There are many factors that influence the health of an individual aside from the traditional healthcare system itself. By this I mean that, having “good” health begins long before one makes a trip to the doctor. It actually starts from “childhood, in our homes, our schools, our workplaces and our communities” (“Health, Not Health Care-Changing the Conversation”, 2010). The health care system exists to help people after they get sick or injured, so what about the conditions that lead to one getting sick or injured in the first place?
Here is a simple story-telling approach provided by the Government of Canada in order to wrap our heads around the complex set of factors or conditions that determine the level of health for 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 neighborhood 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 neighborhood?
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 ...?" (“What Determines Health”, 2011).
This ultimate question of “WHY?” allowed for the identification of the underlying factors and condition that caused Jason to get a bad infection in his leg in the first place.
The Government of Canada explains that “at every stage of life, health is determined by complex interactions between social and economic factors, the physical environment and individual behaviour…. refereed to as determinants of health. They do not exist in isolation from each other. It is the combined influence of the determinants of health that determine health status” (“What Determines Health, 2011).
The social determinants of health consist of:
· Income and social status
· Social support networks
· Education and literacy
· Employment/ work conditions
· Social environments
· Physical environments
· Personal health practices and coping skills
· Healthy child development
· Biological and genetic endowment
· Health services
· Gender
· Culture
The video below provides an introduction to understanding the social determinants of health:
The World Health Organization (WHO) describes that these social determinants of health are, “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at the global, national and local levels and are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries” (WHO, 2018).
The World Health Organization (WHO) describes that these social determinants of health are, “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at the global, national and local levels and are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries” (WHO, 2018).
Now that we know what the social determinants of health are, how can these health inequities (defined by the WHO (2018), as “the absence of avoidable or remediable differences among groups of people”) be measured/ assessed and addressed?
Measuring Health inequities
One of the many tools that are used in Canada in order to measure/ assess the health inequities in the Canadian population is the Health Inequities Data Tool.
Health Inequities Data Tool
The Government of Canada along with the Member States of the WHO endorsed the Rio Political Declaration on Social Determinants of Health and pledged to take action to promote health equity (“Health Inequities Data Tool”, 2017). This declaration “expresses global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities. It will help to build momentum within countries for the development of dedicated national action plans and strategies” (WHO, 2018).
Given this declaration, the Health Inequalities Data Tool supports Canada’s pledge. According to the Government of Canada, “this resource is a collaborative effort of the Public Health Agency of Canada, the Pan-Canadian Public Health Network (PHN), Statistics Canada, and the Canadian Institute for Health Information, and builds on a set of indicators of health inequalities proposed by the PHN in 2010. The Health Inequalities Data Tool contains data on indicators of health status and health determinants, stratified by a range of social and economic characteristics (i.e. social stratifiers) meaningful to health equity. Indicators are grouped into twelve framework components" (“Health Inequities Data Tool”, 2017).
Below is a map of the health inequities data tool of available indicators:
Addressing Health inequities
According to the report titled Health Care in Canada What Makes Us Sick by the Canadian Medical Association, 12 recommendations were established in order to address four main social determinants of health seen throughout the Canadian population, which were: income, housing, nutrition and food security and early childhood development.
These recommendations are provided in the table below from the Canadian Medical Association (“Health Care in Canada What Makes Us Sick”, 2013):
What are some social determinants of health that are more prevalent in your area? How else can we manage and address these health inequities?
References:
Appuhamy, R., & Clark, J. [Let's Learn Public Health]. (2017, June 25). Social Determinants of Heal - An Introduction [Video file]. Retrieved from https://www.youtube.com/watch?v=8PH4JYfF4Ns
“Health Care in Canada What Makes Us Sick”. (2013). Canadian Medical Association. Retrieved from https://www.cma.ca/Assets/assets-library/document/fr/advocacy/What-makes-us-sick_en.pdf
“Health Inequities Data Tool”. (2017). Government of Canada. Retrieved from https://infobase.phac-aspc.gc.ca/health-inequalities/
“Health, Not Health Care-Changing the Conversation”. (2010). Government of Ontario. Retrieved from
“What Determines Health”. (2011). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
World Health Organization. (2018)
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