Health is achieved through having positive outcomes in the following factors: personal, economical, social, and environmental (GOC, 2020). Within these factors are specific elements that can further determine one's health. Being cognizant of these factors as a health professional is important as it will shape how you deliver care.
Throughout my research of this topic, I have found that like the definition of health, there are variations. The one static element throughout is that money is a driving force in achieving success in each determinant. I invite you to continue reading this post to better understand the determinants of health, how they may affect our clients, and how the determinants of health have been affected by COVID.
The Government of Canada (2020) states that the determinants of health 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 Government of Canada (2020) also states that the social determinants of health (SDH) are a specific group within these determinants and relate to where a person fits into society.
The SDH listed by WHO (2021) explain ways in which an individual's health may be affected through social factors; although out of a person’s control, they can have a negative or positive effect on a person’s health (WHO, 2021).
The WHO (2021) states the SDH are:
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.
The Canadian Public Health Association (CPHA, 2021) states that there are 14 social determinants of health that include:
Income and income distribution
Education
Unemployment and job security
Employment and working conditions
Early childhood development
Food insecurity
Housing
Social exclusion
Social safety network
Health services
Aboriginal status
Gender
Race
Disability
The CPHA state that the greatest factor in this list is income (2021). Although Canada is a fairly well-off country, low-income populations are often underrepresented as they can be overshadowed by high levels of population health status within the population (CPHA, 2021).
Indigenous communities have been studied and it was found that there are great health disparities for those Indigenous people – so much so that these communities are compared to communities in developing nations (Hajizadeh, et al., 2018). Basic necessities like running water, sanitation, housing, and food are scarce in many Indigenous communities (Hajizadeh, et al., 2018). Its no wonder these communities are unhealthy.
COVID-19 has been a great illuminator of health inequities and inequalities present within our seemly healthy world. I located a document from Public Health Ontario (PHO) that was published on May 24th, 2020 that compared how the SDH affect the risk of contracting COVID-19. Outlined in this synopsis were ways that the risk of exposure and infection were greater and I couldn't help but think that these factors can also play a role in other risk, too. These risks include:
· Structural social inequities (ie: colonialism, social exclusion, etc.). Black and Indigenous populations were particularly affected.
· Essential service occupations (ie: those who are unable to work from home or practice social distancing without access to PPE). Women and racialised workers were particularly affected.
· Precarious occupations (ie: low-skill jobs).
· Indigenous populations. Unsuitable housing was noted as being an influential factor. A figure of 23% of First Nations people and 52% of Inuit Nunangat people live in unsuitable housing. These shocking figures help to explain why Indigenous peoples live in close quarters with many generations in one dwelling.
· Sex and gender. Although scientists are still testing theories, it is currently believed that the risk level for contracting COVID-19 raises when gendered differences in risk, occupation, and health practices exist (ie: women are more frequently employed as nurses and men are mre frequently employed in construction – in these roles, women are not afforded the ability to keep social distance guidelines where men often work outside and/or at a distance from other workers/the public).
· Requiring assistance. Those with poor: literacy (reading, writing, speaking), communication (due to langue barriers), health literacy, transportation, and medical care access are at a higher risk of developing COVID-19.
· Homelessness. As I’m sure you can imagine, homeless populations rely heavily on shelters to provide them with basic necessities. Throughout COVID, access to homeless shelters has been greatly affected. Although shelters offer warmth, food, medical care, and more – they are unable to provide safe, social distancing. Shelters have had to reduce their occupancy and/or have closed.
· Incarcerated populations. Similar to homeless shelters, prison offers limited space and high occupancy. Incarcerated individuals with symptoms have been reluctant to tell officials due to the fear of physician isolation.
How can we improve success in the determinants of health?
One thought is through reducing inequalities across Canada’s social groups. This idea was accepted in 2011 by the Government of Canada along with several other countries (Hajizadeh, et al., 2018).
Reflection:
I grew up in an upper-middle class, predominantly white town where I was quite sheltered from what the rest of the world experienced. I wish this had been a topic discussed in school. I wonder if society would be kinder to those with social disparity if they knew how how little control they have over the situation. I encourage you to review my curated resources on the Social Determinants of Health and share what you have learned with someone else, in hopes that knowledge leads to a solution.
The following video offers a great synopsis of the determinants of health and health inequity. https://www.youtube.com/watch?v=RMkBUXJLW9g
References:
Canadian Public Health Association (February 15,2021). What are the social determinants of health? https://www.cpha.ca/what-are-social-determinants-health
Government of Canada (October 7, 2020). Social determinants of health and health inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Hajizadeh, M., Hu, M., Bombay, A., & Asada, Y. (2018). Socioeconomic inequalities in health among Indigenous peoples living off-reserve in Canada: Trends and determinants, Health Policy. Retrieved February 15, 2021, from https://0-www-sciencedirect-com.aupac.lib.athabascau.ca/science/article/pii/S0168851018301969?via%3Dihub
World Health Organization. (February 15, 2021). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Public Health Ontario (May 24, 2020). COVID-19 – What we know so far about… Social determinants of health. https://www.publichealthontario.ca/-/media/documents/ncov/covid-wwksf/2020/05/what-we-know-social-determinants-health.pdf?la=en
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