The most important influences on our health may not be the first things we think of.
People often believe their health is influenced solely by behaviours such as smoking, diet and exercise. While these factors play a role, they often stem from determinants such as income, education, employment and social connections. Having a secure predictable job, affordable housing, food on the table, and a neigbourhood where one feels a sense of belonging and safe all have powerful impacts on health -from childhood onward! These broad factors are called the social determinants of health. And this way of thinking about what determines health is called ‘upstream’.
When we understand these factors and the impact on our overall health, we can influence our physical and social environments and make changes to support health where we live, work and play.1 The following video illustrates these ideas.
The choices we make as individuals do not occur in a vacuum. How a person’s overall health and wellness are affected by the determinants of health is illustrated in Nadia’s story8.
Nadia has asthma and once again she’s in the emergency room. Lately she’s been stressed. She would really like to move because her apartment is old and musty. But she can’t because her rent is all she can afford right now… plus it’s close to where she works shifts at a low-skill manufacturing job.
Recognizing how the social determinants of health influence our opportunities to be healthy changes how we look at improving health and wellbeing. The question, “how do we promote healthy behaviours?” becomes, “how can we create the community environments that make the healthier choice the easier choice”2
The Healthy Communities Approach empowers communities to take action on the social determinants of health and on chronic disease prevention.
The social determinants of health
From biology to behaviour and beyond, our understanding of what determines health has evolved over the past 50 years. The CANADIAN FACTS identifies the key determinants that impact health in our contemporary Canadian context. These fundamental determinants are:3,4
Income and its distribution
Health improves with every step up the income ladder. The less income we have, the worse are our chances for good health. Money grants access -to a good education, a good job, a better home in a safer neighbourhood, reliable transportation and health care. Income also affords recreation and leisure. But not all groups have the same resources. The greater the income gap between rich and poor, the less healthy the society is overall.
Like income, more education is usually better; a gateway to a higher paying job and a positive work environment. Low literacy sidelines people from civic engagement which plays a significant role in one’s sense of belonging.
Unemployment and job security
Being out of work or having unpredictable or precarious employment significantly impacts income and material wellbeing. It also creates ongoing stress of not being able to make ends meet.
A good job with good pay, security and benefits, along with a safe physical environment and positive workplace culture fosters health and wellbeing. High demand jobs with little control over the quality and pace of work, physical hazards and/or negative workplace culture produce damaging physical and mental stress.
Early childhood development
Supportive nurturing relationships with family and others, nutritious food, a safe home and opportunities for play and learning, and an absence of violence set the stage for future health and development potential.
Due to lack of money and financial support, food insecurity means not having the quality, quantity or variety of food needed for health and development.
Housing is a basic human right. Without appropriate, affordable, safe, clean housing stock, people have more difficulty securing and holding a job, more health problems and require more health care, yet experience greater barriers to accessing needed services.
Having family and friends to talk to, opportunities to participate in community activities, and a sense of belonging reduces stress and foster positive social, physical and mental health. Isolation, discrimination and other barriers to participation such as low literacy and poverty exclude people from mainstream society.
Social safety net
This is the range of benefits, programs and supports that can protect citizens during various life changes or events that can affect their health.
Canada’s universal health care system is designed to improve the health of all Canadians, especially those who can’t afford needed treatment and services. Access to health care services and providers is essential, yet not equally available to all citizens contributing to health inequities primarily in rural, remote and Indigenous (First Nations, Métis and Inuit) communities.
As a whole, Indigenous groups have lower incomes, education and health outcomes than other Canadians; the product of social exclusion due to systemic discrimination, loss of land, language and culture.
Whether male, female, gender-diverse or transgender, society has different roles and expectations for us. These affect our health as well as our job prospects and income, poverty levels, leisure time and the likelihood of discrimination and social exclusion.
This refers to groups of people who have differences and similarities in biological traits deemed by society to be socially significant meaning that people treat other people differently because of them. Racism, then, is prejudice based on socially defined physical features5.
This is a physical or cognitive impairment that substantially limits one or more of the major life activities of such individual being impairment6.
But understanding how health is shaped by these broad factors cannot be conveyed in a list. Acting alone and together, these determinants form the conditions for life-long health and wellness. Canada’s Wellesley Institute, a leader in research, policy and community mobilization tells us how in the following video7.
For more information visit:
Public Health Agency of Canada, What determines health?
World Health Organization (WHO) Conceptual Framework on the social determinants of health
Wellesley Institute SDOH -The Canadian Facts
1. Canadian Council on Social Determinants of Health, 2013, p. 2
3. Social Determinants of Health THE CANADIAN FACTS http://www.thecanadianfacts.org/The_Canadian_Facts.pdf
4. The Social Determinants of Health…understanding how health is shaped, Apple Summer 2015, Issue 18, p. 37 http://www.applemag-digital.com/applemag/summer_2015?pg=NaN#pgNaN
5. Stanford Encyclopedia of Philosophy https://plato.stanford.edu/entries/race/
6. Fried, L.P., Ferrucci, L., Darer, J., Williamson, J.D. and G. Anderson. Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care The Journals of Gerontology: Series A, Volume 59, Issue 3, 1 March 2004, Pages M255–M263, https://doi.org/10.1093/gerona/59.3.M255
7. Wellesley Institute: Making the Connections: Our City, Our Society, Our Health
8. Public Health Agency of Canada http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php#determinants
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