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While many would recognize equity in healthcare as a noble principle, there are still notable barriers on the path to its implementation in practice. Among those barriers are institutions and ideologies that govern social life and regulate people’s access to social determinants of health. Canadian neoliberalism makes income and education essential social determinants, and while I am lucky enough to have reasonable access to these, they are not equally accessible in Canada, much less the developing world.
Ideology and institutions currently prevailing in Canada do not pursue equity in distributing social determinants of health. As Jacobs noted, contemporary Canada leans heavily toward neoliberalism with its emphasis on personal freedom and the restricted prerogative of the government (37). In the neoliberal – as well as classical liberal – paradigm, the core social value is a person’s “right to choose and the right to pursue one’s own self-interests freely” (Visano 177).
As a result, neoliberal ideology demotes healthcare from a common concern to a constellation of individual choices: healthcare becomes not as much a subject of consistent policy as everyone’s personal affairs. In terms of institutions, the dominance of neoliberalism led to the gradual abolishment of the Keynesian welfare state, which oriented on helping those most disadvantaged in a market economy (Jacobs 37).
According to Health Canada, income level and education – the latter being directly conducive to better job opportunities and higher income as well – are essential social determinants of health (Jacobs 40). This fact stresses that health inequity closely mirrors economic inequity in Canada. Thus, neoliberal ideology and institutions of contemporary Canada do not promote equity in the distribution of social health determinants.
As a resident of Ontario, I have reasonably good access to social health determinants, but it is not based on equity. As noted above, income level and social status constitute the most important social determinant of health, and I fare reasonably good in this respect. A social support network that includes my family members and relatives allows me to partake in the resources accumulated by it for better health status (Jacobs 40).
Finally, I also have access to education – the third most important social determinant of health in Canada – as evidenced by the fact of me writing this essay (Jacobs 40). Thus, social determinants of health impact my health status positively, but it does not obscure the fact that they are not distributed evenly. For instance, prices of college enrollment mean that higher education as an institution restricts access to an essential social determinant of health. Therefore, my experience is an example of a relatively successful adaptation to neoliberal ideology and institution, but it highlights rather than obscures its inherent inequity in terms of health.
The same health status would be unachievable in the developing world due to the issues with several social determinants of health. For instance, developing parts of the world face the problem of “undernutrition in the early stages of life,” thus adversely impacting such a determinant as healthy child development (Jacobs 36). Sufficient nutrition in early life – something natural for most residents of Ontario – may constitute a problem in the developing world and, thus, make a health status of an average Canadian socially unachievable in the developing world.
To summarize, neoliberal ideology and institutions in contemporary Canada do not promote equity in health. An example of my health status illustrates the barriers in access to social determinants of health these institutions create. As the developing world has problems even with sufficient nutrition in early life, it further illustrates how health status available for certain social groups remains inaccessible for others.
Works Cited
Jacobs, Merle A. “Social Inclusion.” Race In-Equity: Intersectionality, Social Determinants of Health, and Universal Rights, edited by Merle Jacobs and Awalou Ouedraogo, APF Press, 2017, pp. 33-41.
Visano, Livy A. “Ideologies, Institutions, and Law.” Race In-Equity: Intersectionality, Social Determinants of Health, and Universal Rights, edited by Merle Jacobs and Awalou Ouedraogo, APF Press, 2017, pp. 172-181.
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