2 - Social Determinants of Health, Health Literacy, Behaviour Change

determinants of health

• health is determined by an interaction between:
  individual characteristics (genetic makeup)

• environment

• social and economic environment (where we live and work)

social determinants of health

• social determinants of health:

• the conditions in which people are born, grow, live, work, and age

• this is shaped at global, national, and local levels

• they are responsible for health inequalities

• inequality - differences in health status or in the distribution of health determinants between different population groups

Canada’s social determinants of health

• 1) income and income distribution

• 2) education

• 3) unemployment and job security

• 5) early childhood development

• 6) food insecurity

• 7) housing

• 8) social exclusion

• 9) social safety net

• 10) health services

• 11) aboriginal status

• 12) gender

• 13) race/ethnicity

• 14) disability

income and income distribution

• levels of income determines living conditions and influences health-related behaviour

• income determined the quality of other social determinants - inability to afford food, clothing, housing, recreational things, cultural, and educational experiences

• 4.8M Canadians live below the poverty line

• income inequality is an issue in Canada

education

• higher level of education=better health and access to job training/opportunity for gainful employment

• education is a predictor of health and mental health

• level of education is correlated with other social determinants of health (level of income, employment security, and working conditions)

• higher education leads to a better understanding of the world and the influential factors that shape their own health

• higher education increases the understanding of how one can change one’s own health

unemployment and job security

• lack of employment leads to material and social deprivation, psychological stress, and the adoption of health-threatening coping strategies

• associated with physical and mental health problems (depression, anxiety, and suicide rates)

• unemployment has been shown to increase the chances of making unhealthy life choices (smoking, alcohol)

employment and working conditions

• work factors that influence health outcomes include:

• employment security

• physical working conditions

• work pace and stress (unrealistic demands and time pressure)

• working hours

• opportunities for individual development

• imbalances between demands and rewards

• stress: mental and emotional health issues, high BP, cardiovascular disease, and workplace injury

early childhood development

• early childhood experiences have an effect on biological, psychological, and social health

• lack of cognitive and emotional maturity when entering school, leading to lower education attainment

• often living in low-income households, therefore at a greater risk for health problems related to nutrition and social deprivation

food insecurity

• dietary deficiencies (malnutrition) is associated with chronic disease (heart disease, diabetes, high BP), food allergies, and emotional/behavioural/academic problems

housing

• housing crisis in canada

• this is a public policy issue because Canada is part of the human rights agreement that guarantees the provision of shelter

• connected to other determinants (low income, lack of job security)

• poor housing conditions lead to health effects (lead, asbestos, poor heating, lack of smoke detectors, radon, cockroaches, bed bugs, etc.)

• homeless are more likely to have chronic health conditions (arthritis, hypertension, asthma, diabetes etc.)

housing: homelessness

• there are two types of homelessness

• 1) visible homelessness

• sleep on the street or shelters

• 2) invisible/hidden homelessness

• living in unsafe of unstable housing, abandoned buildings, cars, etc.

• couch surfer (live in temp arrangements provided by family and friends)

housing: homelessness

why do people become homeless?

1) trauma - loss of job, bankruptcy, eviction, domestic violence, divorce, death of spouse/caregiver, accident or illness

2) inappropriate discharge - released from public institutions without a place to go

3) chronic - physical or mental illness, disabilities, and substance abuse, typically the visible homeless

social exclusion

• the lack of opportunity to participate fully in society (discrimination)

• often based on gender, age, ability, sexual orientation, race, ethnicity, religious beliefs

• this includes racialized groups, aboriginal people, non-binary people, unpair care-givers, disadvantaged youth/children, recent immigrants, people with disabilities, elderly, single parents

social exclusion

• denied participation in civil affairs, access to goods and services, participation and contribution to social and cultural activities

• more likely to be unemployed and earl low-income

social safety net

• a range of benefits, programs, and services that help and protect Canadians during various life changes

social safety net

• normal life transitions: having and raising kids,, seeking housing, retirement, entering the labour force, attaining education and employment training, entering the labour force

• unexpected life events: divorce, unemployment, physical or mental illness or disability

• threaten health by increasing economic insecurity and provoke psychological stress

health services

• the Canadian health act states that every Canadian has to be provided uniform access to health services that is free of financial barriers

• continuing issues of access to care: rural vs. urban and low-income vs. high income earners

aboriginal status

• increased food and housing insecurities

• lower education levels

• higher rates of chronic disease and infections

• higher suicide rates

gender

• women experience more adverse social determinants of health than men, they are:

• less likely to have full time employment

• lower paying jobs

• less eligible for unemployment insurance (EI)

• increased child-care responsibilities

• often earnings and job opportunities are compromised because of this

gender

• men also have adverse health risks:
  suicide rate is 4x higher

• more likely to be a victim or assault and involved in crime

race

• race=biological constructs: DNA (hair, eyes, etc)

• ethnicity=cultural factors (nationality, ancestors, lang)

• culture= the customary beliefs, social forms, and material traits of a racial, religious, or social group (ex. student university culture)

• the health status of immigrants to Canada deteriorates over time, compared to Canadian-born residents

• higher unemployment rates and increase in mental health issue

disability

• Canada doesn’t have a good record in supporting Canadians with disabilities

• Canada provides one of the lowest compensation and benefits to citizens with disabilities (often still below the poverty line)

• Canada has some of the strictest restrictions for successful application for benefits