Social Determinants of Health

“The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience.” (Raphael, 2010)

These conditions have come to be known as the social determinants of health.

What are the Social Determinants of Health?

The Office of Disease Prevention and Health Promotion defines the social determinants of health (SDOH) as “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

According to the government of Canada, the determinants of health are:

• Income and social status

• Employment and working conditions

• Education and literacy

• Childhood experiences

• Physical environments

• Social supports and coping skills

• Healthy behaviours

• Access to health services

• Biology and genetic endowment

• Gender

• Culture

• Race / Racism

Why is it essential to address the Social Determinants of Health?

“Addressing social determinants of health (SDOH) has been acknowledged as an essential objective for the promotion of both population health and health equity” (Blair et al., 2018). However, despite a lack of supporting evidence, most of Canada’s health promotion strategies focus on individual behaviour changes rather than addressing the SDOH (Raphael, 2003).

As individuals, we are often told to take responsibility for our health; for example, we need to eat healthier and exercise more. While eating well and exercising will improve your health, for some, a low income or lack of education on its importance means this is not possible or likely to happen.

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Average gym membership per year = $50

On average, it would cost a family of four $2200 more a year to eat healthy vs unhealthy.

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“Poverty has been identified as a key determinant of health in many of these federal and provincial statements” (Raphael, 2003). Evidence shows that, in general, the lower an individuals’ socioeconomic position, the worst their health. Although the Canadian Health Act ensures, all Canadians are entitled to publicly funded health services, several additional health services, such as prescription drugs, mental health services, and physiotherapy, have additional fees many cannot pay. This means millions of Canadians are unable to afford evidence-based treatments that could positively affect their overall health (Boozary & Laupacis, 2020).

Raphael (2003) writes “that despite the literature detailing the importance of addressing the social determinants of health, such as poverty, and the ineffectiveness of a lifestyle approach,” the majority of discussion continues to focus on the preventing of disease as it relates to medical and lifestyle risk factors. If research indicates that one’s area code is more important to health than your genetic makeup, perhaps it is time to shift our focus onto creating policies that address the SDOH, such as income, employment, and education, to promote health equality.

References:

Blair, A., Siddiqi, A., & Frank, J. (2018). Canadian report card on health equity across the life-course: Analysis of time trends and cross-national comparisons with the United Kingdom. SSM - Population Health, 6, 158–168. https://doi.org/10.1016/j.ssmph.2018.09.009

Boozary, A., & Laupacis, A. (2020). The mirage of universality: Canada’s failure to act on social policy and health care. In CMAJ (Vol. 192, Issue 5, pp. E105–E106). Canadian Medical Association. https://doi.org/10.1503/cmaj.200085

Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Raphael, D. (2010). Social Determinants of Health: The Canadian Facts Juha Mikkonen. http://www.thecanadianfacts.org/

Raphael, D. (2003). Barriers to addressing the societal determinants of health: Public health units and poverty in Ontario, Canada. Health Promotion International, 18(4), 397–405. https://doi.org/10.1093/heapro/dag411