Social Accountability

Social accountability is a foundational principle for DFCM. The term was paired with global health in recognition of the central role social and structural determinants play in shaping health, and the need to address these determinants to help achieve equity and improve the health of marginalized people and communities in Canada and abroad. 

In practice, this means using an equity and anti-oppression lens to systematically reflect on our work in education, research, clinical care, quality and innovation, advocacy and leadership, and thinking deeply about how our individual actions and structural changes can support the best care for marginalized people.  

Led by Dr. Danyaal Raza, Faculty Lead in Social Accountability, DFCM is DFCM is examining our practices and structures to build a culture of deep and meaningful commitment to social accountability. Read more about Dr. Raza's appointment to the position. 

 

Definitions

The terms global health, social accountability, health equity, social determinants of health and structural determinants of health are often used together, and sometimes interchangeably, to refer to activities carried out to address the health and social needs of individuals and communities subject to unfair and oppressive social, economic and political structures. However, each is imbued with a particular meaning. Click each term above to jump down to its definition.

 

What is global health?

While there is no single, universally endorsed definition of global health (GH), at DFCM, global health is “an organizing framework”  for “study, research and practice that places a priority on improving health and achieving health equity for all people worldwide.”

DFCM global health activities have evolved from what was once called “International Programs” (IP), a range of international partnerships and collaborative capacity-building activities established in the mid-1990s that aimed to strengthen family medicine and primary care worldwide, based on an explicit recognition of their role in enhancing health equity. With the emergence of the academic concept of GH early in the new millennium, the name of the portfolio was changed to Global Health to make its focus on health equity more explicit. As had been the case since the inception of the IP, global health at DFCM leverages excellence in family medicine to achieve health equity, in Canada and abroad. In addition to health equity, the notions of reciprocity, co-dependence, partnership, and interdisciplinarity are central to the concept of global health. In keeping with the ongoing evolution of the concept of GH, GH at DFCM and elsewhere has increasingly included attention to health inequities “within borders,” in our local GTA context, and within Canada.

 

What is social accountability?

In the context of medical education, social accountability is “the obligation [of medical schools] to direct their education, research and service activities towards addressing the priority health concerns of (those) they have a mandate to serve.”

More broadly in family medicine, “the essence of social accountability rests in responding to the health needs of our society with whatever capacity we have and in whatever ways we can. In the case of family physicians and their organizations, this accountability encompasses the actions taken within the primary care setting in individual doctor-patient relationships (micro), the collective interactions of physicians and organizations with the communities they serve (meso), and the interactions of societies with their professions (macro).”

The DFCM’s commitment to social accountability is reflected across its activities and was recently expressed most explicitly through the creation of new roles and programs to meet the needs of the patients, learners and faculty populations they serve. These include the creation of the faculty lead positions in Social Accountability, Indigenous Health, Climate Change, Equity, Diversity & Inclusion (EDI) as well as a Patient Engagement Specialist.

 

What is health equity?

The WHO defines health equity as the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically”.  It is created when individuals have the fair opportunity to reach their fullest health potential,  and often requires a deliberate allocation of resources to marginalized communities in an effort to overcome long-standing, institutional and/or historical barriers to opportunity.  

At DFCM, health equity is acknowledged as an overarching goal of the department, an outcome we strive towards through the full range of our activities in research, education, quality, leadership and global health. While relevant to all portfolios, the concept of equity is explicit as one of the dimensions of the Global Health and Social Accountability (GHSA) portfolio and is central to the very definition of global health and social accountability.

 

What are social and structural determinants of health?

Social determinants of health refer to a specific group of social and economic determinants of health that relate to an individuals place in society. They include income and social status, employment and working conditions, education and literacy, childhood experiences, physical environment, gender and race/racism. Experiences of discrimination, racism and historical trauma are important social determinants of health for groups such as Indigenous Peoples, LGBTQ and Black Canadians.

Structural determinants of health refer to the social, economic and political mechanisms that generate hierarchies of power, access to resources and prestige. In this way, structural determinants of health shape, and are the upstream causes of, social determinants of health.

In the context of family medicine, addressing social and structural determinants of health are fundamental for improving the health of the patients and communities we serve. Doing so in a way that is reflective of the health needs of the communities we serve, is acting in accordance with the principle of social accountability.