Social Determinants of Health

Question 1

What makes a person healthy?

Answer 1

The determinants of health.
The most important factors that influence one’s health isn’t the healthcare they have, but the living conditions they experience known as the social determinants of health.
The social determinants of health can help explain the wide health inequalities that exist in Canada.

Question 2

Social Determinants of Health

Answer 2

The economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole… and the primary determinants of whether individuals stay healthy or become ill

Question 3

Determinants of Health in Canada

Answer 3

We have bragged for years that we in Canada have been identified as the best country to live in.
Certain groups within our country sit at a status similar to third world countries.

Question 4

Some Determinants of Health

Answer 4

Gender/sex
Disability
Housing
Early life/childhood development
Income and income distribution
Education
Race
Employment and working conditions
Social Exclusion
Food in security
Social safety net
Health services

Question 5

Income and Income Distribution

Answer 5

Arguably the strongest determinant of health.
Level of income shapes overall living conditions that affect physiological and psychological functioning, and the take-up of health-related behaviours.
Ie. physical activity, alcohol/substance abuse, diet.
Studied at the following levels…
-how health is related to actual income a family/individual receives
-how income is distributed across the population and how this distribution is related to the overall health of the population
-linked with many other determinants of health (if not all)
Low income leads to social deprivation and poverty
-social deprivation - inability to afford basic food, clothing, housing; limits participation in recreation, education, and culture
-poverty = higher rates of suicide, heart disease, type 2 diabetes, infant mortality, death rates, and alcohol/substance use
Progress in recent decades as been a facade
-the rich get richer, the poor stay poor
-not only do the top 1% have significantly more money, but also more power/influence

Question 6

Education

Answer 6

People with higher education tend to be healthier than those with lower educational attainment.
They have a better understanding of how to actively engage in healthy lifestyles, while also being more likely to eventually obtain higher quality/income occupations.
Canada relatively good in terms of education
-immigrant children and children of immigrants perform as well as children in Canada to Canadian-born parents

Question 7

What are the 3 pathways in which education leads to better health?

Answer 7

1) related to other determinants of health (ie. income, employment, working conditions)
2) greater capacity to benefit from training opportunities, facilitates engagement in political processes
-better understanding of the world and more able to see and influence societal factors that shape their own health
3) increases overall literacy and understanding of how one can promote one’s own health through individual action

Question 8

Employment and Working Conditions

Answer 8

Employment provides income, sense of identity, and day-to-day structure.
Includes employment security, physical conditions at work, work pace and stress, working hours, and opportunities for self-expression and individual development at work.
Unemployment gives a person material and social deprivation, psychological stress, adoption of health-threatening coping behaviours, and physical/mental health problems (ie. depression, anxiety, increased suicide rates).
An average of 4 work-related deaths per working day in Canada.

Question 9

What are the key dimensions of the workplace environment related to health?

Answer 9

Job strain - when people’s autonomy over their work and ability to use their skills are low, while their psychological demands are high.
Effort-reward imbalance - when efforts are perceived to be higher than rewards, lead to emotional distress.
Organizational justice - extent to which people believe that their supervisor considers their viewpoints, shares information concerning decision making, and treats individuals fairly.
Work Hours - too many or too few related to health problems.
Status inconsistency - education level higher than skills required for occupation.
Precarious work - instability, lack of protection, etc.
Only 30% of Canadians had jobs with positive scores on these dimensions.

Question 10

Early Child Development

Answer 10

Early childhood experiences have strong immediate and longer lasting biological, psychological, and social effects upon health.
Incorporates in utero and early exposure to parental risk behaviours (ie. diet, alcohol use, stressors)
Shaped the economic and social resources available to parents primarily through employment (ie. childcare, public policies that support/benefit children).

Question 11

Three Types of Effects on Early Childhood Development

Answer 11

1) Latency effects - how early childhood experiences predispose children to either good or poor health regardless of later life circumstances (ie. biological processes during pregnancy, early psychological experiences).
2) Pathway effects - children’s exposure to risk factors don’t have immediate health effects, but later lead to situations that do have health consequences (ie. child’s readiness to learn as they enter school eventually leads to lower educational attainment and ultimately can impact employment).
3) Cumulative effects - the longer children live under material and social deprivation, the more adverse developmental and health outcomes

Question 12

Food Insecurity

Answer 12

Food is a basic human need, and an important determinant of human dignity.
Food insecure Canadians experience a variety of adverse health outcomes, lacking adequate nutritional intake (ie. fruits, vegetables, vitamins).
Associated with increased likelihood of chronic diseases (ie. heart disease, high blood pressure).
Long-term effects on a child’s physiological and psychological development.
Predicts reporting poor or fair health, rather than good/very good/excellent.
Almost always caused by lack of economic resources.

Question 13

Household Food Insecurity (HFI)

Answer 13

On determine food insecurity.
Marginal HFI - worrying about running out of food and/or limited food selection due to lack of money.
Moderate HFI - consuming food inadequate in either quality or quantity.
Severe HFI - experiencing reduced food intake or disrupted eating.
12.7% of Canadians households experiences one of the above

Question 14

Housing

Answer 14

Housing is an absolute necessity for living a healthy life and living in unsafe, unaffordable or insecure housing increases the risk of many health problems.
Housing quality is an important consideration (ie. mould, lack of ventilation, clean water, basic sanitation).
Unaffordable, insecure, and/or poor quality housing increases risk of many health problems.
-overcrowding = transmission of respiratory and other illnesses
-high costs lead to less resources for other social determinants of health
-poor housing = stress and unhealthy means of coping
-lead, mold, dampness, poor heating, draft, inadequate ventilation, vermin all lead to adverse health outcomes.
Lack of economic resources primary reason for housing problems.
Also a result of Canadian public policy that has reduced public spending on affordable housing.
Children living in poor quality housing have greater likelihood of poor health during childhood and eventual adulthood.
Canada in housing crisis (ie. rents and cost of living rising).
Homeless people experience greater rate of physical/mental health problems, and are at 8-10 greater risk of early death with Canada being in a homelessness emergency state in many cities.
Lack of affordable rental accommodation and growth of part-time and precarious employment (low paying and insecure) lead to homelessness crisis.
Canada has one of the highest levels of low-paying jobs (22%) among western nations.
Housing insecurity linked to income insecurity, which leads to illness and premature death.

Question 15

What is the “Core Housing Need”?

Answer 15

Captures the essence of housing insecurity (a precursor to homelessness).
Affordability - households spends 30% or more of income on shelter.
Suitability - housing inappropriate for size and composition of household.
Adequacy - housing requires major repairs.
12.7% of Canadians in core housing need.

Question 16

Social Exclusion

Answer 16

Refers to specific groups being denied the opportunity to participate in Canadian life.
Socially excluded Canadians are more likely to be unemployed and earn lower wages.
Immigrants, indigenous Canadians, Canadians of colour, persons with disabilities, women, and the 2SLGBTQ1+ community are all particularly effected
-creates living conditions that endanger health.
-creates educational and social problems.
-creates a sense of powerlessness, hopelessness, and depression

Question 17

What are the four aspects of social exclusion?

Answer 17

1) Denial of participation in civil affairs (ie. prevention of non-status residents and immigrants from participation in a range of activities).
2) Denial of social gods (ie. healthcare, education, housing, income security, lower incomes, less access to services).
3) Exclusion from social production (ie. lack of opportunity to participate and contribute to social and cultural activities).
4) Economic exclusion (ie. individuals cannot access economic resources and opportunities such as participation in paid world)

Question 18

Social Safety Net

Answer 18

Refers to a range of benefit programs and supports that protect citizens during various life changes that can affect their health (ie. family allowances, childcare, EI, etc.)
Supports offered to Canadians are well below those of most other wealthy nations.
Range of benefits and programs /supports that protect citizens during life changes, that can affect their health.
-normal life transitions (ie. having/raising children, attaining education or employment training, seeking house)
-unexpected life events (ie. accidents, break-ups, unemployment, development of physical/mental illness or disability
Becoming unable to work through unemployment/illness and family break-ups predict poverty.
Canadian protections/supports well below most other wealthy nations.
Should include EI, counselling, employment training, and community services.

Question 19

Health Services

Answer 19

A basic human right.
Purpose is to protect the healthy of citizens and spread health costs across the whole society.
Concept of a universal health care system particularly effective in protecting citizens with lower incomes who cannot afford private healthcare insurance.
Range of insured services varies among provinces and territories.
Canada’s health care system ranked 9th of 11 wealthy nations.
30% of Canadian doctors reported their patient often had difficulty paying for medications or out of pocket costs.
-28% skipping dental check ups
above-average income Canadians more likely to attend regular check-ups and greater access to care
-3 times more likely to fill a prescription than low-income Canadians.

Question 20

Disability

Answer 20

Typically viewed as medical rather than social.
Issue is whether society is willing to provide persons with disabilities with the supports and opportunities necessary to participate in Canadian life.
Very low levels of benefits to and integration of persons with disabilities in Canada, compared to other wealthy developed nations.
22.3% of Canadians report a disability.
People with disabilities less likely to be employed (59% vs 80%) and when employed they earn less
-76% employment for those with mild disabilities
-31% with severe disabilities
8.6% poverty rate for Canadians without disabilities, 23.2% for those with a disability

Question 21

Gender

Answer 21

Women in Canada are employed in lower paying occupations, earn less, work fewer hours (often due to childcare responsibilities), and experience more discrimination in the workplace than men.
Women experience more adverse social determinants of health, largely due to carrying more responsibilities for raising children and housework and systematic discrimination.
More long-term disability and chronic disease.
Lower pay, more discrimination, less full time work.
-86% of men among senior managers
-68% of men among top executives
Single mothers at particularly high risk of poverty
However, men are also at risk in different ways…
-higher suicide rates (4 times)
-more prone to criminal behaviours (95% of the prison population) when young men experience disadvantage (ie. poverty, low education, unemployment).
-often rooted in unhealthy constructs of masculinity (ie. aggressiveness, self-reliance)

Question 22

Race

Answer 22

Racialized Canadians experience lower rates of income, higher rates of unemployment, and lower occupational status.
All of the above threaten their physical, mental, and social health, but also the overall health and well-being of Canadian society.
Racialized Canadians make up 22% of the population.
Racism harms health in 3 relevant ways…
1) economic and social deprivation
2) socially inflicted trauma (ie. verbal threats, violent acts)
3) Inadequate or degrading medical care
For indigenous peoples in particular = degradation of ecosystem.
Black Canadians experience the most everyday discrimination in Canada (30.8%).