Determinants of Health

According to the Government of Canada, the determinants of health are social and economic factors, physical environment, and behavior (Government of Canada, 2018). These do not exist in isolation from one another (Simcoe Muskoka District Health Unit, n.d,). The Simcoe Muskoka Health District Unit defines the determinants of health as a "range of factors that influence the health status of individuals or populations (Simcoe Muskoka District Health Unit, n.d.)."

The Public Health Agency of Canada has identified twelve determinants of health as follows:

· Income and social status

· Social support networks

· Education and literacy

· Employment/working conditions

· Social environments

· Physical environments

· Personal health practices and coping skills

· Healthy child development

· Biology and genetic endowment

· Health services

· Gender

· Culture

(Simcoe Muskoka District Health Unit, n.d.).

The Social Determinants of Health

According to the World Health Organization (WHO), the social determinants of health are non-medical aspects that influence health outcomes (World Health Organization, n.d.). These include where a person is born, grows up, works, lives, and ages (World Health Organization, n.d.). It also includes other factors such as economic policies and systems, development agendas, social norms, social policies, and political procedures. In addition, it can play a crucial role in influencing health inequities (World Health Organization, n.d.). Moreover, the World Health Organization states that the social determinant of health is significant for improving health and decreasing inequalities in health (World Health Organization, n.d.).

A list of examples of the social determinants of health that can influence health equity in positive and negative ways:

· Income and social protection

· Education

· Unemployment and job insecurity

· Working life conditions

· Food insecurity

· Housing, basic amenities, and the environment

· Early childhood development

· Social inclusion and non-discrimination

· Structural conflict

· Access to affordable health services of decent quality

(World Health Organization, n.d.)

Journal Article Summaries

Social determinants of self-reported health for Canada's indigenous peoples: a public health approach

By: Bethune, R., Absher, N., Obiagwu, M., Qarmout, T., Steeves, M., Yaghoubi, M., Tikoo, R.,

Szafron, M., Dell, C., & Farag, M.

Key Points:

· The study proved that Indigenous peoples suffered from health disparities based on

the social determinants of health from those who self-reported.

· Participants of this study were off-reserve First Nations and Metis peoples who

completed the Statistics Canada Aboriginal Peoples Survey in 2012.

· Older female Indigenous participants living in urban settings were associated with

negative ratings of self-reported health status.

· Education and income directly impact how one views their health. In comparison with

higher educated/higher income participants vs. lower educated/lower-income (grade

Eight or lower/less than $20 000 per year) participants

The higher educated/higher income participants were ten times more likely to report

"excellent" or "perfect" health.

· Volunteers in the community were also associated with better self-reported health

status.

· As per the study, protective determinants of health are income and education, verse

the risk determinants of health are the location of residence, gender, and age.

(Bethune et al., 2019)

Evolution of the determinants of health, health policy, and health information systems in Canada

By: Glouberman, S. and Millar, J

Key Points

· Recently, several Canadian health commissions35–38 have emphasized the

importance of addressing the determinants of health and incorporating population

health concepts and approaches into the health care system to improve the health of

individuals and communities and reduce inequities.

· Health promotion was developed out of the Lalonde report in 1974, which recognized

that the determinants of health went beyond traditional public health and medical

care. It showed the importance of socioeconomic factors.

· In the 1980s, the Canadian Institute for Advanced Research revealed a health

inequalities along socioeconomic lines, which paved the way for policy development

for children.

· Early development is essential for a child’s future schooling, employment, and health.

· Thomas McKeown, a professor of social medicine at the University of Birmingham in

England was the first to use the term determinants of health.

· The Lalonde report identified four major components of the health field concept:

human biology, health care systems, environment, and lifestyle.

· The Lalonde report also marked the first stage of health promotion in Canada.

· The Lalonde report identified that the following is needed to address the

determinants of health, including research, health education, social marketing,

community development and legislative and healthy public policy approach.

· Economic development and the distribution of wealth in society are essential

determinants of population health.

· The work environment is a significant health determinant.

· All provinces except for Ontario have regionalized the delivery of health services.

Regional service managers focus more on addressing the broad determinants of

health. For example, Edmonton is working with the board of education to address

obesity. Montreal’s health department is working with universities and municipalities

to promote child and family poverty into action.

(Glouberman and Millar, 2003)

Canada: December 2019 federal government mandate letter review. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy, and Practice

By: Kelsey Lucyk

Key Points:

· Decreasing the inequalities amongst groups within Canada requires an intersectoral

action on determinants of health.

· Most determinants of health lie outside of the health sector

· Cabinet ministers in Canada receive policy objectives from the Prime Minister in

“mandate letters” are known as tools which outline criteria for identifying critical

department priorities.

· Non-health sector ministers can benefit from the health sector supporting policy

development to improve health inequity.

· Social determinants of health have to do with where a person is born, how they live,

how they grow, work and age, racism, sex and gender, and education.

· There is an ongoing challenge to intersectoral action for health as it is not the top

priority.

· Canada’s Commitment on Determinants of Health and Health Equity

· Inequities are created through the unequal distribution of funds, power, and

resources within and between nations,

· It is vital to consider how Canada’s international policy investments address

determinants of health.

· Canada’s international activities and assistance will focus on gender equality and

women’s empowerment.

· It will create opportunities to reduce poverty amongst women in developing countries

by decreasing the pay inequalities amongst care workers through Canada’s Women,

Peace and Security agenda.

· The plan also includes working with the UN to target determinants of health,

including ending poverty and hunger and decreasing inequalities.

· The National Institute for Women’s Health Research will fill research gaps in health

care.

· The Canadian Institutes of Health Research and Social Sciences and Humanities

Research Council will execute grants for research on race, diversity, and gender.

(Kelsey Lucyk, 2020)

Resources

Bethune, R., Absher, N., Obiagwu, M., Qarmout, T., Steeves, M., Yaghoubi, M., Tikoo, R.,

Szafron, M., Dell, C., & Farag, M. (2019). Social determinants of self-reported health for

Canada's indigenous peoples: a public health approach. Public Health, 176, 172–180.

Retrieved on June 12, 2022, from https://doi.org/10.1016/j.puhe.2018.03.007

Glouberman, S., and Millar, J. (2003). Evolution of the determinants of health, health policy,

and health information systems in Canada. American Journal of Public Health (1971),

93(3), 388–392. Retrieved on June 12, 2022, from Evolution of the Determinants of

Health, Health Policy, and Health Information Systems in Canada | AJPH | Vol. 93 Issue 3

(aphapublications.org)

Government of Canada. (2018, May 22). Determinants of Health. Retrieved June 14, 2022,

from https://www.canada.ca/en/services/health/determinants-health.html

Kelsey Lucyk. (2020). Intersectoral action on the social determinants of health and health

equity in Canada: December 2019 federal government mandate letter review. Health

Promotion and Chronic Disease Prevention in Canada, 40(10), 314–323.

https://doi.org/10.24095/hpcdp.40.10.03

Simcoe Muskoka District Health Unit. (n.d.). Determinants of Health. Simcoe Muskoka

Health Stats. Retrieved June 14, 2022, from

ttps://www.simcoemuskokahealthstats.org/topics/determinants-of-health

World Health Organization. (n.d.). Social Determinants of Health. Health Topics: Social

Determinants of Health. Retrieved June 14, 2022, from https://www.who.int/health-

topics/social-determinants-of-health#tab=tab_1