Determinants of Health

I have been wrestling with what are determinants of health and what are social determinants of health. Are they the same thing or is one a subset of the other. I found the informative video by entitled “Social Determinants of Health – an Introduction” by Let’s Learn Public Health (2017). The video explains that a person’s health is influenced by a range of factors called determinants of health. This includes individual factors such as age, sex and genetics and health behaviours such as physical activity, substance abuse and diet. Health is also influenced by the conditions in which people are born, grow, live work and age. These includes social and community networks, socio-economic, cultural and environmental conditions people live and also health systems. These are called social determinants of health.

The National Collaborating Centre for Determinants of Health (NCCDH, 2022) goes on to define social determinants of health as:

…the interrelated social, political and economic circumstances in which people are born, grow up, live, work and age. The social determinants of health (see below) do not operate as a list or in isolation. It is how these determinants intersect that causes conditions of daily living to shift and change over time and across the life span, impacting the health of individuals, groups and communities in different ways.

• disability

• early child development

• education

• employment and working conditions

• food insecurity

• gender

• geography

• globalization

• health services

• housing

• immigration

• income and income distribution

• Indigenous ancestry

• race

• social inclusion/exclusion

• social safety net

• unemployment and job security

The social determinants are largely shaped by the distribution of money, power and resources at an international, national and local level. Raphael et al (2020) goes on to state that:

Canadians are only now becoming more aware that our health is shaped by how income and wealth is distributed, whether we are employed, and if so, the working conditions we experience. Furthermore, our well-being is also determined by the health and social services we receive and our ability to obtain quality education, food and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living and working conditions are – for better or worse – imposed upon us by the quality of the communities, housing situations, our work settings, health and social service agencies, and educational institutions with which we interact.

The factors of health that are relatively easy to modify from a personal level are health behaviours. The factors that are non-modifiable are individual factors. Social determinants are not so black and white but many are affected by public policies. By supporting public policies that improve the quality of the social determinants of health and make their distribution more equitable would go a long way in improving living and working conditions necessary for good health. Raphael et al (2020) suggests that Canadians should educate themselves about the social determinants of health and ask their elected representatives what is being done to address the issues. One can also raise these issues with agencies, organizations, and institutions whose mandate is to promote public health. Also “organizations such as hospitals and professional associations should educate themselves and step-up by urging governments and policymakers to implement health promoting public policies.”

References:

Let’s Learn Public Health. (2017, June 25). Social Determinants of Health – an Introduction [Video]. YouTube. https://www.youtube.com/watch?v=8PH4JYfF4Ns

NCCDH. (2022). National Collaborating Centres for Determinants of Health. Retrieved June 8, 2022, from https://nccdh.ca/

Raphael D, Bryant T, Mikkonen J, Raphael A. Social determinants of health: the Canadian facts. 2nd ed. Oshawa (ON): Ontario Tech University, Faculty of Health Sciences; 2020 . Retrieved June 8, 2022, from https://www.thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf