A look at the current climate of Social Determinants of Health specifically in Canada.
The World Health Organization (WHO) identifies social determinants of health (SDoH) as the non-medical factors that influence health outcomes (WHO, n.d). SDoH can influence an individual’s health equity in a positive or negative way depending on the conditions where they are born, grow, work, live, age and the political systems in place (WHO, n.d). Thus, creating large disparities between countries. Life expectancy is 18 years longer in high-income countries compared to low-income countries (WHO, n.d.). Generally, individuals born in areas of lower socioeconomic positions have poor health and this disparity is seen in all countries regardless of income (WHO, n.d.) Even a well-developed country like Canada is unable to escape the social gradient of health and illness. The poor are more prone to experiencing worse health. The population of Canada is plagued with health inequity.
The government of Canada defines SDoH as specific group of social and economic factors within the broader determinants of health. These determinants of health are broken down into 12 main determinants by the government of Canada (Government of Canada, n.d.). All this is used to establish an individual’s place in society. As a result, Canadians have different experiences with health and health care. These differences are referred to as health inequalities and result in the health inequity present in Canada. A prime example of this is in Canadians that live in remote or northern regions with limited access to nutritional foods compared to other Canadians (Government of Canada, n.d). Canada recognizes these health inequalities and has pledged to take action to create a country with health equity. The government of Canada is tackling health inequalities by strengthening the use of evidence base knowledge to make informed decisions, engaging beyond the health sector and by sharing knowledge of action across Canada (Government of Canada, n.d). Canada has been recognized and continues to be at the forefront of research into the SDoH (Donkin et al, 2017). Consequently, provincial governments have taken notice and started to take action as well.
In British Columbia (BC), the government established the B.C. Social Determinants of Health Standards (Standards) with the goal to provide consistency and guidance for SDoH data collection within British Columbia’s health care community (Government of British Columbia, n.d). The Standards sets out to standardize the definitions and terminology surrounding SDoH, improve culturally safer care and health equity in communities experiencing health inequity, bring SDoH data into the mainstream and improve information practices. Essentially, the Standards is meant to help identify, capture, maintain, understand SDoH and highlight negative impacts of health inequalities on individuals and the population (Government of British Columbia, n.d). However, very limited information is available on what they have accomplished. As of right now the Standards is currently working on cultural identity and Indigenous identity (Government of British Columbia, n.d).
Furthermore, it should also be noted that British Columbians are generally healthy people and tend to live longer than the average Canadian. This statement however creates the illusion that British Columbia has health equity. However, variations in socio-economic status, social support and other factors have created considerable health disparities between British Columbians (BCNU, 2011). Majority of these disparities are due to the distribution of wealth, access to basic necessities and unjust government policies. In BC, the top 20% make 10 times more than the bottom top 20% (BCNU, 2011). As a result, the poor have difficulty obtaining adequate housing and access to food. A large portion of people experiencing poverty are First Nations, new immigrants, single mothers, those with disabilities and the elderly. The BCNU stresses eliminating poverty will create more health equity among British Columbians. They propose eliminating poverty through similar policies established in Newfoundland and Labrador that focus on poverty reduction and supporting low-income families (BCNU, 2011). Additionally, other provinces have also acknowledged the importance of SDoH. Alberta for instance established a province-wide SDoH and health equity approach. The Alberta Health Services (AHS) are improving people’s health and wellness by targeting 3 different levels. They are targeting individuals, the community and through policy reform (AHS, n.d). Through this, the AHS hopes to eliminate health equalities. A similar trend in creating health equity can be seen across the Canadian provinces and territory.
Social factors determine about 75% of our health (BCCDC Foundation for Public Health, n.d). SDoH play an important role in an individual’s health and health status. Numerous studies suggest that SDoH account for between 30-55% of health outcomes in individuals (WHO, n.d). This demonstrates that an individual’s social factors and environment can either positively or negatively impact one’s health. All across world there has been significant progress made in the recognition and adoption of SDoH and health equity (Marmot & Allen, 2014). However, significant work is still required and this is clearly evident in Canada. Although, Canada has been progressive on this front both federally and provincially. Federally, Canada is taking steps to promote and advocate for health equity. While provincially, provinces like British Columbia and Alberta have taken steps in creating policies and establishing committees to tackle SDoH and health inequalities.
References:
Alberta Health Services (n.d). What Determines Health? Alberta Healthy Communities. Retrieved February 14, 2022 from https://albertahealthycommunities.healthiertogether.ca/about/what-determines-health/
BCCDC Foundation for Public Health. (n.d.). Social Determinants of Health 101: Decoding Public Health. Retrieved February 14, 2022 from https://bccdcfoundation.org/social-determinants-of-health-101-decoding-public-health/
BMJ. (2016). Social Determinants of Health. British Medical Journal. Retrieved from https://www.youtube.com/watch?v=_X2tdLTx_1Y
British Columbia Nurses’ Union. (2011). Position Statement: Social Determinants of Health. BCNU. Retrieved February 14, 2022 from https://www.bcnu.org/AboutBcnu/Documents/position-statement-social-determinants-of-health.pdf
Donkin, A, Goldblatt, P, Allen, J, Nathanson, V & Marmot, M. (2017). Global Action on the Social Determinants of Health. BMJ Glob Health, 3. https://gh.bmj.com/content/bmjgh/3/Suppl_1/e000603.full.pdf
Government of British Columbia. (n.d.). B.C. Social Determinants of Health Standards. Government of British Columbia. Retrieved February 14, 2022 from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/health-information-standards/standards-catalogue/bc-social-determinants-of-health-standards
Government of Canada. (n.d.) Social determinants of health and health inequalities. Government of Canada. Retrieved February 14, 2022 from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Marmot, M, & Allen, J. (2014). Social Determinants of Health Equity. American Journal of Public Health, 104. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2014.302200
Public Health Agency of Canada. (2019). Health Inequalities in Canada. Public Health Agency of Canada. Retrieved February 14, 2022 from https://www.youtube.com/watch?v=RMkBUXJLW9g
UBC Medicine. (2017). The Social Determinants of Health. University of British Columbia. Retrieved from https://www.youtube.com/watch?v=nTqknri15fQ
World Health Organization. (n.d.) Social determinants of health. World Health Organization. Retrieved February 14, 2022, from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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