Determinants of Health: A politically Driven Approach

Globally, we are on a mission to discover the best methods for predicting and improving our overall health. This is not unique to Canadians. Throughout this journey, researchers have identified various determinants of health that seek to help gather health information and drive policy.  In Canada, determinants of health (DOH) are defined as “social and economic factors, physical environment, and your behaviour” (Canada P.H.A., 2023). The government of Canada recognizes the following as DOH: 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, and race/racism (Canada P.H.A., 2023). A large onus is placed on the social determinants of health (SDOH) and their effect on an individual’s health. “[SDOH] refers to a specific group of social and economic factors within the broader [DOH]. These relate to an individual’s place in society, income, education or employment. Experiences of discrimination, racism, and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, LGBTQ, and Black Canadians” (Canada P.H.A., 2023).  

As can be inferred, differences in any of these determinants can have a positive or negative effect on our health outcomes. Differences in the health status of individuals can be referred to as health inequalities (whether it be genetic or decision based) (Canada P.H.A., 2023). Inequalities that are unfair or unjust, yet modifiable are called health inequities (Canada P.H.A., 2023). 

Glouberman seeks to emphasize the importance of addressing the DOH and how to incorporate them into our current healthcare system to improve individual health and reduce health inequities (2003). The author explains that the DOH were born of the combination of health promotions and health inequalities (Glouberman, 2003). Together, they have helped create this explanation of determinants of health, which has helped to improve overall health information gathering, but still could show significant improvement in how we use it to drive policy change (Glouberman, 2003). Glouberman went further to identify that early reports on DOH were progressive in “identifying the need for intersectoral collaboration and recognizing multiple interventions – a combination of research, health education, social marketing, community development, and ... public policy approaches – are needed to properly asdress the [DOH]” (2003). These reports were initially well received, as government bodies felt it could bring major insights into financial savings and reduced expenditure (Glouberman, 2003). The following were some successes noted in the early messaging developed out of this new theory of DOH (Glouberman, 2003):  

• Health education surrounding cigarette smoking combined with reduced advertising resulted in a smoking rate that dropped from approximately 50% to approximately 25%.  

• New legislation implemented the use of seatbelts in vehicles and helmets on bicycles and motorcycles  

• A reduction in drunk driving was noted in response to both education and stricter laws  

• Improved diets: less red meat, more fish, less fat, more fruits  

• Increased physical exercise resultant from various health promotion publication and programs  
  

This all changed in the 1990s, when the government further sought to cut expenditure. The anticipated savings did not occur due to an increase in new therapeutic and diagnostic technologies (Glouberman, 2003). Glouberman also noted that there was mixed reception among various populations, and though there was some improvement in the areas of messaging the population had proved to spend more time in cars, watching tv, and eating more than at the time of the initial messaging (2003).  

In all my blog posts, there has been an underlying policy development theme. Has there been anything to come out of this focus on DOH? Initially, there were some federal policy changes born of these initiatives. All provinces use the determinants to improve working and living conditions, health behaviors, development in childhood, access to healthcare, and Indigenous health (Glouberman, 2003). Ontario is the only province that doesn’t have a regionally focused delivery of health information, all provinces have increased funding for research on various determinants, child tax benefits to improve the effects of poverty on children, and various educational programs (Glouberman, 2003).  

What does this mean? Health inequities are largely based on political downfalls. These are areas where our policy has failed its people. Children are exposed to poverty, which reduces their exposure to education and adequate healthcare. Adults cannot access transportation, which cannot get them to adequate healthcare. Anti-racist programs are at a minimum in Canada (in my experience, anyway). Using these inequities combined with measurable health tools that are currently in place to find causation between the two could help drive policy in a different direction. Access to funding to improve all these determinants needs to start with our policy makers, without that there cannot be a change. Gore and Kothari explored this in depth and came to the following conclusion:  

“Addressing the social determinants of health necessarily means moving away from depoliticized frameworks that emphasize biomedical factors in disease. Attention to the social determinants and inequalities has been growing, as health promotion movements evolve – movements that were initially led in Canada. However, it is necessary that health be seen for what it is: a political matter. As such, the health sector needs to diversify to a more political approach to find solutions for health inequities. Until this occurs, it is debatable how much progress can occur ...” (2019).  

RESOURCES 

Canada, P. H. A. of. (2023, June 1). Social determinants of health and health inequalities - Canada.ca. Government of Canada. Accessed 5 Feb 2024 from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html 

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 

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(1), 41. https://doi.org/10.1186/1475-9276-11-41