Determinants of Health - Explored

The World Health Organization (WHO, 2021) describes social determinants of health as non-medical factors that affect health outcomes. Increasing evidence points to "socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes (Braveman & Gottlieb, 2014)." As the WHO (2021) points out, factors such as where people live and work, their education and socio-economic status together can impact their health more than their lifestyle choices and level of health care.

A macro level indicator of a country's welfare state can be determined by assessing its social expenditures as a proportion of its Gross Domestic Product (GDP) (Raphael, 2008). Canada ranks quite low in this area: 24th out of a total of 30 countries that belong to the Organization for Economic Cooperation and Development. While a country's social spending to GDP ratio isn't a tried and true means of assessing how well it meets its citizens social needs, it does provide a glimpse into how a country prioritizes social spending in relation to other budget areas such as Healthcare and Military for example. Furthermore, the indicator enables nation to nation comparisons as they relate to expenditures on the topic. Esping-Anderson (1990 and 1999) reports that the quality of a country's social determinants of health can be predicted by its political economy: liberal, conservative or social democratic. Social democratic governments, which are more common in Europe, are known for prioritizing social issues and equality. In comparison to liberal governments, such as in Canada for example, which are known for providing minimal government intervention in relation to social welfare (Raphael, 2008). Interestingly, but not surprising, Navarro and Shi (2001) point out that liberal welfare states have both the greatest wealth along with earning inequality, the lowest population health, and the weakest safety nets.

The government of Canada (2021) identifies the main determinants of Canadians health as follows: 1. Income and social status; 2. Employment and working conditions; 3. Education and literacy; 4. Childhood experiences; 5. Physical environments; 6. Social supports and coping skills; 7. Healthy behaviours; 8. Access to health services; 9. Biology and genetic endowment; 10. Gender; 11. Culture; and 12. Race / Racism. The federal government is working to reduce health inequities and address social determinants of health in a number of ways including improving the country's evidence base to inform decision making, engaging public health beyond the health sector, and communicating knowledge of actions across Canada (Government of Canada, 2021). At a provincial level, British Columbia is in the process of developing a Standard for the social determinants of health. The intent of the Standard is to help improve the delivery of provincial health programs and reduce health inequities (Government of British Columbia, 2021). As part of this work, the province will be incorporating determinants of health data into the electronic medical records of British Columbians (Government of British Columbia, 2021). I'm hopeful that the province succeeds in integrating meaningful determinants of health data into electronic medical records and that this information will be used in an effective manner to guide individual interventions and social system change.

References

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the causes of the causes. Public health reports (Washington, D.C. : 1974), 129 Suppl 2(Suppl 2), 19–31. https://doi.org/10.1177/00333549141291S206

Esping-Andersen, G (1990). The three worlds of welfare capitalism. Princeton University Press. (PDF) The Three Worlds Of Welfare Capitalism (researchgate.net)

Esping-Andersen, G. (1999). Social Foundations of Postindustrial Economies.: Oxford University Press. https://oxford.universitypressscholarship.com/view/10.1093/0198742002.001.0001/acprof-9780198742005.

Government of BC (2021, January). BC Social Determinants of Health Standards. Retrieved October 13, 2021 from B.C. Social Determinants of Health Standards - Province of British Columbia (gov.bc.ca)

Government of Canada (2020, October 7). Social Determinants of Health and Health Inequities. Retrieved October 13, 2021 from Social determinants of health and health inequalities - Canada.ca

Navarro V, Shi L (2001). The political context of social inequalities and health. Int J Health Services, 31(1):1–21. The political context of social inequalities and health - PubMed (nih.gov)

Raphael, D. (2008). Getting serious about the social determinants of health: new directions for public health workers. Promotion & Education, 15(3), 15–20. https://doi.org/10.1177/1025382308095650

World Health Organization (2021). Social Determinants of Health. Retrieved October 13, 2021 from Social determinants of health (who.int)