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This publication discusses 10 social determinants, facts about each determinant and policy implications. To bring about change, we need to fully understand what is affecting the health of people living in all parts of the world and all levels of society. It has been clearly shown that for those at higher income levels, they have an increased life expectancy. Through this report, we learn that income is not the only factor that affects our health. Other factors such as: stress, childhood, social exclusion, work, unemployment, social support, addiction, food, and transport. Each determinant is of equal importance and they are all interconnected. We need to look after the 'whole person' to truly improve the health of everyone.
"Even in the most affluent countries, people who are less well of have substantially shorter life expectancies and more illnesses than the rich, Not only are these differences in health an important social injustice, they have also drawn scientific attention to some of the most powerful determinants of health standards in modern societies, They have led in particular to a growing understanding of the remarkable sensitivity of health to the social environment and to what have become know as the social determinants of health."
Wilkinson R, Marmot M, editors. Social determinants of health: The solid facts [Internet]. 2nd ed. Copenhagen: World Health Organization; 2003. Retrieved from: http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf
Their focus is on the social and economic factors that influence the health of Canadians. They translate and share evidence with public health organizations and practitioners to influence interrelated determinants. This site provides a vast amount of information for public health professionals regarding public health threats, chronic disease and injury, infectious diseases and health inequities. There is an extensive resource library that contains over 150 resources and is continually growing. There are six collaborating centres across Canada including: National Collaborating Centre for Aboriginal Health, National Collaborating Centre for Environmental Health, National Collaborating Centre for Infectious Disease, National Collaborating Centre for Methods and Tools, National Collaborating Centre for Healthy Public Policy, and the National Collaborating Centre for Determinants of Health.
"Our health is determined to a large extent by the conditions of everyday life, and by the systems put in place to promote health, prevent disease, and support us when we get sick. The ‘social determinants of health’ (SDH) is a name given to the many social conditions that interact to influence our health and well-being, the circumstances in which people are born, grow up, live, work and age".
The National Collaborating Centre has been commissioned by the World Health Organization to Improve daily living conditions; tackle the inequitable distribution of power, money, and resources; and measure and understand the problem and assess the impact of action. The Collaboration Centre takes this seriously and is working hard toward improving health for all Canadians.
National Collaborating Centre for Determinants of Health. (2017). Retrieved from National Collaborating Centre for Determinants of Health: http://nccdh.ca/
"This wonderful document, Social Determinants of Health: The Canadian Facts, is about us, Canadian society, and what we need to put faces and voices to the inequities – and the health inequities in particular – that exist in our midst. Only when we see a concrete description of these complex and challenging problems, when we read about their various expressions in all the regions of the country and among the many sub-groups making up
Canada, can we move to action."
In the mid 1800's it was determined that it is not medical treatments or lifestyle choices that define ones health, but the living conditions they experience. For those who live in poor conditions, they experience significantly higher levels of physiological and psychological stress. By living in an environment that causes a person to keep their stress level high and offers little to no opportunity to lower the stress level, they will suffer chronic effects such as a lower immune system, and hormonal and metabolic imbalances.
This document delves deeply into the key aspects of the determinants of health so that through a better understanding, we can finally begin to improve the health of everyone regardless of social standing or race.
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts.
Toronto: York University School of Health Policy and Management.
"The social determinants of health influence the health of populations. They include income and social status; social support networks; education; employment/working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; gender; and culture"
What the determinants of health are, what we can do about it, and what changes are needed to improve health for everyone can be a daunting issue to tackle. The Public Health Agency maintains a website on the Government of Canada that is available for anyone to read and help the reader gain a thorough understanding of this topic. Data provides a clear picture of the health of all Canadians regardless of perceived health status. The data is offered in sections for all of Canada, aboriginal people, and by each province. Provincial and federal strategies are available for all provinces across the country that address all sectors. to assist in the implementation of change, there are federal and provincial recommendations to offer guidance on how the change should be implemented, where the change should occur, and who should be involved.
Public Health Agency of Canada. (2016, June 27). Social determinants of health. Retrieved from Government of Canada: http://cbpp-pcpe.phac-aspc.gc.ca/public-health-topics/social-determinants-of-health/
Explains what is meant by determinants of health, lists the key determinants, discusses evidence based decision making, and describes how health status indicators are used.
