We have discussed how factors like income, education and the social safety net can all have an effect on the health of Canadians. These ‘social determinants of health,’ as they are called, also include Aboriginal status, gender, disability, housing, early life, income distribution, race, employment and working conditions, social exclusion, food insecurity, health services, unemployment and job security.
Having already looked at income, education and the social safety net, we turn to three more key influencers of health.
Closely related to income, but significant in their own right, are unemployment and job security. We know that employment not only provides income, it also helps define identity and structures day-to-day life.
Conversely, unemployment may lead to material and social deprivation, psychological stress, and the adoption of health-threatening coping behaviours. Lack of employment is associated with physical and mental health problems that include depression, anxiety and increased suicide rates.
In Canada, we have seen an increase in the rate of job insecurity over the past several decades. Today, only half of working age Canadians have had a single full-time job for more than six months or more. And there are many people working under precarious conditions: part-time, self-employment or have temporary work.
Early childhood experiences have strong immediate and longer lasting biological, psychological and social effects upon health. Some factors including low birth weight, poor maternal diet during pregnancy and disadvantaged conditions predispose children to poor health regardless of later life circumstances.
Other factors may not immediately cause health problems, but can do so over the longer term. For example, not being ready to start school can limit learning and lead to effects later in their education, and in their lives.
There are also cumulative effects. For example, the longer children live under conditions of material and social deprivation, the more likely they are to show adverse health and developmental outcomes.
Gender makes a difference. Being female in Canada usually means being responsible for raising children and looking after the household. This means women tend to face more adverse social determinants of health than men. They are less likely to be working full-time thus making them less likely to be eligible for unemployment benefits. Moreover, they are typically employed in lower paying occupations with less job security.
For Canadian women, there is a measureable income gap versus the incomes of men. For a number of reasons, women not only work fewer hours, but they also receive only about 80 per cent of the hourly wages of men. In addition to these challenges, it is also difficult to find affordable, high quality daycare so that they can actually go out to work.
Decades of research tells us our health is shaped by how income and wealth is distributed, whether or not we are employed, by the health and social services we receive, and our ability to obtain quality education, food and housing, among other factors. Public policy needs to address these factors.
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.
