Upstream Lab Journal Club

March 28, 2017: Roy MJ, Lysaght R, Krupa TM. Action on the social determinants of health through social enterprise. CMAJ 2017 March 20;189:E440-1. doi: 10.1503/cmaj.160864

Social enterprises are defined here as “organizations that engage in commercial trade for a social purpose – most often to address one or more aspects of social vulnerability – rather than for the personal financial enrichment of owners or shareholders”. A number of positive impacts on health of social enterprises are described, as well as a call for further research on how these complex interventions work.


March 21, 2017: Pettignano R, Bliss L, McLaren S, Caley S. Interprofessional medical-legal education of medical students: assessing the benefits for addressing social determinants of health. Academic Medicine 2017 (online early)

The authors describe a novel medical school curriculum informed by the medical-legal partnership model of service provision. This model recognizes that patients’ social determinants of health are structured by the justice system. It therefore involves physicians in low income patients’ legal advocacy. Physicians require a working knowledge of the justice system and community legal services to work more effectively with low income patients who present with legal needs. The results of a pre- and post-survey study describe the curriculum’s positive and statistically meaningfully influence. Students’ reported increased awareness of community legal services, and more specifically greater motivation to refer directly to these services. Despite the limits of the low-moderate response rate, this curriculum nonetheless represents a tool for addressing the disconnect between social determinants of health theory and practice.


March 7, 2017: Sullivan SS, Mistretta F, Casucci S, Hewner S. Integrating social context into comprehensive shared care plans: A scoping review. Nursing Outlook 2017 (online early)

This paper is relevant to those interested in addressing the social determinants of health (SDH) of complex patients. One common solution proposed is to develop a comprehensive plan that includes both health and social details, and share this among caregivers. Reading this article, a number of questions arise: Is having this data on SDH enough? How will SDH be incorporated into workflow and will providers have the time, training and resources? Very applicable to Ontario’s Health Links initiative.


February 28, 2017: Hughes LS, Phillips RL, DeVoe JE, Bazemore AW. Community Vital Signs: Taking the pulse of the community while caring for patients. JABFM 2016; 29(3): 416-422

Hughes et al discuss the idea of community vital signs (CVS) in this brief paper. The authors define CVS as “information about the neighborhoods in which [patients] live, learn, work, and play” and “convey contextual social deprivation and associated risks based on where patients live”. Such data could include census information, disease surveillance and vital statistics. CVS could be used to “understand the context in which their patients reside, increase awareness of resultant health risks, and tailor clinical or community interventions”.  The authors provide a few examples of where this could be rolled out using existing infrastructure and plans for its implementation at OCHIN. CVS are a powerful idea, but many research questions remain to be explored, including examining how providers and organizations will process such data and what the impact on health will be. This is an excellent example of addressing social determinants at the interface between clinical care and public health.

See also: Bazemore AW et al. J Am Med Inform Assoc 2016; 23(2): 407-412


February 21, 2017: McPherson C, Ndumbe-Eyoh S, Betker C, Oickle D, Peroff-Johnston N. Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity. Int J Equity in Health 2016; 15:129

This paper provides insight into the implementation of the Social Determinants of Health Public Health Nurses (SDH-PHN) initiative in Ontario. It discusses the role of internal organizational capacity and presents the importance of leadership (across systems, organizations and at the individual level). Not surprisingly, there are differences in how the Ontario Public Health Standards relevant to health equity are put into practice across the province. Overall, many PHUs benefited from having two SDH-PHNs on staff to address health equity. Challenges include overcoming power dynamics, navigating different ideologies (e.g. having to spend time convincing decision-makers of the value of addressing health equity) and making organizational changes to address health equity.