"In a population health approach, taking action on the complex interactions between factors that contribute to health requires: a focus on the root causes of a problem, with evidence to support the strategy to address the problem; efforts to prevent the problem; improving aggregate health status of the whole society, while considering the special needs and vulnerabilities of sub-populations; a focus on partnerships and intersectoral cooperation; finding flexible and multidimensional solutions for complex problems; public involvement and community participation".
Each of the 12 determinants of health are discussed: Income and Social Status, Social Support Networks, Education and Literacy, Employment/Working Conditions, Social Environments, Physical Environments, Personal Health Practices and Coping Skills, Healthy Child Development, Biology and Genetic Endowment, Health Services, Gender, and Culture. The underlying premises and evidence to support this are documented for each determinant. Each of these factor are equally important and interconnected. Work cannot be completed on one factor without affecting the rest.
Government of Canada. (2011, October 21). What determines health. Retrieved from Government of Canada: https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
The World Health Organization offers a comprehensive description of what the determinants of health are, how they affect our health, and additional information that can be found for each determinant. We cannot blame people for poor health when they have neither the means or the education to improve their situation and by association, their health. This is why change needs to come at a global level and we need to move past the stereotypes and social differences to truly make a difference. Each plan for change has been developed through extensive research to create a plan that is evidence-based with the positive, negative and size of the impact well defined.
"Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact."
World Health Organization. (2018). The determinants of health. Retrieved from Health Impact Assessment: http://www.who.int/hia/evidence/doh/en/
Dr. Northern is a chiropractor describing what health is from the perspective of a natural health care provider. The World Health Organization states that 'Health is physical, mental, social and spiritual well being; not just the absence of disease.' Health is a journey and we need to focus on health and prevention and not on the disease. To have good health, the brain must have a clear communication with the body via the nervous system. With good communication, the body can self heal. It is interference of the communication system between the brain and the nervous system that causes disease. Our nervous system also control immunity, digestion and respiratory systems - not just sensation and tingling. A misalignment of the vertebrae can cause illness and disease.
"The absence of symptoms does not mean health."
Northern, D. R. (2013). What is Health. Johansberg, Illinois, United States.
The World Health Organization (WHO) definition of health is a state of completed physical, mental and social well-being and not merely the absence of disease. Wellness refers to the presence of positive attributes in one’s life: well-being, quality of life, happiness, and satisfaction. Illness is a person’s subjective experience of feeling unwell. A sickness is a socially and culturally defined entity and disease is the pathologic process going on inside the body. Both social determinants and physical determinants decide how healthy a person is. Stress occurs when there is uncertainty of the future. When stress levels stay constantly high, this can create chronic disease and unhealthy coping behaviours.
“Remember that health is more than just being disease free, it means different things to different people”
Lovesey, N. (2016). Concept of health and its determinants. Retrieved from https://www.youtube.com/watch?v=tuNxuoP2lEM
The authors of this article believe the World Health Organization (WHO) definition of health to be sadly outdated and more utopian than realistic. Nearly 70 years after the initial definition was penned, it may be time to redefine health into something more pragmatic and relevant to where we are today. There are three main concepts that should be taken into consideration when developing a new definition of health: environmental equilibrium, spirituality, and adaptation. The environmental equilibrium focuses on maintaining a balance between what is inside and outside a person. Since both are closely connected, treatments and care must look at the whole person. A person’s spirituality is defined by their happiness and well-being. Lastly, a person’s ability to adapt to their surroundings is as equally important as a balanced life and spirituality.
“For the Inuit community, to be healthy is to belong to a human group of limited size, to be in harmony with the natural space, and to be able to hunt and face the obstacles.”
Charlier, P., Coppens, Y., Lamaurie, J., Brun, L., Kepanga, M., Hoang-Opermann, V., . . . Herve, C. (2017). A new definition of health? An open letter of autochthonous peoples and medical anthropologists to the WHO. European Journal of Internal Medicine, 37, 33-37. Retrieved from https://0-www-sciencedirect-com.aupac.lib.athabascau.ca/science/article/pii/S0953620516301960?