The World Health Organization (WHO) defines the social determinants of health as “the circumstances in which people are born, grow up, live, work and age and the systems put in place to deal with illness.” (WHO, 2017). This definition also states that “these circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.” The WHO (2017) considers several factors as determinants of health- income and social status, education, physical environment, social support networks, culture, genetics, gender and health services. The concept presented is that many factors combine to affect the health of individuals and communities. The WHO” plays an essential role in the global governance of health and disease; due to its core global functions of establishing, monitoring and enforcing international norms and standards, and coordinating multiple actors toward common goals.” (Ruger & Yach, 2009). In order to be a member of this organization, a country has to collaborate on an international scale, and adopt the principles set forth by the WHO.
Canada defines social determinants of health as “a specific group of social and economic factors within the broader determinants of health.” (Canada, 2001). The Government of Canada (2001) identifies that “experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, LGBTQ and Black Canadians.” This document also notes that Canada is one of the healthiest countries in the world and that reducing health inequalities is one of its priorities for addressing the social determinants of health for the ultimate goal of health equity. Glouberman and Millar (2003) state “over that past decade, as the public dialogue has been dominated by concerns about the costs and delivery of health care services, inadequate attention has been paid to emerging health issues, especially those that relate to inequalities.” They note that there is no national plan coordinated for these issues (i.e. Aboriginal health, obesity). Perhaps a national plan is needed for improving the determinants of health and the individual provinces tailor the strategies to their priority needs.
Each province within Canada is responsible for the delivery of health care and social services for their residents. The social determinants of health vary slightly between provinces depending on the identified priorities of their governments. Nova Scotia (my province of residence) has adopted a population health approach. A brochure published by the Nova Scotia Department of Health Promotion and Protection entitled Healthy People, Healthy Communities (n.d), outlines the provinces determinants of health, the population health approach and what it means, as well provides examples of successful initiatives that adopted this methodology. This document also outlines a specific instance of how all the determinants of health need to be considered for one single element. The example is food insecurity and it encapsulates the correlation of income, literacy skills, transportation, social environment, and culture. Though this document likely was written in the early 2000’s, it seems to remain relevant to the current philosophy of the Government of Nova Scotia. The key focus areas currently identified are healthy eating, injury prevention and control, reduction of health disparities and inequities, sexual health and tobacco control (Nova Scotia Department of Health and Wellness, 2021).
The evolution of what constitutes a determinant of health is ongoing as society transforms. Improvements to the social determinants of health is an extremely complex and longstanding challenge that needs to involves multiple stakeholder collaboration, upstream investment, evidence based decision making, multiple strategies, citizen engagement, and increased accountability (Canada, 2013).
References
Canada, P. H. A. of. (2001, November 25). Social determinants of health and health inequalities [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Canada, P. H. A. of. (2013, January 15). What is the Population Health Approach? [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-population-health-approach.html#key_elements
Glouberman, S., & Millar, J. (2003). Evolution of the Determinants of Health, Health Policy, and Health Information Systems in Canada. American Journal of Public Health, 93(3), 388–392. https://doi.org/10.2105/AJPH.93.3.388
Healthy Communities | novascotia.ca. (2021). Retrieved February 9, 2022, from https://novascotia.ca/dhw/healthy-communities/
Healthy-People-Healthy-Communities-Population-Health-Approach.pdf. (n.d.). Retrieved February 9, 2022, from https://novascotia.ca/dhw/publications/Public-Health-Education/Healthy-People-Healthy-Communities-Population-Health-Approach.pdf
Ruger, J. P., & Yach, D. (2009). The Global Role of the World Health Organization. Global Health Governance : The Scholarly Journal for the New Health Security Paradigm, 2(2), 1–11.
Social determinants of health: Key concepts. (2017). Retrieved February 9, 2022, from https://www.who.int/news-room/questions-and-answers/item/social-determinants-of-health-key-concepts
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