1️⃣ Analytical summary

A committed shift towards structural determinants

Fourth analysis of the context of the CCNDS since 2010, this report documents how the Canadian public health community acts — or struggles to act — on the structural determinants of health: political, economic and cultural structures, history and legacy of colonialism and racism, relationship to the environment. Conducted over three years (2021-2024) using a mixed method, it brings together an exploratory and systematic review of the literature, a bilingual survey, interviews, a dialogue with researchers and focus groups. The central finding: the discourse has matured (we now openly talk about power, oppression and planetary health), but action remains hampered by a major conceptual blur, a lack of robust data, and tense working contexts (funding, staffing, priority).

Five action areas and three frameworks to reactivate

On the operational side, the report proposes three intertwined recommendations: develop a « critical method » (reflect on root causes and allow oneself to be transformed), invest in five action areas (clarify values and concepts; do what we can with what we have; be in relationship within the community; advocate and lead change; work together to share stories and solutions), and accelerate three existing frameworks of the CCNDS (public health roles 2013, common program 2016, organisational capacity 2020). Section 8 provides questions ready to stimulate team reflection.

2️⃣ Key points of the document

1️⃣ A robust and long-term analysis

Fourth analysis of the context of the CCNDS, conducted over three years (2021-2024) by mixed method: exploratory review and systematic review of the literature, bilingual online survey, follow-up interviews, dialogue with researchers and focus groups (p. 9-13).

2️⃣ The will is there, the means are lacking

68 % of respondents believe that acting on these determinants is part of their role (18 % “maybe”) and 42 % consider themselves “ champions” of equity; but action is hindered by a lack of funding, staff shortages, and a decrease in priority (p. 15-16). Non-representative self-reported data.

3️⃣ The “conceptual vase”

The ambiguity about what structural determinants are is the main barrier cited. The OPS framework “Just Societies” is deemed incomplete: absence of commercial determinants, limited consideration of intersectionality (p. 24-25).

4️⃣ The field outpaces the literature

Effective structural interventions are very poorly documented; the participants believe that practitioners and community partners are “probably ahead” of research — hence the importance of experiential knowledge (p. 13, 25-26).

5️⃣ Three interconnected recommendations

Develop a critical method; invest in five areas of action; accelerate three existing CCNDS frameworks (2013, 2016, 2020). The table 5 provides concrete examples (p. 5, 34-35, 44-45).

3️⃣ Action points for local actors

1️⃣ Position yourself with the four field strategies

Use four "persevering" strategies (do what we can; advocate and lead; community-informed relational approach; value diverse knowledge) as a framework to recognise what we are already doing (p. 19-23).

2️⃣ Team self-diagnosis with the five areas of action

Review Table 5 as a team: for each area, "where are we? what is the most difficult?" — a concrete starting point for an improvement plan (p. 34-35).

3️⃣ Facilitate a structured conversation

Take the reflection questions from section 8 as they are to initiate a team or organisational discussion, from the "first item retained" to the "what can I offer?" (p. 46-47).

4️⃣ Map one's actions… and blind spots

Classify one's interventions according to the OPS framework (structural factors vs living conditions), while noting what is missing from the framework (commercial determinants, intersectionality) to avoid invisibilising certain audiences (p. 16, 24-25).

5️⃣ Document and share experiential knowledge

Record narratives of initiatives, obstacles and observed effects (area of action no. 5) to fill the gap in literature and equip the collective advocacy (p. 35).

6️⃣ Reactivate three existing frameworks

Build on the three frameworks of the CCNDS — roles of public health (2013), common programme (2016), organisational capacity (2020) — rather than starting from scratch (p. 36, 44-45).

Unmet needs / adaptations

The report does not offer a turnkey intervention protocol (assumed limit, p. 30). For French use, plan for: a transposition of Canadian frameworks, an identification of national equivalents (INSPQ, Public Health France, ARS/CLS), and the translation of vocabulary ("structural" vs "social" determinants).

4️⃣ Additional references

Internal reference Practices in Health — on determinants: https://www.pratiquesensante.com/blog/tag/determinants-398

The Practices in Health blog addresses the axis "social determinants / social health inequalities / equity". The area being closed to automated consultation, the exact link could not be confirmed here: to be checked manually before dissemination via the internal search of the site (pratiquesensante.com/blog).

Three external references 

• CCNDS — Partnerships with community organisation groups: Practice guide (2026) — same publisher; operationalises the field of action "being on relationship and within the community".

• WHO — Global report on the social determinants of health equity (May 2025) — first report of its kind since 2008; global framework on structural action and power.

• Public Health Ontario — Towards equity-informed approaches for synthesising evidence (Dec. 2024) — directly addresses the lack of evidence pointed out by the report (PROGRESS-Plus framework, racism, colonialism).

5️⃣ Frequently asked questions (FAQ)

1️⃣ What difference is there between "structural" and "social" determinant?

