Social accountability is a foundational principle for DFCM. The term recognizes the importance of identifying unmet care needs of a constituent community, the central role social and structural determinants play in shaping their health, and addressing care gaps in-order to achieve equity and improve health.
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.
The terms social accountability, health equity, global health, 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.
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).”
DFCM’s commitment to social accountability is reflected across our activities and was recently expressed in the 2022-2027 strategic plan. This includes working to support the needs of our communities, including faculty, learners, and the patients we serve and want to serve under the guidance of our Indigenous Leadership Circle, Family Medicine Patient Advisory Committee, and others.
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.
DFCM has embraced a community-serving mindset in the curriculum and pays special attention to health equity in considering population health outcomes and social and structural determinants of health. The department is dedicated to bridging the gap between academic medicine and the real-life experiences of the people who use, seek, or need healthcare services. While relevant to all portfolios, the concept of equity is central to the very definition of social accountability.
While there is no single, universally endorsed definition of global health, 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 global health early in the new millennium, the name of the portfolio was changed to global health education 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 global health, global health at DFCM and elsewhere has increasingly included attention to health inequities “within borders,” in our local GTA context, and within Canada.
Social determinants of health refer to a specific group of social and economic determinants of health that relate to an individual’s 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.