Why Hospitals Can, and Should, Do More to Help With Public Health.

The Canadian Medical Association’s Healthcare Transformation initiative is an impressive example of the work being done to communicate the importance of the social determinants of health to the Canadian public. The communication element of this work is critical, given widely held beliefs that downplay the importance of the social determinants of health: “Despite much research indicating that higher income levels and educational attainment are critical factors associated with better health, Canadians do not seem to understand this relationship or agree with it.” The system transformation element of the Canadian Medical Association’s (and others) work is equally important, given the economic burden of chronic diseases and their common modifiable risk factors. However, in our opinion, a commonly understated requirement for true system transformation is that of hospital administrators to take on larger local advocacy roles. As we will explain, hospitals (particularly small community hospitals) have an opportunity to influence health by advocating locally for healthy communities and social justice. This editorial presents the rationale for (a) hospitals to take on a larger advocacy role and (b) for hospital advocacy to be reinstated as a requirement for health system transformation. Thirty years ago, a cadre of international experts met in Ottawa to chart a course for improved health in industrialized countries. They discussed a future where hospitals have a “community conscience” and “move increasingly in a health promotion direction, beyond [their] responsibility for providing clinical and curative services.” This sentiment translated into the fifth principle of the Ottawa Charter for Health Promotion: Reorient Health Services.5 The fifth principle aims to influence the foremost determinants of health: the social, economic, and built environments, which, by Canadian estimates, are responsible for 60%