For as long back I could find information, the main focus for an individual’s health mainly focuses on not being "medically ill". Decreasing illness and/or morbidity has historically been the key component around health care spending, promotion, and education. Since most of the determinants of health are not directly within the “medical system”, they are often laid to the side and not focused on when it comes to priority. The Ottawa Charter (1986) talked about things that are requirements for the health of individuals including quality housing/shelter, quality education, nutritional food, stable income that is sufficient for the cost of living, social justice and equality, and a healthy environment.
One of the most concise descriptions of the determinants of health was from Health Canada. They state “Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health”. (Government of Canada, 2020).
The primary determinants of health listed are:
Income and social status
Employment and working conditions
Education and literacy
Childhood experiences
Physical environments
Social supports and coping skills
Healthy behaviours
Access to health services
Biology and genetic endowment
Gender
Culture
Race / Racism
The social aspect of these determinants refers to the social and/or economic elements that are engrained within the determinants. They include, but are not limited to an individual’s education level, employment type or income level, and personal circumstances such as housing or being a minority.
Through good health promotion, we can enable individuals to gain control over their own health by providing them with proper resources and education. For many aspects this includes some of the social determinants of health. For example: if you have young parents that are not well educated, they can still provide a healthy, safe and quality life for their family through education surrounding accessibility and managing daily tasks such as ensuring safe housing and how to grocery shop for healthy food within their budget. Even for myself as an educated person with stable and good income, who grew up in a healthy household and environment, I sometimes struggle in knowing if what I am doing for my child is the right thing. So I cannot imagine working in a job that makes me have to choose between the light bill and healthy food for my kids. Or having to ensure my children as not outside after dark because we live in an unsafe neighborhood.
“The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience”. (Mikkonen & Raphael, 2010)
All levels of government, including federal, provincial/territorial, and municipal must have laws and policies to ensure that all Canadians have equitable pay that is sustainable with the cost of living, no matter their employment level or if they are on social assistance. Government also needs to ensure that all Canadians have equitable, safe and affordable housing, access to affordable and nutritional food, and positive social and recreational programs. The World Health Organization describes events that are detrimental to ones health as “a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics”. (WHO, 2008)
Until the government agencies make a shift in focus and gain a better understanding of what truly causes health disparity, and how important the social determinants of health are, we will not have a truly healthy population. There is an astronomical amount of money being spent on health care, which is only growing as time goes on, while social spending has basically halted. There is no point in us continuing on this “band-aid” trajectory on trying to fix people’s health issues later in life when focusing on and supporting the social determinants of health could have possibly prevented it.
Government of Canada (2020) Social Determinants of Health and Health Inequlatities. Retrieved February 15, 2021, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts.
Toronto: York University School of Health Policy and Management.
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