While our health-care system often comes to mind when thinking about health, non-medical factors have a profound impact on health and health outcomes.
Social determinants of health are the social and economic factors that influence health. The World Health Organization (WHO) writes, “they are the conditions in which people are born, grow, live, work and age, and the wider set of forces and systems shaping the conditions of daily life.” These systems include economic and social policies, social norms and political systems. Multiple studies suggest that the social determinants of health account for 30 to 55 per cent of health, the WHO states.
Examples of social determinants of health from the WHO include income and social protection, education, food insecurity, housing and the environment, access to quality health services and social inclusion and non-discrimination, among others. These social categories also intersect and interconnect to shape experiences and opportunities, and influence health inequity between groups of people.
The WHO writes that in all countries of all levels of income, “health and illness follow a social gradient: the lower the socio-economic position, the worse the health.”
In the 2018 report titled Key Health Inequities in Canada: A National Portrait, the Public Health Agency of Canada (PHAC) writes, “Canadians are among the healthiest people in the world,” yet “the benefits of good health are not equally enjoyed by all Canadians.”
Significant health inequalities were observed among Indigenous peoples, sexual and racial minorities, immigrants, people living with functional limitations and a range of inequalities by socio-economic status in several health indicators.
The WHO says progress on the social determinants is “fundamental” to improving health and well-being and reducing health disparities; yet many argue Canada’s public policy has fallen short.
What to do?
Social prescribing (in which health-care providers link patients to non-medical community resources) is growing in Canada. The Toronto-based University Health Network’s social medicine program is “focused on integrating the social determinants of health into care delivery and partnering with community organizations to improve the quality of care for disadvantaged populations.” This includes Canada’s first hospital-led supportive housing initiative.
From a policy perspective, the PHAC report lists key actions to address health inequities, such as adopting a human rights approach to action on social determinants, applying evidence-informed and culturally safe policy interventions across the life course, implementing targeted interventions and universal policies, addressing material conditions and the socio-cultural factors that maintain health inequities and establishing a health-in-all-policies approach, among others.
Federal Retirees’ advocacy on retirement income security, national seniors strategy and pharmacare supports these objectives.
Advocates also raise the collective and ethical responsibility to drive progress on health equity and social determinants. For instance, if we believed food security was a human right, would we accept increasing food insecurity in Canada?
Society and governments at all levels have a role to play in creating the conditions that support and promote health and well-being. The 2018 PHAC report concludes “ultimately, achieving the goal of health equity demands that we acknowledge our interdependence — our shared responsibility to create and sustain healthful living and working conditions and environments, and the shared benefits that we can all enjoy when those conditions are in place.”