Social Determinants of Health: What Makes Canadians Sick?
In life, some of us are dealt cards that wouldn't technically be classified as a "good hand", while others have gotten a bit luckier. There's not a whole lot that can be done about this situational lottery, yet our circumstances seep into and affect every aspect of our lives. Time and time again, we hear the saying "we are the product of our environment". This frequently rings true for many issues in the lives of Canadians, including poor health.
According to the Public Health Agency of Canada (PHAC), the social determinants of health are a complex set of factors or conditions which play a huge role in determining the level of health of every Canadian. These determinants have been extensively researched and are individual and collective factors which affect the health status of both individuals and populations. The social determinants of health can be broken down into the socioeconomic environment and physical environment (both natural and human-built). The socioeconomic environment includes income and social status, social support networks, education, employment and working conditions, and social environments (societal values and rules). The physical environment includes healthy childhood development, personal health practices, individual capacity and coping skills, biology and genetics, health services, gender, and culture.
Let's break down these determinants and see how they actually affect and influence the overall health and well-being of Canadians.
Income and social status
Health tends to improve as income and social status increase. This can be linked to how income can help improve living conditions, from housing to nutritious food. According to statistics from PHAC, Canadians of low-income status are more likely to die earlier and to suffer more illnesses than Canadians with higher incomes, regardless of their age, sex, race, and place of residence.
Social support networks
Social support networks help people solve their problems and control life circumstances. Having support from families, friends, and communities are linked to better health and the care, respect, and sense of satisfaction from relationships also help protect against health issues.
Education fundamentally provides individuals with the knowledge and skills to solve problems and take control of their life circumstances. It also increases the opportunity for a job, income security, and job satisfaction.
Employment and working conditions
People who have control of their work circumstances and have less stress or safer work often live longer in comparison to those who do not have control of their work environment and its associated risk and stress. Furthermore, unemployment and underemployment are strongly correlated with poorer health; this could be again linked to lower levels of income as well. Paid employment, in addition to money, provides a sense of purpose, identity, social contacts, and opportunities for personal growth.
Social environments (societal values and rules)
The social environment refers to concepts beyond community and also includes the strength of social networks within any perspective (community, province, country, region, or even organizations and institutions). A social environment can help people to share resources together and build attachments with each other. The values, norms, social stability, diversity, and cohesiveness can definitely help avoid potential risk to good health.
The physical environment, itself plays a vital role in overall health. Especially, contaminants in the air, water, food, and soil, which can negatively affect health. These negative health effects can vary from cancer, birth defects, and other illnesses.
Healthy childhood development
There is such strong evidence that early child development is a powerful determinant of health. The early experiences weigh heavily on brain development, school readiness, and health play a great role. Furthermore, this early development can again be affected by the physical environment (housing and neighbourhood), family income, parent's education, access to nutritious food, genetics, and access to health care.
Personal health practices
Once again, this social determinant can be interrelated with other factors such as income, education, employment, culture, and social environment. Our personal health practices and coping skills allow us to prevent diseases and promote health and wellbeing. Our lifestyle and choices are again influenced by many of the other social determinants, as well.
Biology and genetics
Our basic biology and genetic endowment also play a huge role in our overall health. We all inherit different predispositions to particular diseases and health issues.
The availability and accessibility of health services allow to promote health, prevent disease, and restore health and function.
It is evident that different genders have different life expectancies, predisposition to different disease and conditions at different ages. This can also be interrelated to other social determinants, such as income, social environments, biology, and physical environment.
A person's upbringing, background, traditions, customs, and the beliefs of their family or community; play a huge role on overall health because it influences how one may think, feel, act, and value.
What's the solution?
To be honest, there is no simple solution and the experts have yet to figure it all out... However, it is pretty evident that simple, one facet approaches will not provide sustainable solutions but merely be a "band-aid" solution. Simply subsidizing health foods or increasing financial assistance will not make Canadians healthier! Increasing the availability or affordability will definitely help a portion of the population that values or understands the importance of proper nutrition, but what about the rest of the population who is not aware, interested, or educated about healthy eating? This is what makes the issue so complex. However, it also supports the notion that different initiatives and programs need to focus on specific objectives, rather than a complex metrics like improving the overall health of ALL Canadians.
These specific objectives would have to consider all the social determinants of health and build strategies that cater to working around these determinants. However, we would have to accept that the program itself will not improve the overall health of their users directly. Instead, it would cater to helping them live "better" in their environment and by providing them essential skills to overcome certain obstacles. For example, a local community food non-profit could focus on the nutrition education piece and also help their members get access to healthier food options through a "Good Food Box" program. These efforts would be carried out with the understanding that the program itself cannot improve the income, social status, employment status of their users. This is where the government and policymakers need to step in.
The Bottom Line
Sadly, many Canadians struggle to make ends meet, approximately 4.8 million lived in a low‑income household in 2015, of which 1.2 million were children, and these statistics have cyclical consequences that carry over generationally. As a fellow Canadians, we need to stop validating the idea that poor health and poverty are merely outcomes of poor decision making. Our country must understand and accept that we all have circumstances that go beyond what can initially be seen. Through this, we can make concrete steps towards removing "bad luck" from the health equation.