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Determinants of Health
What Makes Canadians Healthy or Unhealthy?

This deceptively simple story speaks to the complex set of factors or conditions that determine the level of health of every Canadian. "Why is Jason in the hospital?
Because he has a bad infection in his leg.
But why does he have an infection?
Because he has a cut on his leg and it got infected.
But why does he have a cut on his leg?
Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on.
But why was he playing in a junk yard?
Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them.
But why does he live in that neighbourhood?
Because his parents can't afford a nicer place to live.
But why can't his parents afford a nicer place to live?
Because his Dad is unemployed and his Mom is sick.
But why is his Dad unemployed?
Because he doesn't have much education and he can't find a job.
But why ...?"

- from Toward a Healthy Future: Second Report on the Health of Canadians


What are the social determinants of health?

There are many different factors that determine whether or not someone will enjoy good health. Some of these determinants are biological and unchangeable – like a person’s gender or genetic background—but some determinants specifically relate to an individual’s place in society.  These socio-economic variables called social determinants of health, can play an important role in how long people will live, or how likely they are to develop a disease.

Health Nexus collaborated on a resource called Primer to Action: Social Determinants of Health that categorizes social determinants of health in the following way:

We need money to help us secure housing, food, clothing, transportation, cultural and recreational opportunities and all the other things we need for a healthy life in society. Adequate income creates opportunities for positive life chances, including healthy choices.
How evenly wealth is distributed throughout a country also has a significant influence on how healthy its overall population will be.  Studies have demonstrated that where there is a larger income divide between the richest and poorest in a country, there is a higher incidence of disease and a lower average life expectancy for all. 
Inadequate income has profound effects on those who live in urban areas, but also those who live in rural areas.

A satisfying job can provide a sense of self-worth and engagement that gives people a feeling of control over their lives, and this kind of control has been shown to have a positive effect on health. The more security and choices people have, the more they feel prepared to deal with the biological and social stresses they encounter in their lives. 
The connection between employment and health is particularly evident when examining the effects of unemployment or job loss on society.  Increased rates of depression, anxiety and substance abuse make those without a steady income far more susceptible to developing disease and chronic health problems. 

Education is seen universally as a necessary condition for personal and societal success. The knowledge of how to live a healthy life is not something we are born with.  According to the Canadian Public Health Association, in Canada, 60% of adults lack the capacity to read, understand and act upon health information and services in order to make appropriate health decisions for themselves and their families.  In addition, a lack of education often makes it difficult to gain a good standard of employment and financial stability.

Affordable housing
Our homes must be clean, warm and secure – the absence of these qualities in substandard housing – or no housing – leads directly to illness and poor health. One of the main reasons low-income families are often unable to eat a healthy diet is because they often have to spend much of their monthly income on housing. 

Built environment
In addition to exposure to chemical and other hazardous contaminants found in the air, soil, water, and food, the built environment can significantly impact our health.  We need communities that are safe and walkable with options for active as well efficient public transportation systems, access to green space and adequate housing.
Food security
We need healthful, nutritious food to lead productive lives and reach our full potential, however, this is not the reality for many people. Food insecurity is closely linked to income. Studies have shown that people in low-income neighbourhoods have less access to grocery stores and fresh foods and more access to fast-food restaurants.  For low-income families, the cost of food represents a larger chunk of the household budget than it does for those with higher incomes.  
Those groups most likely to be affected by low incomes in Canada include Aboriginal people, single mothers and their children, persons with disabilities, recent immigrants and those who have not completed high school.

The need for social and economic inclusion is a common theme that runs through all of the social determinants.  Inclusion is a sense of belonging – to our families, our places of work, and our cultural and community groups–that helps us feel connected to society as a whole and engaged in our lives and the lives of those around us. 
Inclusion can be a way of addressing the systemic ways in which different groups and communities face exclusion and marginalization in society, and therefore, poorer health outcomes. This is particularly true for those who live on low incomes and lack the advantages that wealthier people take for granted.

For more information:

WHO – Social Determinants of Health
Contains information on the Determinants and up to date WHO publications and reports issued by the Commission on Social Determinants of Health.

WHO – Ottawa Charter for Health Promotion  (PDF)
This document is an international agreement which solidified international commitment to advancing action on the social determinants of health and health promotion.

National Collaborating Centre for Determinants of Health
One of six National Collaborating Centres for public health, the NCCDH helps public health organizations and practitioners learn about interventions that promote health-enhancing social and economic conditions and use evidence to create more effective programming to advance health equity.

Social Determinants of Health: The Canadian Facts
This book by Dennis Raphael and Juha Mikkonen outlines the importance of the social determinants of health and what Canada is doing to addressing the determinants. The book outlines actions that can be taken to improve the Social Determinants of Health.

Ontario Healthy Communities Coalition 
Highlights a recent initiative led by OHCC on the relationship between health and the built environment.

The National Collaborating Centre for Healthy Public Policy Learn more about the built environment and how it affects our health.

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