Health Policy
Volume 80, Issue 1 , January 2007, Pages 158-171

Knowledge into action?

Understanding ideological barriers to addressing health inequalities at the
local level

Patricia A. Collinsa, , , Julia Abelsonb and John D. Eylesb, c

aDepartment of Geography, RCB 7230, Simon Fraser University, 8888
University Drive, Burnaby, BC, Canada V5A 1S6
bDepartment of Clinical Epidemiology and Biostatistics, Centre for Health
Economics and Policy Analysis, McMaster University, 1200 Main St. W,
Hamilton, Ont., Canada L8N 3Z5
cSchool of Geography and Geology, McMaster University, 1280 Main St. W,
Hamilton, Ont., Canada L8S 4K1

Abstract
The objective of this study was to explore the presence of ideological
barriers to addressing local health inequalities in Hamilton, Ontario,
Canada. A survey of active citizens revealed low levels of awareness of the
social determinants of health (SDOH) framework, and some incongruence
between understanding and attitudes towards the SDOH. Support for
addressing health inequalities was associated with awareness of the SDOH
framework, liberal value-systems, and a cluster of socio-demographic
characteristics. Liberal leaning participants were also more politically
active than their conservative counterparts. Ideological barriers included
lack of SDOH awareness, narrow understandings of the relative influences of
the SDOH, resistance to de-prioritizing healthcare, and conservative
values. Advancement of a SDOH policy agenda should incorporate wider
dissemination efforts to citizens and local service providers to increase
support for this framework, and utilization of existing support and
political engagement from liberal-leaning demographics.

Keywords: Social determinants of health; Health inequalities; Health
policy; Questionnaire; Ontario; Social values

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