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Can Fam Physician. 2017 Nov;63(11):e476-e482.

Framework for building primary care capacity to address the social determinants of health.

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Founder and Director of the Upstream Lab at the Centre for Urban Health Solutions at the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto, Ont, a family physician and public health and preventive medicine specialist in the Department of Family and Community Medicine at St Michael's Hospital, and Assistant Professor in the Department of Family and Community Medicine and Adjunct Professor in the Dalla Lana School of Public Health at the University of Toronto.
Family physician in the Department of Family and Community Medicine at St Michael's Hospital and Associate Professor in the Department of Family and Community Medicine at the University of Toronto.



Family physicians have long understood that social factors influence the health of individuals and communities; however, most primary care organizations have yet to develop the capacity to specifically address these social determinants of health (SDOH).


To support SDOH interventions and foster an organizational culture in which addressing SDOH is considered part of high-quality primary care.


An academic family health team in Toronto, Ont, established a committee comprising a diverse group of health professionals focused on the SDOH. The committee analyzes how social factors affect patients and supports the development and implementation of interventions. The committee's current interventions include the following: collecting and analyzing detailed sociodemographic data to identify health inequities; launching an income security health promotion service; establishing a medical-legal partnership; implementing a child literacy program in its clinics; and developing an advocacy and service program to improve access to decent work. Each intervention includes a rigorous evaluation plan to assess implementation and effect. Next steps include developing tools to enable organizations to "move upstream" and adopt a health equity approach to all work, including joining in advocacy.


Primary care providers are well situated to address SDOH. This article provides a framework that can assist every large primary care organization in establishing a similar committee dedicated to SDOH, which could help build a network across Canada to share lessons learned and support joint advocacy.

[Indexed for MEDLINE]
Free PMC Article

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