The truth is that Canada – the ninth richest country in the world – is so wealthy that it manages to mask the reality of poverty, social exclusion and discrimination, the erosion of employment quality, its adverse mental health outcomes, and youth suicides. While one of the world’s biggest spenders in health care, we have one of the worst records in providing an effective social safety net. What good does it do to treat people’s illnesses, to then send them back to the conditions that made them sick? (Mikkonen, 2010, p.5)
Many factors affect health; There is so much more to be considered than health inequalities such as genetics and lifestyle choices (Canada, 2001). “Health inequity refers to health inequalities that are unfair or unjust and modifiable” such as gender, intergenerational cultural trauma, or access to resources (Canada, 2001). When assessing the health of an individual, a family, a community or a country the social, economic, and environmental influences need to be considered in order to appreciate the resources and challenges being faced. This paper will discuss social determinants of health in Canada.
“Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health” (Canada, 2001). “Their effects are actually much stronger than the ones associated with behaviours such as diet, physical activity, and even tobacco and excessive alcohol use” (Raphael, 2009).
There is ample literature on social determinants of health available. In searching for a comprehensive list that best addressed the influences on Canadian’s health, the list developed at a York University Conference held in Toronto in 2002, as recorded in Raphael’s (2009) book titled Social Determinants of Health: Canadian Perspectives, 2nd ed, has proven especially useful for understanding why some Canadians are healthier than others. The 14 social determinants of health in this model are:
1. Aboriginal status
2. gender
3. disability
4. housing
5. early life
6. income and income distribution
7. education
8. race
9. employment and working conditions
10. social exclusion
11. food insecurity
12. social safety
13. net health services
14. unemployment and job security
In 2011, the World Conference on Social Determinants of Health was held in Rio De Janeiro, Brazil, by the World Health Organization (WHO). “The Rio Political Declaration on Social Determinants of Health was adopted" and Canada joined many other nations in endorsing this non-binding pledge (WHO, n.d.; Stankiewicz, Herel, & DesMeules, 2015). “The declaration expresses global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities” (WHO, n.d.). The Rio declaration recognizes that “health inequities… are politically, socially and economically unacceptable, as well as unfair and largely avoidable, and that the promotion of health equity is essential to sustainable development and to a better quality of life and well-being for all, which in turn can contribute to peace and security” (WHO, n.d.).
Canada must continue to strive for health equity. Health equity is defined as “the absence of unfair systems and policies that cause health inequalities. Health equity seeks to reduce inequalities and to increase access to opportunities and conditions conducive to health for all” (Canada, 2001). To achieve this, we must “keep in mind the importance of the broader political, economic, and social environments in which Canadians are now living” (Raphael, 2009). “Key Canadian developments across different levels of government and with civil society include further reorientation of the health sector towards reducing health inequities and initiatives to monitor progress and increase accountability” (Stankiewicz, Herel, & DesMeules, 2015).
The World Health Organization recognizes health as a fundamental human right (WHO, n.d.). Governments around the world, Canada included, are developing action plans to tackle health inequalities and inequities. The Public Health Agency of Canada created the Canadian Council on Social Determinants of Health (CCSDH) in 2005. “The CCSDH brings together individuals and organizations from many sectors in Canada, such as urban planning, social policy, public health, municipalities, Indigenous organizations, philanthropy and research. These members bring to the CCSDH knowledge and experience regarding the upstream factors that influence health and wellbeing” (“About CCSDH,” n.d.)
Every policy put into affect and every resource provided that supports and improves the determinants of health of Canadians will foster not only healthier individuals and communities, but a healthier nation. Health is a resource. Health is a right. Health is attainable.
References
About CCSDH | CCSDH. (n.d.). Retrieved February 15, 2019, from http://ccsdh.ca/about-ccsdh/
Canada, P. H. A. of, & Canada, P. H. A. of. (2001). Social determinants of health and health inequalities [policies]. Retrieved February 9, 2019, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Mikkonen, J., Raphael, D., York University (Toronto, O. ., & School of Health Policy and Management. (2010). Social determinants of health: the Canadian facts. Toronto, Ont.: York University School of Health Policy and Management. Retrieved from http://ra.ocls.ca/ra/login.aspx?inst=centennial&url=https://www.deslibris.ca/ID/223317
Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives, 2nd edition. Toronto: Canadian Scholars’ Press. Retrieved February 12, 2019 from https://crofsblogs.typepad.com/files/sample-pages-chapter-sdoh-revised.pdf
Stankiewicz, A., Herel, M., & DesMeules, M. (2015). Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015. Maladies Chroniques et Blessures Au Canada, 35(7), 113–114.
WHO | Rio Political Declaration on Social Determinants of Health. (2011). Retrieved February 11, 2019, from https://www.who.int/sdhconference/declaration/en/
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