Social determinants of health & community engagement : developing a framework for public health

Discussion includes Canada and Northeastern Ontario.There is a growing understanding within Canada and internationally that our current model of curative medicine is not properly meeting the needs of the population and is unsustainable. The National Health Expenditure Trends 1975-2007 describes how spending on health care in Canada continues to rise (Canadian Institute for Health Information (CIHI, 2007). In 2007, health care spending is expected to be just over $160 billion dollars (which is approximately $4,800 dollars per person) (CIHI, 2007); of which approximately 5% is currently being spent on preventive health measures and health promotion (Shah, 1998). As the rates of chronic diseases within Canada continue to increase (Ontario Prevention Clearinghouse, Ontario Chronic Disease Prevention Alliance and the Canadian Cancer Society, 2007), it is becoming evident that the health of the population is not improving proportional to the amount spent on health care. Clearly, such levels of spending are not feasible for the long term, particularly as it has not led to better health outcomes