A health care system – even the best health care system in the world – will be only one of the ingredients that determine whether your life will be long or short, healthy or sick, full of fulfillment, or empty with despair. – The Honourable Roy Romanow, 2004
(Mikkonen, J., & Raphael, D. 2010).
So, what are the other ingredients that influence health? When one is asked this question, answers may be eating right, being physically active or practicing meditation. A factor that an individual has control over. However, Mikkonen, J., & Raphael, D. (2010) explain that “the primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience”. These living conditions are called the social determinants of health. Mikkonen, J., & Rapheal, D. (2010) also argue that “each of these social determinants of health are actually much stronger than the ones associated with behaviours such as diet, physical activity, and even tobacco and excessive alcohol use”.
Health just got more complex.
Through my research on the social determinants of health, I found that there is not one list that all health agencies go by, however I chose to use the following outlined by Mikkonen, J., & Raphael, D. (2010) as I feel this is the most appropriate for Canadians. The following are considered social determinants of health:
- income and income distribution
- education
- unemployment and job security
- employment and working conditions
- early childhood development
- food insecurity
- housing
- social exclusion
- social safety net
- health services
- Aboriginal status
- gender
- race
- disability
(Mikkonen, J., & Rapheal, D., 2010)
How are these determinants tackled? How do we try to put every individual on a level playing field? Is Canada doing a good job? Tackling health inequities is the answer. However, it is not an easy task to tackle. A snapshot of some of the information from the Health Inequalities Reporting Initiative by the Pan-Canadian Public Health Network (May 2018) is as follows:
"The proportion of developmental vulnerability in early childhood among children living in the most materially and socially deprived neighbourhoods was more than twice as high as among children living in the least deprived neighbourhoods
household food insecurity among adults in the lowest income group is nearly 30 times that of adults in the highest income group
core housing need among Canadians in the lowest income group was nearly 7.5 times as higher than Canadians in the highest income group, recent immigrants reported a prevalence of core housing need twice that of non-immigrants
low self-rated mental health decreased as socioeconomic gradients increased
life expectancy and health-adjusted life expectancy were consistently lower and infant mortality and unintentional injury mortality were consistently higher among those living in lower-income areas, with lower educational attainment, and with greater material and social deprivation. These health outcomes were also worse in areas with a high concentration of First Nations, Inuit, and Métis people.”
Source: Pan-Canadian Public Health Network (May 2018).
Canada is dedicated to take steps towards improving health equity. In 2012, Canada signed the World Health Organizations 2011 Rio Political Declaration on the Social Determinants of Health. Data is also collected using the Health Inequalities Data Tool which can be used to inform decision making. The Canadian Council on Social Determinants of Health was also created in 2005. The council works with leaders from various sectors of the social determinants of health to help improve health inequities.
Each province also has different strategies to tackle health inequalities. For example, Ontario has focus on a poverty reduction strategy, as income is argued as the most important social determinant of health. The Ministry of Health and Long-Term Care also added Health Equity as a foundation to the Ontario Public Health Standards that guide public health practices, therefore embedding a health equity lens into all programs delivered by local public health units.
There is a lot of work to be done which will include continued data collection and synthesis, policy change at local, provincial and federal levels and community capacity building, however every step towards health equity is a positive step to healthier Canadians.
References:
Government of Ontario (2014). Realizing Our Potential: Ontario’s Poverty Reduction Strategy (2014-2019). Retrieved from: https://www.ontario.ca/page/realizing-our-potential-ontarios-poverty-reduction-strategy-2014-2019-all
Jackson, B., & Huston, P. (2016). Advancing health equity to improve health: The time is now†. Canada Communicable Disease Report, 42(Suppl 1), S1-1–S1-6.
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management.
Pan-Canadian Public Health Network (May 2018). Key Health Inequalities in Canada, A National Portrait. Executive Summary. Retrieved from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/science-research/key-health-inequalities-canada-national-portrait-executive-summary/hir-executive-summary-eng.pdf
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