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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. These 12 factors
are known as the determinants
of health.
Some of these determinants are biological and
unchangeable - like a person's gender or genetic background-but
contained within the broad group of determinants is a smaller
group specifically relating to an individual's place in society.
These socio-economic variables are known as social determinants
of health, and they are hugely influential in deciding things
like how long people will live, or how likely they are to develop
a disease.
The social determinants are interconnected,
and work together in a complex relationship. Health promoters
have categorized these relationships in many different ways. The
following, based on the Primer to Action:
Social Determinants of Health, is one way to group the social
determinants of health.
Wealth and income inequality
Financial stability is crucial to ensuring that
we stay healthy - physical wellbeing is not free. Adequate housing,
clothing, food and the other essentials of life all cost money,
and the stress of not being able to make ends meet can take a
major toll on our minds and bodies. One Canadian
study found that men in the top 20 per cent income bracket
live an average of six years longer than those in the bottom 20
per cent.
How wealth is distributed throughout a country
also has a significant influence on how healthy its population
will be. Studies have demonstrated a clear relationship between
the overall health of a country and the size of the gap between
the high income and low-income segments of its population. Where
there is a larger divide, there is a higher incidence of disease
and a lower average life expectancy for all. Japan is a perfect
example of this trend, having one of the narrowest income gaps
and the highest
life expectancy of any country in the world, despite spending
a much smaller percentage of its GDP on healthcare than Canada
or the United States.
Affordable housing and food security
Our homes must be clean, warm and secure - the
absence of these qualities in substandard housing leads directly
to illness and poor health. Shelter must be addressed before any
other need. One of the main reasons low-income families are often
unable to eat a healthy diet is because they have to spend most
of their monthly income on housing. A 2002
Statistics Canada study revealed that low-income families
were most likely to live in accommodation below normal standards
of quality, while spending proportionately twice as much on housing
as other families did.
Food insecurity is also linked to an increased
risk of chronic diseases. A study by the Canadian
Cancer Society noted that families with low incomes were also
four times more likely to suffer from food insufficiency
- an inability to acquire enough food to meet the needs of all
household members. People suffering from food insufficiency were
shown to be at increased risk of developing certain forms of cancer,
due to inadequate intake of cancer preventative foods like fruit
and vegetables. Children need to eat well in order for their bodies
and minds to develop properly. According to the National Longitudinal
Survey on Children and Youth (1994), children in low-income families
are most prone to malnutrition problems that interfere with daily
functioning, and are far more likely to drop out of school than
children from wealthier backgrounds.
Education and literacy
Staying healthy is not an automatic process.
People have to be able to read and understand information that
will help them make the right choices for themselves and their
families.
Researchers and policy-makers in the health
and education fields consider health
literacy as a critical pathway linking education to health outcomes,
as a causal factor in health disparities between different population
groups and as a predictor of overall population health. In Canada,
60% of adults lack the capacity to obtain, understand and act
upon health information and services and to make appropriate health
decisions on their own.
A high standard of education is required to
obtain fulfilling employment and earn a stable income. Furthermore,
people with higher education tend to have more
personal control about things like where they live, what they
eat, and how they work and relax.
Employment
and working conditions
Beyond financial considerations, a satisfying
job provides a sense of self-worth and engagement that also 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 unemployment
or job loss has on society. Increased rates of depression,
anxiety and substance abuse make those without a steady income
far more susceptible to developing disease and other chronic health
problems. Montreal, with the highest unemployment and poverty
rate of any city in Canada, is also the unhealthiest, scoring
lower than other cities on almost all indicators of health.
Social environments and inclusion
A sense of belonging - to our families,
our places of work, and our cultural and community groups- helps
us feel connected to society as a whole and engaged in our lives
and the lives of those around us. When these kinds of social
supports are missing, people are less likely to look after
themselves and reach out to help others, and become more vulnerable
to the stresses of life that can contribute to the weakening of
their immune systems.
Socio-economic exclusion is the common theme
that runs through all of the social determinants. Without the
social advantages that wealthier people take for granted, lower
income segments of the population suffer from reduced access to
the fundamentals of good health. We're all in this together -
as we've seen, the larger the income gap between rich and poor,
the more the overall health of the entire population suffers.
We must all share the responsibility of putting social programs
into place that will ensure the equitable distribution of wealth
and health throughout our society.
Additional
information:
 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.
Social
Determinants of Health - The Solid Facts, Second Edition,
World Health Organisation report, 2003 (Note- please update with
latest WHO 2008 report when it is out later this year)
Books:
Social
Determinants of Health, by Michael Marmot (Editor) and
Richard G. Wilkinson (Editor), Oxford Press, 1999 (book)
Social
Determinants of Health: Canadian Perspectives, by Dennis
Raphael (Editor), Canadian Scholars' Press Inc. 2001 (book)
This article was originally
written for the Canadian Health Network as a FAQ.
Revised by Health Nexus, May 2008.
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