What Makes Canadians Healthy (or Sick)?

A Review of the Social Determinants of Health

We previously discussed the World Health Organization’s (WHO) definition of health and its increasing need to change. But what actually contributes to and shapes our health? Believe it or not but our health is determined by several factors that we may not even realize influence it. It is partly influenced by access to social and economic opportunities, the quality of our schooling, the resources available to us and the cleanliness of our water, food and air (Office of Disease Prevention and Health Promotion, 2020).

Social Determinants of Health

The WHO (2018) defines the social determinants of health (SDH) as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” In Canada, the main 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 behaviors

• Access to health services

• Biology and genetic endowment

• Gender

• Culture

• Race / Racism (Government of Canada, 2020).

The SDH framework aids in the understanding of health inequalities (Lundberg, 2020). Health inequality “refers to health inequalities that are unfair or unjust and modifiable. For example, Canadians who live in remote or northern regions do not have the same access to nutritious foods such as fruits and vegetables as other Canadians” (Government of Canada, 2020).

Canadian Statistics

Unfortunately, Canadians knowledge and understanding about SDH and the correlation to their health is fairly limited. We are more likely to think our health is influenced by individual factors such as diet and smoking versus factors such as education and income (Canadian Council on Social Determinants of Health, 2013). This is highlighted in a survey conducted by the Canadian Institute for Health Information (CIHI) and the Canadian Population Health Initiative (CPHI). The purpose of the study was to “understand the public’s perception and understanding of health and the factors considered to influence health” (CIHI, 2005, p.1). The survey results align with the statement that Canadians knowledge surrounding the SDH is limited and primarily focused on individual health. Highlights of the survey (n=1200) include:

• 55% reported a “good knowledge” of health issues.

• Even though 30% of respondents reported that the economically disadvantaged had poorer health, 24% did not consider any group as having worse health than other Canadians.

• Respondents ranked diet (82%) and physical activity (70%) as the top factors shaping health. Conversely, factors such as employment, income and status were not recognized as factors impacting health.

• Behaviours and lifestyle choices such as smoking (80%) were given a significantly higher value in affecting health versus how involved someone is in her/his community (17%).

• Physical environment factors such as water and air quality (64%) as well as second hand smoke exposure (61%) were shown to have a high impact on health than the availability of quality housing (37%) (CIHI, 2005).

Tying it all Together

So what does this all mean? Globally, Canada has been seen as a world leader in health policy development and health promotion but implementation of these policies has been underwhelming. Canadians do not fully understand how the SDH are interrelated and how they personally affect them. This has been considered one of the barriers to having a SDH approach; the notion of individualism as opposed to community responsibility (Raphael, Curry-Stevens & Bryant, 2008). Issues such as:

• Food and housing insecurity

• Basic income guarantee

• Equal rights for the LGBTQIA+ community

• Healthcare access related to income and education level

• Equal rights to temporary foreign workers

• Healthcare literacy

• Water cleanliness and living conditions of Indigenous communities

These issues are typically seen as affecting only a certain group or community of people and not society as a whole which is supported by the CIHI/CPHI Survey results. Raphael et al. (2008) reports that this train of thought “leads to a strong bias towards understanding health problems rather than societal ones (p. 226).

Moving Forward

Moving forward, the Canadian government needs to revisit its approach in the introduction and dissemination of health policy information and initiatives. WHO proposes that there needs to be an improved way of framing and explaining the SDH approach. Lundberg (2020) suggests that “although health inequalities are not primarily generated by the health sector, there are too many examples of health inequalities being amplified rather than reduced by the way health services are organized, financed and operated” (p. 478).

Canadians need to work towards a society that not only cares about oneself but also about society as a whole. We need to continue to work on evening out the inequities that are leading to poor health outcomes. Only then can we say that we truly have a good knowledge and understanding of what it means to be healthy.

References:

Canadian Council on Social Determinants of Health. (2013, October 23). Communicating the social determinants of health: Guidelines for common messaging. https://www.deslibris.ca/ID/245995

Canadian Institute for Health Information. (2005). Select highlights on public views of the determinants of health. https://secure.cihi.ca/free_products/CPHI_Public_Views_FINAL_e.pdf

Government of Canada. (2020). Social determinants of health and health inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Lundberg, O. (2020). Next steps in the development of the social determinants of health approach: the need for a new narrative. Scandinavian Journal of Public Health, 49, 473-479. https://doi.org/10.1177/1403494819894789

Office of Disease Prevention and Health Promotion. (2020). Social determinants of health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Raphael, D., Curry-Stevens, A., & Bryant, T. (2008). Barriers to addressing the social determinants of health: Insights from the Canadian experience. Health Policy, 88(2-3), 222-235. https://linkinghub.elsevier.com/retrieve/pii/S0168851008000833

World Health Organization. (2020). Social determinants of health. https://www.who.int/social_determinants/en/