The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as follows: “The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of people’s lives – their access to health care, schools, education, their conditions of work and leisure, their home, communities, towns, or cities – and their chance to lead a flourishing life. Together, the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries” (Gore & Kothar, 2012).
The Public Health Agency of Canada (PHAC) proposes that the SDOH are a “broad range of personal, social, economic and environmental factors that determine individual and population heath – they are income and social status; employment and working conditions; education and literacy; childhood experiences; physical environments; social supports and coping skills; healthy behaviours; access to health services; biology and genetic endowments; gender; culture; race/racism” (PHAC, 2001). Furthermore, the Centres for Disease Control and Prevention (CDC) infer that the above SDOH account for the “conditions in places where people live, learn, work, and play that infer a wide range of health and quality of life risks and outcomes” (CDC, 2020).
In Mikkonen & Raphael’s influential report, The Social Determinants of Health: The Canadian Facts, they begin by addressing the “primary factors that shape the health of Canadians are not medical treatments or choices but rather the living conditions in which they experience” (Mikkonen & Raphael, 2010). They further summarize the following SDOH as useful in identifying why some Canadians are healthier than others. A scoping review conducted by Cheff, Roche, & Snyder (2016) to gain a deeper appreciation for whether Canadians understood and could identify SDOH which contribute to or impact their health and wellbeing. It was discovered, in fact, that a “strong individualistic understanding of health (such as modifiable factors like smoking, physical activity, and diet) were present. However, it was reported that in terms of a SDOH understanding, many Canadians did not know about these determinants and inequalities, which include essential and basic human needs, like housing adequate housing, food security (Cheff et al., 2016). This identifies a huge disparity that must be addressed from a multilevel perspective, and it highlights the blaringly evidence that health population health promotion and teaching are desperately needed.
The SDOH, according to Mikkonen & Raphael are: Aboriginal status; disability; early life; education; employment and working conditions; food insecurity; health services; gender; housing; income and income distribution; race; social exclusion; social safety net; unemployment and job security (Mikkonen & Raphael, 2010).
The Registered Nurses’ Association (RNAO) add the SDOH are the “circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness these circumstances are shaped by a wider set of political, economic, social, cultural, and environmental conditions and forces” (RNAO, 2021).
One common thread running through all these definitions is that there is a direct relationship between the SDOH and health inequalities. Which is why it is ever so important to also consider that health is a political matter (Gore & Kothar, 2012) and reform the inherent political, social, and economic factors which invariably contribute to imbalances in health and health outcomes as these factors “directly influence health status and the lifestyle choices and behaviours that produce health and illness” (Franzini, Low, Swint, & Pathak, 2012). These imbalances are “shaped by the distribution of money, power and resources at global, national and local levels, which themselves are influenced by policy choices” (Canadian Nurses Association (CNA), n.d.) and these imbalances weigh heavily for individuals and families who are on the lower spectrum of socioeconomic status (PHAC, 2018). These inequalities do not exist within a vacuum, and how the government, at a provincial, territorial, and federal level decides where to set the focus on funding and legislation, will impact health across Canada (Canadian Public Health Association (CPHA, n.d.).
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References
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Cheff, R., Roche, B., & Snyder, J. (2016, December). Perceptions of the Social Determinants of Health Across Canada: An Examination of the Literature. Wellesley Institute. From
www.wellesleyinstitute.com/wp-content/uploads/2016/12/Perceptions-of-SDOH-across-
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Neufeld, H.T. (2017). Determinants of Indigenous Peoples’ Health in Canada: Beyond the Social. Canadian Studies in Population, 44. From https://doi/org/10.25336/P6MC71
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Raphael, D. (2014). Social Determinants of Children’s Health in Canada: Analysis and Implications. International Journal of Child, Youth, and Family Studies, 5(2), 220-239. From https://www.doi.org/10.18357/ijcyfs.raphaeld.522014
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