Determinants of Health: A National, Provincial and Individual Perspective

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Determinants of health are defined by the Office of Disease Prevention and Health Promotion (n.d.) as “the range of personal, social, economic, and environmental factors that influence health status” (para. 3). The interrelationships between these factors shape health of individuals and of the population. Determinants of health vary across the world. In Canada, our determinants of health consist of:

• income and social status

• employment and working conditions

• education and literacy

• childhood experiences

• physical environments

• social supports and coping skills

• healthy behaviours

• access to health services

• biology and genetic endowment

• gender

• culture

(Government of Canada, 2019)

To narrow our determinants, I looked specifically at the social determinants of health, which relate to an individual’s place in society (Government or Canada, 2018). An excellent explanation of social determinants of health by Appuhamy (2017) can be found on Youtube. He describes how social determinants of health are ultimately shaped by the distribution of money, power and resources; these influence health inequities among different groups of people (Appuhamy, 2017). I found this explanation to be engaging and feel it could be a useful tool to help the greater population understand social determinants of health.

To focus in more on Canada, I explored journal articles pertaining to health determinants and their role in shaping policy. Gore & Kothari (2012) examined how healthy living initiatives were being implemented by the Ontario and British Columbia using recent policy frame works. It was found that most initiatives were geared toward life-style changes and community programs, with very few aimed at changing upstream determinants that create inequities between genders, income levels and ethnic groups (Gore & Kothari, 2012). The authors also expressed that health should be seen as a political matter and a political approach should be taken to decrease health inequities.

Finally, I explored social determinants in Nova Scotia. In 2014, Robert Strang, Chief public health officer for Nova Scotia discussed health inequities and inequalities among Nova Scotians. In consultation with the various communities, it was determined that public health needed to have a stronger role in improving social inequities and determinants of health. Thus, six stakes were created by Nova Scotia Public Health (2010) surrounding these requests, one of which is “social justice and the determinants of health must be the underpinning of all of our work” (Nova Scotia Public Health, 2010). To aid in this endeavour, December 4th 2019, the Government of Canada introduced the Research Nova Scotia Corporation. The primary goal of this corporation is to “foster research and development contributing to improved social and economic outcomes for Nova Scotians.” (Research Nova Scotia Corporation, 2019, para. 1).

The Nova Scotia Department of Health and Wellness strives to help individuals maintain health. Protocols for healthy communities and healthy development of individuals can be found here. The Healthy Communities Protocol (2014) and Healthy Development Protocol (2014) explain public health planning, assessing, implementing and evaluating actions with consideration of health inequities and inequalities pertaining to the determinants of health in Nova Scotia.

One health determinate that creates inequity and health disparity in Nova Scotia is income and social status. Krostein, an advocate for disability rights and a voice for social justice issues discusses poverty in Nova Scotia on his blog “The Nova Scotia Advocate”. In a post titled “The social determinants of health in Nova Scotia. Part 1: Poverty makes you sick” (2017) he discusses the difficulty for Nova Scotians who earn minimum wage to live healthily. The current minimum wage in Nova Scotia is $11.55 per hour (Nova Scotia Labour and Advanced Education, 2019). The Canadian Centre for Policy Alternative Nova Scotia Office (2016) states “A living wage covers what it actually costs to live and raise a family in a specific community.” (p. 1). In 2016, the living wage for Halifax was $19.15 per hour, approximately 40% higher than what is attainable for those working for minimum wage. How can individuals expect to live a healthy life when they cannot afford the necessities? (Canadian Centre for Policy Alternatives, n.d.)

Sacrifices are being made by those who cannot earn enough to pay their bills, and this creates greater disparities in health. As a health care professional, I hear from patients that they cannot afford their recommended dental and hygiene treatment due to cost. This brings us back around to the discussion about limitations of the Canada Health Act (CHA). Would altering the CHA decrease health inequities? Martin et al (2018) raise strong points that the working poor are often the most vulnerable to health inequities and “…inequities in health outcomes driven by the social determinants of health are at risk of being compounded by…publicly funded services” (p. 1729).

It is interesting to see all of these topics weave together as we progress through the course, and I am interested to find out how the next topic will expand on health in Canada.

References:

Appuhamy, R. (Director). (2017, June 25). Social Determinants of Health - an introduction [Video file]. Retrieved June 5, 2019, from https://www.youtube.com/watch?time_continue=154&v=8PH4JYfF4Ns

Canadian Centre for Policy Alternatives. (n.d.). Study calculates living wage for Halifax and Antigonish. Retrieved June 5, 2019, from https://www.policyalternatives.ca/newsroom/news-releases/study-calculates-living-wage-halifax-and-antigonish

Canadian Centre for Policy Alternatives Nova Scotia Office. (2016, December 19). Working for a Living, not Living for Work. Retrieved June 5, 2019, from https://www.policyalternatives.ca/sites/default/files/uploads/publications/Nova%20Scotia%20Office/2015/06/CCPA-NS_Halifax_Living_Wage2015.pdf

Gore, D., & Kothari, A. (2012). Social determinants of health in Canada: are healthy living initiatives there yet? A policy analysis. International journal for equity in health, 11, 41. doi:10.1186/1475-9276-11-41

Government of Canada. (2019). Social Determinants of Health and Health Inequalities. Retrieved June 05, 2019, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Kronstein, A. (2017, May 12). The social determinants of health in Nova Scotia. Part 1: Poverty makes you sick. Retrieved June 5, 2019, from https://nsadvocate.org/2017/05/11/the-social-determinants-of-health-in-nova-scotia-part-1-poverty-makes-you-sick/

Martin D., Miller A.-p., Quesnel-Vallée A., Caron N.-r., Vissandjée B., Marchildon G.-p. (2018). Canada's universal health-care system: Achieving its potential doi:https://doi.org/10.1016/S0140-6736(18)30181-8

Nova Scotia Department of Health and Wellness. (2014). Nova Scotia public health: Healthy communities protocol. Halifax, N.S.: Dept. of Health and Wellness.

Nova Scotia Department of Health and Wellness. (2014). Nova Scotia public health: Healthy development protocol. Halifax, N.S.: Dept. of Health and Wellness.

Nova Scotia Labour and Advanced Education. (2019, April 01). Minimum Wage : NS Labour and Advanced Education, Employment Rights. Retrieved June 5, 2019, from https://novascotia.ca/lae/employmentrights/minimumwage.asp

Office of Disease Prevention and Health Promotion. (n.d.). Determinants of Health. Retrieved June 2, 2019, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

Research Nova Scotia. (2019). Introducing Research N.S: About. Retrieved June 6, 2019, from https://researchns.ca