Social determinants of health are factors that influence and effect one' health. These factors are evident in our everyday lives and can be positive and negative. What is evident when looking at the literature and reports on this topic is that many of these social determinants of health are outside of the individual's influence. These may, more frequently than not is something that catches people off guard. The number of things that impact health, but that they cannot control. Particularly when we live in an everyman for themselves society or when the health is covered in the media as something that we can control - e.g., don't smoke, don't drink much, eat healthy food, - this advice does not take into consideration the effects of poverty - stress, lack of access to affordable health food, ability to exercise. As reflected in the Registered Nurses Association of Ontario (RNAO) website on the Social Determinants of Health page, which states "Access to conditions that permit health is shaped by the circumstances in which people are born, grow up, live, work and age, and an array of political, economic, social, cultural and environmental conditions and forces" (n.d.).
The RNAO brochure on social determinants of health key determinants are listed as follows:
income and income distribution
social inclusion and exclusion
employment and working conditions
education
food security
housing
social safety nets
health services
Aboriginal status
racialized status
gender disability
The Government of Canada also recognizes the impact of the many influences on an individual’s health. The determinants of health laid out by the government of Canada are:
Income and Social Status – Health status improves at each step up the income and social hierarchy. High income determines living conditions such as safe housing and ability to buy sufficient good food. The healthiest populations are those in societies which are prosperous and have an equitable distribution of wealth
Social Support Networks – Support from families, friends and communities is associated with better health. Such social support networks could be very important in helping people solve problems and deal with adversity, as well as in maintaining a sense of mastery and control over life circumstances.
Education and Literacy – Health status improves with level of education.
Employment / Working Conditions - Unemployment, underemployment, stressful or unsafe work are associated with poorer health.
Social Environments - The importance of social support also extends to the broader community. Civic vitality refers to the strength of social networks within a community, region, province or country. It is reflected in the institutions, organizations and informal giving practices that people create to share resources and build attachments with others. The array of values and norms of a society influence in varying ways the health and wellbeing of individuals and populations. In addition, social stability, recognition of diversity, safety, good working relationships, and cohesive communities provide a supportive society that reduces or avoids many potential risks to good health. A healthy lifestyle can be thought of as a broad description of people's behaviour in three inter-related dimensions: individuals; individuals within their social environments (eg. family, peers, community, workplace); the relation between individuals and their social environment.
Physical Environments - The physical environment is an important determinant of health. At certain levels of exposure, contaminants in our air, water, food and soil can cause a variety of adverse health effects, including cancer, birth defects, respiratory illness and gastrointestinal ailments.
Personal Health Practices and Coping Skills - Personal Health Practices and Coping Skills refer to those actions by which individuals can prevent diseases and promote self-care, cope with challenges, and develop self-reliance, solve problems and make choices that enhance health.
Healthy Child Development - New evidence on the effects of early experiences on brain development, school readiness and health in later life has sparked a growing consensus about early child development as a powerful determinant of health in its own right. At the same time, we have been learning more about how all of the other determinants of health affect the physical, social, mental, emotional and spiritual development of children and youth. For example, a young person's development is greatly affected by his or her housing and neighbourhood, family income and level of parents' education, access to nutritious foods and physical recreation, genetic makeup and access to dental and medical care.
Biology and Genetic Endowment - The basic biology and organic make-up of the human body are a fundamental determinant of health.
Health Services - Health services, particularly those designed to maintain and promote health, to prevent disease, and to restore health and function contribute to population health. The health services continuum of care includes treatment and secondary prevention
Gender - Gender refers to the array of society-determined roles, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis.
Culture - Some persons or groups may face additional health risks due to a socio-economic environment, which is largely determined by dominant cultural values that contribute to the perpetuation of conditions such as marginalization, stigmatization, loss or devaluation of language and culture and lack of access to culturally appropriate health care and services
You can see that there are many different determinants that influence our health. When reviewing the World Health Organization (WHO) definition from 1948 health is “the state of complete physical, mental and social well-being” we are now aware that in defining health there are many variants to consider. You can clearly see the similarities laid out by the Government of Canada, and the RNAO in what constitutes those determinants that impact health. What is interesting is that these determinants do vary somewhat from province to province and country to country. Whereas there is no doubt that there are similarities there is more emphasis on some determinants over others. This variation is dependent on many factors such as the socio-economic climate and cultural influences that impact people’s lives.
For instance, when looking at the determinants of health that impact aboriginal populations such as first nations people in Canada. As stated in the Nccah-loppie-wien_report “these include circumstances and environments as well as structures, systems and institutions that influence the development and maintenance of health along a continuum from excellent to poor. The social determinants of health can be categorized as distal (e.g., historic, political, social and economic contexts), intermediate (e.g., community infrastructure, resources, systems and capacities), and proximal (e.g., health behaviours, physical and social environment). (2009) According to Health Determinants for First Nations in Alberta this can be broken down even further to include “Indians, Metis and Inuit’ (2009).
Social Determinants of Health. (n.d.) Registered Nurses’ Association of Ontario http:/rnao.ca/policy.projects/social-determinants-health
Health determinants for First Nations in Alberta [PDF]. (2009). Health Canada. http://publications.gc.ca/collections/collection_2011/sc-hc/H34-217-2010-eng.pdf
Nccah-loppie-wien_report [PDF]. (2009). https://www.nccah-ccnsa.ca/docs/social determinates/nccah-loppie-wien_report.pdf
Social determinants of health map | public health ontario. (n.d.). Public Health Ontario. https://www.publichealthontario.ca/en/data-and-analysis/health-equity/social-determinants-of-health
What makes canadians healthy or unhealthy? - canada.ca. (n.d.). https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health/what-makes-canadians-healthy-unhealthy.html
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