As much as some would have us believe that individual decisions are the reason some people are healthier than others, the truth is far more nuanced.
In truth, the primary factors that shape the health of Canadians are not medical treatments or lifestyle choices, but rather the living conditions they experience. These ‘social determinants of health’ are much more influential in whether people are more or less healthy.
The definition of the determinants of health vary, but for Canada, a group of 14 are generally agreed upon: Aboriginal status, gender, disability, housing, early life, income and income distribution, education, race, employment and working conditions, social exclusion, food insecurity, social safety net, health services, unemployment and job security.
Each of these has been proven to have a strong effect on the health of Canadians. Their effects are actually much stronger than the ones associated with behaviours such as diet, physical activity, and even tobacco and excessive alcohol use.
Income is probably the most important of all the determinants. This is because it is so closely associated with other determinants of health. There is a clear link between income and socio-economic status and health outcomes: how long we can expect to live and the state of health rise with position on the income scales.
Level of income determines living conditions, diet and food security. It also influences health-related behaviours such as extent of physical activity, tobacco use, and excessive alcohol use. Low income may push basic requirements of health out of reach: food, housing and clothing.
Education is another crucial determinant of health: people with higher education tend to be healthier than those with lower educational attainment. A person’s level of education is highly correlated with other social determinants of health such as the level of income, employment security and working conditions.
More and better education offer a pathway up the socio-economic ladder and better access to other societal and economic resources.
Less obvious than some of the other determinants, the social safety net is nonetheless a significant element in Canadians’ health. The term social safety net refers to a range of benefits, programs and supports that protect citizens during various life changes that can affect their health. These life changes include normal life transitions such as having and raising children, attaining education, entering the labour force and reaching retirement. They also include the unexpected like having an accident, becoming unemployed and developing an illness or disability that can affect health.
An effective social safety net counterbalances the many challenges people face, which is why all wealthy developed nations have created such systems. This is in contrast to sole reliance on the private market system which actually increases insecurity among the population. A weak social safety net turns citizens against communal action and decreases social cohesion. These have health-threatening effects.
Canada’s social determinants of health allow us to understand complex relationships that influence people’s lives and the challenges they face. Good public policy demands action based on this understanding.
Editor’s note: Dr. Paul Martiquet is the medical health officer for rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.
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