A place to cook: A scoping review

Abstract

There has been a growing concern with health equity in public health systems worldwide. It is well known that the primary drivers shaping health are not medical treatments or genetics, but the conditions in which we live. Conditions, such as food and housing insecurity are pervasive problems in North America, but their relationship is not well understood. While housing and food security remain to be problems in high-income countries, there is minimal research linking the two conditions. The objectives of this research are to identify literature involving housing and food as a means to addressing health inequities and to inform future research. As well, we identify barriers and opportunities on how to address multiple social determinants of health (SDH) from an intersectoral approach. We used Arksey and O’Malley (2005) scoping review design and Dahlgren and Whitehead’s (2007) SDH as a conceptual framework. The most prominent drivers shaping health that are associated with housing and food insecurity are income and material needs, housing status, the built environment, social support networks, and the food environment, but they do not occur in isolation. Three research themes emerged from this review: (1) healthcare access and utilization consequences; (2) typifying the causes and solutions to housing and food insecurity; (2) gaps in research design. There are two emerging challenges to addressing multiple SDH challenges: (a) public health paradigms that frame causes and solutions to health inequalities, and (b) the effect on professional roles, structural-level decision making, and contribution to silo interventions. Opportunities to overcome challenges and advance the SDH agenda are guaranteed income, intersectionality and intersectoral collaboration, and approaching health inequalities with a social justice orientation. Silo interventions are ineffective in achieving health equity and addressing the SDH. Pathways to address food and housing insecurity require coordinated efforts and recognition of the structural determinants guided by political ideology. The task of addressing the SDH in a coordinated way is a daunting mission, given the recognizably challenging domination of the neoliberalism and individualism guiding policy and interventions. However, if reducing inequities is truly a health and population challenge worth striving for, political and structural change is essential.