The Social Determinants of Health: Defining a Research Agenda for Canada’s Urban Aboriginal Population

In the past few decades, the health of Aboriginal peoples has become a priority among Canadian health researchers (Adelson 2005; Reading and Nowgesic 2002). To date, however, the bulk of this literature has been overrepresented by research seeking to establish rates of disease and mortality, with considerably less attention paid to the social and economic processes underlying them. Indeed, while it is vital to characterize the health inequalities borne by Aboriginal Canadians—as they are vast, and, in some cases, growing—the fact remains that these observations have not transformed into a common understanding of the underlying causes of inequality, such as the important role played by the social determinants of health (SDOH) (Loppie and Wien 2009; Richmond and Ross 2009). What’s more, this body of research has tended to concentrate its efforts on segments of the Aboriginal population living on-reserve and in rural and remote areas, with appreciably less regard for patterns of urbanization that now characterize vast segments of the Aboriginal population. As of the last census count, 54% of the Aboriginal population lived in an urban centre, which includes large cities, or Census Metropolitan Areas (CMAs), and smaller urban centres. This was an increase from 50% in 1996 (Statistics Canada 2006). In spite of the recognition that increasing numbers of Aboriginal people now live in urban centres, and the challenges that this pattern of urbanization poses for Aboriginal health policy and program development, little substantive research has explored SDOH within the urban Aboriginal context. In this chapter, we examine if the current base of research on the social determinants of Aboriginal health reflects the population and geographic diversity of Canada’s increasingly urbanized population. We also describe what this base of literature looks like; specifically, we illustrate which SDOH have been examined, and through which methods this research is occurring. As an introduction, we begin with a discussion of the SDOH, and we demonstrate why the urban Aboriginal context is deserving of such research. We then describe the methodology we undertook in this review, followed by a discussion of our results. We conclude with a description of areas in which research is most urgently needed.

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