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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.
There are many different factors that determine whether or not individuals and communities 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, play an important role in how long people will live, or how likely they are to develop a disease.
Health promotion = the social determinants of health
An understanding of the social determinants of health, and how they are interconnected, is fundamental to health promotion. As the majority of differences in health status are socially created, strategies need to address social factors. An understanding of the social determinants provides health promoters with the tools to assess what kind of program and policy interventions will best improve the health status of a specific population.
There are many ways to explore the complex relationships between social determinants. Health Nexus collaborated on a resource called Primer to Action: Social Determinants of Health that categorizes social determinants of health in the following way:
Income
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.
Education
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.
Employment
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.
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.
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.
Inclusion
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.
Where can you go for more information?
 Health Nexus Learning Resources
 Primer to Action: Social Determinants of Health by Health Nexus and Ontario Chronic Disease Prevention Alliance, 2008 (Guide)
Social Determinants of Health (Slides)
Additional information:
The National Collaborating Centre for Determinants of Health
The Tides of Change: Addressing Inequity and Chronic Disease in Atlantic Canada A Discussion Paper (2003), an Annotated Bibliography (2003), and a Tool Kit (2005).
Social Determinants of Health and Nursing: A Summary of the Issues. Canadian Nurses Association, 2005
WHO Commission on Social Determinants of Health - final report (2009)
Canadian Best Practices Portal
Books:
Social Determinants of Health, by Michael Marmot (Editor) and Richard G. Wilkinson (Editor), Oxford Press, Second Edition, 2006 (book)
Social Determinants of Health: Canadian Perspectives, by Dennis Raphael (Editor), Canadian Scholars’ Press Inc., Second Edition, 2008 (book)
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