Social Determinants of Health - Are We Doing Enough?
- chatyrbok4
- Feb 14, 2021
- 6 min read
Updated: Mar 21, 2021
Image retrieved from February 14, 2021 https://unsplash.com/@timmarshall?utm_source=wix-media-manager&utm_medium=referral
As a healthcare worker, our job is not only to treat people who are ill but to prevent and alleviate the conditions that are making them sick. Dr. Martin Luther King Jr. stated “of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” It is important when looking at health of people that we not only treat the illness but look at the causes and deal with it at a grassroots level.
According to the World Health Organization (2021) the social determinants of health are considered “non-medical factors that influence health outcomes.” This is a very broad statement and according to the WHO, research has shown that social determinants of health account for 30-55% of health outcomes (WHO, 2021). That is an incredible percentage when you think about it, leading me to believe this could have both a positive or negative impact on health outcomes, depending on which side you fall on.
Health Inequalities in Canada Retrieved March 21, 2021 from https://www.youtube.com/watch?v=RMkBUXJLW9g
We can recognize that the Social Determinants of Health are not just Canada’s issue, that they affect every country across the world. Health inequities is not only differ from country to country but is also from area to area in each of those countries. World Health Organization invited 150 experts to meet in 2017 in Adelaide, Australia which represented 21 countries to review and celebrate Health in All Policies. The group recognized that the Social Determinants of Health needed to be acted on globally and that to do so would require strong representation from all levels of governments and society (WHO, 2019). Manitoba has 63 First Nation Reserves and knowing that First Nations people are a population that suffer from inequalities related to health puts Manitoba in the forefront in needing to address the social determinants of health affecting that population. The Government of Manitoba (2018) position statement on health equity is this:
"that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socio-economic status or other socially determined circumstance. Achieving health equity will improve the health of all Manitobans. Health inequities “are preventable, unfair health differences between different population groups, such as the health related differences observed between high and low income groups.”
It also states that "Only 25 percent of overall health outcomes are influenced by the health care system and its services. Other factors, known as the “social determinants of health” (SDOH), contribute up to 60 per cent to a population’s health status" (Government of Manitoba, 2018). 60 percent... that is a huge number that relates to health status. We need to pay more attention in closing the gaps and decreasing the barriers for populations affected by the social determinants of health therefore increase better health status and equities for all. Our government believes that the health disparities found in certain population groups directly impacts budgets therefore affecting the long term sustainability of the healthcare system. The need to close the gaps in health equity is a reachable goal but requires government implementation and attention to the social determinants of health (Government of Manitoba, 2018). We need to be proactive not reactive to care. Instead of looking at the illness we need to focus on prevention and provide healthcare across the lifespan and not just acute interventions when needed. Governments need to focus in on the health of communities and not just the acute hospital health care. When looking at the upstream approach, health needs to be at the center of policy development regardless of whether talking about social, environment, or education policies. We need all sectors to work collectively to develop strategies together to build healthy communities.
I love this statement written by Katherine Heggie (2018) “Indicators of health and wellness are used to evaluate a community’s overall health. Traditionally, Western approaches to health monitoring have tended to focus on an individual’s physical aspects of health and indicators that can be quantified, such as disease rates. They also too often measure the absence of something negative, rather than the presence of something positive. While it’s important to know what the issues are, measuring only the negative aspects of a community can reinforce a harmful narrative.” I believe it shows that as much as the Social Determinants of Health can affect negatively, we can take those same determinants and reflect that people who are not exposed to them have very positive outcomes to health. Take for example the Social Determinant of poverty – not having a proper income can negatively impact health from poor housing, to food scarcity, to decrease access to proper healthcare, poorer academic performance or access to it a proper education. Yet if that same individual grew up in a community or household not wrought with poverty, the health inequities faced by them would be considerably lower. They would be able to go to school, earn a higher education which in turn would lead to potentially a higher paying job thus affording them to eat more nutritious food and live in proper housing.
Raphael et al (2020) stated that the World Health Organization’s Commission on Social Determinants of Health stated that “the conditions in which people live and work directly affect the quality of their health.” They also state that Canada being one of the wealthiest countries in the world and boasts record high expenditures on healthcare – so how is it, and what good does that do, when we treat the illness and then send them back to live in the same conditions that made them sick in the first place??? Let the sink in for a moment…for all our talk on Social Determinants of Health, what are we actually doing to improve the lives of those living in Canada? Our living conditions are directly impacted by “the quality of the communities, housing situations, our work settings, health and social service agencies, and educational institutions with which we interact” (Raphael et al, 2020). Healthy Child Manitoba (2017) directly reports that children more likely to experience poverty especially in lone-parent families and Indigenous families. As discussed earlier, poverty leads to challenges in accessing nutritious food suitable housing, thus increasing negative health outcomes for them.
If we think of our First Nations communities where it is well known the determinants to health they face is greater than the general population. The government has instituted The Nutrition North Program which helps offset the cost of nutritious foods being shipped to the north making them more affordable to purchase. They have implemented the Jordan’s Principle Program to try and decrease the barriers and access to proper healthcare and services. The Public Health Agency of Canada formed the Canadian Council on Social Determinants of Health which works to help influence factors affecting health and wellbeing (Public Health Agency, 2020). These are just a few of the initiatives that the Canadian Government is running in order to help combat the Social Determinants of Health. Here is a link to the Government of Canada's website on Social Determinants of Health with additional information on programs and groups designed to assist in decreasing the inequities.
To summarize, the Social Determinants of Health is everyone’s concern as well as every country. Measuring health outcomes and social determinants is key to monitoring progress. Education is power.
Are we doing enough? No, we can do better. We have to do better in order to close the gap and break down the barriers that exist in today's society affecting certain populations.
Check out my blog post in my e portfolio regarding equality versus equity...is it one and the same?
Government of Canada (2020). Nutrition North Canada. Retrieved from February 10, 2021
Government of Manitoba (2018) Chief Provincial Public Health Officer Position Statement on Health Equity Retrieved from February 13, 2021 https://www.gov.mb.ca/health/cppho/docs/ps/health_equity.pdf
Health Child Manitoba (2017). Child and Youth Report Retrieved from February 10, 2017
Heggie, K. (2018). Indigenous wellness indicators-including urban Indigenous wellness
indicators in the healthy city strategy. Healthy City Scholar. Social Policy and Projects Vancouver, British Columbia, Canada Retrieved from https://sustain.ubc.ca/sites/default/files/201862%20Indigenous%20Wellness%20Indicators_Heggie.pdf
Public Health Agency of Canada (2020) Canadian Council of Social Determinants of Health
Retrieved from February 10, 2021 http://ccsdh.ca/about-ccsdh/
Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social Determinants of Health:
The Canadian Facts, 2nd Edition. Oshawa: Ontario Tech University Faculty of Health Sciences and Toronto: York University School of Health Policy and Management. Retrieved from February 10, 2021 http://www.thecanadianfacts.org/
World Health Organization (2021) Social determinants of health. retrieved February 10, 2021
World Health Organization, Government of South Australia; (2019). Adelaide Statement II
(2017) on Health in All Policies. Adelaide, South Australia retrieved February 10, 2021 from https://www.who.int/publications/i/item/adelaide-statement-ii-on-health-in-all-policies
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