As healthcare professionals, I’m sure we read through this list and nod our heads in agreement. In our day to day practice we see people with the same diagnosis, but different outcomes and recoveries.
The concept of health is more than just treating illness. It is a big picture concept that relies on many inter-related and complex factors that are described by Mikkonen and Rachael (2014) as social determinants of health. The main determinants of health are described as:
- Aboriginal status
- Disability
- Early life
- Education
- Employment and working conditions
- Food insecurity
- Health services
- Gender
- Housing
- Income and income distribution
- Race
- Social exclusion
- Social safety net
- Unemployment and job security
This broad range of personal, social, economic, and environmental factors are similar to the Government of Canada’s guidance document, Social Determinants of Health and Health Inequalities.
In Ontario, these social determinants of health are supported by the Health Protection and Promotion Act (HPPA). This specifies the mandatory health programs and services by the boards of health. The Ontario Ministry of Health Long Term Care sets the policies and determines the funding that the Local Health Integrated Networks (LHINs, soon to be Ontario Health Teams), Community Care Access Centres, and Public Health Ontario receives.
While it is supposed to be equal care across the Province, the LHINs are able to provide a guided regional approach with their goals and allocation of funding.
Ontario’s Health Equity Guidelines (2018), list the key social determinants of health as:
- Access to health services
- Culture, race, and ethnicity
- Disability
- Early childhood development
- Education, literacy, and skills
- Employment, job security, and working conditions
- Food insecurity
- Gender identity and expression
- Housing
- Income and income distribution
- Indigenous status
- Personal health practices and resiliency
- Physical environments
- Sexual orientation and attraction
- Social inclusion/exclusion
- Social support networks
Notable similarities between Mikkonen and Rachael’s social determinants of health and Ontario’s Health Equity Guidelines is the inclusion food insecurity and job security. These are absent from the Government of Canada’s document. I think that these are important additions to the list because food insecurity in childhood has a significant impact on health related quality of life (Casey et al., 2005). There is also the negative impact on psychological well-being with individuals who experience job insecurity (De Witt, 1999).
Current policy in Ontario under the Conservative government is to “end hallway medicine” by creating increased capacity in long-term care homes, increasing mental health services, addictions and housing.
There is provincial variation to the Social Determinants of Health and Health Inequalities. The priority determinants of health in Alberta are listed as household income, individual level of education, housing type and expenditures, family composition, and housing mobility (Alberta Community Dashboard). They also list specific health equity factors that include: Sex, Age, Education, Home Ownership, Food Security, and Canadian Deprivation Index.
There are notable exclusions to Alberta’s priority determinants of health such as access to health services, culture, race/racism, social supports, physical environments, food security, and job security.
These multi-faceted social determinants of health vary from each complex community, so it is reasonable that you would see a provincial variation. As healthcare providers, we need to be aware of our community needs so that we can tailor our approach to suit their health needs.
References
Casey PH, Szeto KL, Robbins JM, et al. Child Health-Related Quality of Life and Household Food Security. Arch Pediatr Adolesc Med. 2005;159(1):51–56. doi:10.1001/archpedi.159.1.51
Community Cancer Prevention & Screening Dashboard – Alberta Community Health Dashboard | Healthier Together – Prevention Data – Healthier Together | Building Healthy Alberta Communities Together. (n.d.). Retrieved October 17, 2020, from https://www.healthiertogether.ca/prevention-data/alberta-community-health-dashboard/community-cancer-prevention-screening-dashboard/
De Witt, H. (1999). Job insecurity and psychological well-being: Review of the literature and exploration of some unresolved issues. Journal of work and Organizational psychology. 8(2) 155-177.
Government of Canada. (2018). Social Determinants of Health and Health Inequalities. Government of Canada. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Health Equity Guidelines (2018). Ministry of Health Long Term Care. http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Health_Equity_Guideline_2018_en.pdf
Health Protection and Promotion Act, R.S.O. 1990, c. H.7 https://www.ontario.ca/laws/statute/90h07#BK6
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts.Toronto: York University School of Health Policy and Management.
Ontario PC Party. Retrieved October 16, 2020 https://www.ontariopc.ca/plan_for_the_people
Social determinants of health and health inequalities – Canada.ca. (n.d.). Retrieved October 16, 2020, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html