [Video]. YouTube. https://www.youtube.com/watch?v=w18ZuellVts (12 minutes) Tarasuk, V. & McIntyre, L. (2020, April 28). Food banks can’t adequately address COVID -19 food insecurity. Policy Options. https://policyoptions.irpp.org/magazines/april-2020/food-banks- cant-adequately-address-covid-19-food-insecurity/ Government of Canada (2023). About Reaching Home: Canada’s homelessness strategy https://www.canada.ca/en/employment-social-development/programs/homelessness.html CRITICAL THINKING QUESTIONS: 1. How can we as a nation best ensure all people have access to food? 2. What would be the difference in housing availability if housing issues were treated as health issues? 3.What are some of the likely health consequences of food insecurity and housing insecurity?

HTHSCI 1RR3 FALL 2023 Course Manual 17 UNIT 7: GENDER AND HEALTH AIMS: In this unit learners will explore the concept of gender and gain insight into how gender is associated with health. Learners will also examine how gender intersects with other key determinants of health. KEY CONCEPTS: Gender inequity, gender diversity, mainstreaming gender, intersectionality KEY TERMS: Gender, sex, heterosexism, homophobia, stigma, gender roles, gender identity, social norms, socialization, 2SLGBTQ+ REQUIRED READINGS: Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2 nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 16 : Gender) Mager, V. (2015). Gender, health and the Sustainable Development Goals. Bulletin of the World Health Organization 93 (743). https://www.scielosp.org/article/bwho/2015.v93n11/743- 743/ RNAO (2021). Social determinants of health. https://rnao.ca/sites/rnao- ca/files/rnao_sdh_brochure_2013.pdf REQUIRED MEDIA FILES: Demystifying Medicine McMaster (2021). Closing the gap: Addressing gender inequities in healthcare. Closing the Gap: Addressing Gender Inequities in Healthcare - YouTube (10 minutes) University of Alberta (2020). Intersections of gender. IG in conversation: Intersectionality, COVID-19 and health care workers. Intersectionality, COVID-19 and Healthcare Workers | Intersections of Gender (ualberta.ca) TED. (2016, December 7). Kimberlé Crenshaw: The urgency of intersectionality [Video]. YouTube. https://www.youtube.com/watch?v=akOe5-UsQ2o (19 minutes) Community Foundations Canada. Vital Signs 2020: Gender & Equality in Canada https://youtu.be/cgY8azkmsvA

HTHSCI 1RR3 FALL 2023 Course Manual 19 UNIT 8: RACIALIZED COMMUNITIES AND HEALTH AIMS: In this unit the learner will gain an understanding of racialization as a social determinant of health. KEY CONCEPTS: Racialization and health, racism, social inclusion/exclusion, white supremacy KEY TERMS: Black, Indigenous, people of colour (BIPOC), racialized, privileged, identity, mainstream, social justice REQUIRED READINGS: Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian facts (2 nd ed.). Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. (Chapter 10: Social Exclusion; Chapter 17: Immigration; Chapter 18: Race) Joseph, A.J. (2020, June 16). Equity data as an ethical necessity: Understanding the viral confluence of injustice through COVID-19: Canadian Dimension. (5 minute read) https://canadiandimension.com/articles/view/equity-data-as-an-ethical-necessity- understanding-the-viral-confluence-of-injustice-through-covid-19 REQUIRED MEDIA FILES: Scott-Fulton, Veronica (2021) How Social Determinants impact healthcare. (13 minutes) https://www.ted.com/talks/veronica_scott_fulton_how_social_determinants_impact_healthca re Danda, M., Key J. & Pitcher C. (2022) Canadian Nurses Association, Hearing our voices: De- centering Whiteness in Health Care. (12 minutes) https://www.youtube.com/watch?v=C66xZSLMdCk Bowden, O. (2020, May 2 ). Canada’s lack of race -based COVID-19 data hurting Black Canadians: Experts. Global News. https://globalnews.ca/news/6892178/black-canadians-coronavirus-risk/ RECOMMENDED: The University of British Columbia (2021). Black (in) visibility: Black Nurses in Canada who paved the way. https://open.library.ubc.ca/cIRcle/collections/historyofnursinginpacificcanada/46624/items/1.0 398203 (96minutes)

HTHSCI 1RR3 FALL 2023 Course Manual 20 Joseph, A.J. (2019). Constituting “lived experience” discourses in mental health: The ethics of racialized identification/representation and the erasure of intergeneration colonial violence. Journal of Ethics in Mental Health. https://jemh.ca/issues/v9/documents/JEMH%20Inclusion%20i.pdf Ontario Agency for Health Protection and Promotion (Public Health Ontario). COVID-19 in Ontario - A Focus on Diversity: January 15, 2020 to May 14, 2020 Toronto, ON: Queen’s Printer for Ontario; 2020. https://www.publichealthontario.ca/-/media/documents/ncov/epi/2020/06/covid-19-epi- diversity.pdf?la=en Sukhera, J. (2020, July 12). Bias in the mirror: Exploring implicit bias in health professions education [Video]. YouTube. https://www.youtube.com/watch?v=O-hn44ZqG4I (48 minutes) CRITICAL THINKING QUESTIONS: 1. Why is it difficult to study the epidemiology of racism and how it affects the health of populations in Ontario? 2. From the vantage point of social inclusion/exclusion, why are universal interventions preferred to those that target the most disadvantaged? 3. What are some things we can do to check our own biases?