The social determinants of health (SDH) are the non-medical factors that impact our health outcomes (World Health Organization, n.d.). They create health inequities between individuals and populations. Health inequities refer to the differences in our health due to our social conditions.
For example, income level impacts the quality of care one receives, which affects long-term health outcomes – someone who can’t afford a life-saving medication is at risk for worse outcomes than someone who can afford it and respond to their health needs (World Health Organization, 2018). Income is often referred to as the most important SDH (Raphael et al, 2020). Anyhow, I don’t think this is fair. Yes, it’s how the world works, but why should we settle and let it continue to work that way when it could be better? Life can be easier for everyone and I believe that’s worth fighting for.
It is important to note that even the best healthcare systems will not lead to the best possible health conditions a population can have without acknowledging the social determinants of health – our living and working conditions (Raphael et al, 2020). Several studies have demonstrated that the social determinants of health account for a significant portion of health outcomes, potentially over 50% (World Health Organization, n.d.). Since there is also a genetic component to health, this would suggest the healthcare itself that one receives (separate from healthcare accessibility) has a less influential effect than social determinants on health outcomes.
Different models encompass different determinants of health, but the one I will be drawing from (Raphael et al, 2020) includes 17 determinants. These include:
The 17 Social Determinants of Health
Disability
Early child development
Education Employment and working conditions Food insecurity Gender Geography Globalization Health services Housing Immigration Income and income distribution Indigenous ancestry Race Social exclusion Social safety net Unemployment and job security
The Long-Term Impacts of Prolonged Stress
Our environments impact our health directly. Individuals and populations more negatively impacted by various SDH end up with a prolonged “fight or flight” response. This leads to a weakened immune system and hormonal imbalances that make one more vulnerable to chronic illness, such as cardiac and respiratory issues or diabetes (Raphael et al, 2020). The presence of chronic conditions can increase the risk for mental illness (Centers for Disease Control and Prevention, 2021).
The psychological impacts of one’s stressful living conditions may cause feelings of shame and hopelessness (Raphael et al, 2020). This increases the risk of unhealthy coping behaviors, such as substance use (Raphael et al, 2020). Individuals who experience addiction are likely to share other common experiences, such as poverty, racism, interactions with the criminal justice system, homophobia, transphobia, domestic/sexual violence, and barriers to healthcare accessibility.
Healthy Public Policy
What gives me hope in decreasing health inequities is knowing that they are socially produced, which makes them changeable (Raphael et al, 2020). They can be addressed through public policy change.
Public policy refers to authoritative decisions made by public authorities, whether this is from the municipal, provincial, or federal governments in the Canadian context (Let’s Learn Public Health, 2020). Public policy can be a statement or strategic action:
Statement: Defines one or more problems affecting a population or one or more groups within it
Strategic Action: Led by a public authority to address a situation or events that are affecting the population
Healthy public policy is characterized by an explicit concern for health and equity in all areas of policy and by an accountability for health impact (Let’s Learn Public Health, 2020). It makes healthy choices possible or easier for citizens.
In the pursuit of healthy public policy, government sectors concerned with agriculture, trade, education, industry, and communications need to take into account health as an essential factor when formulating policy (Let’s Learn Public Health, 2020). These sectors should be accountable for the health consequences of their policy decisions.
Ultimately, healthy public policy is about recognizing the role the SDH play in our lives and addressing them through collaboration across various sectors.
Health Promotion
Health promotion is an upstream approach that can be applied to public health concerns by addressing the SDH. For example, in terms of the opioid crisis, this would mean addressing the SDH that contribute to one’s likelihood of experiencing addiction and/or what their recovery looks like, such as poverty and food insecurity. Ensuring affordable housing and livable wages can decrease some of the external stressors in one’s life. This can contribute to decreasing future incidence rates of those experiencing addiction.
“Social injustice is killing people on a grand scale” (Raphael et al, 2020). |
Take a look around you. Everything is connected. Once you see that, I can’t imagine how anyone is not willing to fight for change to improve the health of all Canadians.
Until next time,
Raquel
References
Centers for Disease Control and Prevention. (2021). About mental health. Retrieved from https://www.cdc.gov/mentalhealth/learn/index.htm
Let’s Learn Public Health. (2020). Determinants of health – A practical approach. [Video]. YouTube. Retrieved from https://www.youtube.com/watch?v=zSguDQRjZv0
Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian Facts, 2nd edition. Ontario Tech University and York University. Retrieved from https://thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf
World Health Organization. (2018). Health inequities and their causes. Retrieved from https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes#:~:text=Health%20inequities%20are%20differences%20in,right%20mix%20of%20government%20policies.
World Health Organization. (n.d.). Social determinants of health. Retrieved from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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