The structural determinants are the deep structures that produce inequalities: politics, economy, culture, history, colonialism, racism, relationship to the environment. The social determinants are the daily living conditions that arise from this (income, housing, education, employment, health systems). See table 2 (p. 16) and clarification p. 24.

2️⃣ What is a "context analysis" and why read it?

It is a prospective monitoring tool that synthesises knowledge and evidence to inform decisions and organisational change. Here, it provides an overview of what the public health community knows, wants, and can do — useful for comparison and positioning (p. 6).

3️⃣ Does the document provide ready-to-use interventions?

No, and it acknowledges this: effective structural interventions are poorly documented (limit p. 30). It instead offers guidelines, strategies, and self-reported examples, valuing experiential knowledge (p. 13, 25-26).

4️⃣ What is a "critical method"?

It is more than critical thinking: reflecting on the root causes of inequalities, examining one’s own biases and practices (including colonial ones), then acting and allowing oneself to be transformed by what one learns (p. 32-33).

5️⃣ What are the five areas of action?

1) Specify values, concepts, knowledge, and actions; 2) do what you can, with what you have; 3) be in relationship and within the community; 4) advocate and lead change; 5) work together to share stories, data, and solutions (table 5, p. 34-35).

6️⃣ What concrete obstacles hinder field action?

Gaps in knowledge and skills, lack of funding, staff shortages, decreased priority given to equity, absence of an organisational structure supporting leadership, and risk aversion in political work (p. 15-16, 28-29).

7️⃣ What are the three frameworks of the CCNDS to reactivate?

The roles of public health in improving health equity (2013), the joint programme to support action on equity (2016) and the framework for strengthening organisational capacity (2020). The report confirms their current relevance (p. 36, 44-45).

6️⃣ Rewriting in Easy Read (easy to read and understand)

What is this document about?

• This document comes from Canada. It talks about public health.

• Health is not the same for everyone.

• Some people are less healthy than others.

• This is not fair. These gaps can be avoided.

• These gaps arise from deep-rooted causes.

• For example: money, housing, history, racism.

• These causes are called "structural determinants".

What the document says

• Many professionals want to act on these causes.

• But they lack time, money, and staff.

• Often, words are not clear to everyone.

• We do not always know what works. There are few studies.

• Field people often know more than the studies.

• We need to write and share what we do.

What the document proposes

• First : reflect on the true causes of inequalities.

• Ask questions about one's own ways of doing things.

• Then : act in five areas.

• 1. Be clear about your values and your words.

• 2. Do what you can, with what you have.

• 3. Create links with communities.

• 4. Advocate for change and lead it.

• 5. Work together and share what works.

• Finally : use three guides already written by the CCNDS.

7️⃣ Cross-cutting analysis — values of Health Practices

• Literacy : The report emphasises the need for conceptual clarity and clear language; the CCNDS refers to its series "Let’s Talk About It" and a dedicated glossary (p. 11, 24).

• Empowerment : It promotes a "power strengthening" approach informed by the community and invites partners to question the necessary changes (p. 20-23, 34-35).

• Participation : The approach itself mobilises the community (surveys, interviews, focus groups, researcher dialogue) and co-constructs the conclusions with an advisory board (p. 9-11).

• Community health: The collective dimension is central: being present in the community, measuring engagement, acting as an intermediary between communities and government (p. 12-13, 34-35).

• Ethics : The report acknowledges the biases in the field, calls for examining its own "colonial" practices and points out the limitations of its data (p. 30, 32-33).

• Human rights: Equity and dignity are established as foundations; the focus is on marginalised populations (Indigenous, Black, 2SLGBTQIA+) (p. 16, 25).

• Intersectorality : It recommends long-term intersectoral action (housing, environment, income) and working with other sectors and levels (p. 17-21, 34-35).

• Partnership : Models of collaboration are described (community partnerships, peer networks, research dialogue), without a single formalised procedure (p. 20-23).

• Fight against discrimination: Racism, colonialism and intersecting oppressions are explicitly named; non-judgment and the diversity of knowledge are valued (p. 24-25, 32-33).

8️⃣ Assessment of the reliability of the resource

Scientific relevance — high. Recognised institutional publisher (CCNDS, funding from the Public Health Agency of Canada), explicit mixed method over three years, peer reviewed internally and externally, bibliography provided. Major caveat: the survey results are declarative and not representative (voluntary sample); the report itself acknowledges the lack of evidence on the effectiveness of interventions (p. 30).

Operational relevance — indirect for the French field. This is not an intervention guide but a strategic analysis: strong utility for positioning, facilitating team reflection and legitimising action, weaker for ready-to-use protocols. Canadian context to transpose (frameworks, vocabulary, actors).

9️⃣ Strategic hashtags

#HealthEquity #StructuralDeterminants #PublicHealth #SocialInequalities #HealthPromotion #CommunityHealth #Advocacy #healthpractices

This article was developed in accordance with the Charter of the use of artificial intelligence of Health Practices. Click on the image