Social Determinants of Health: The Canadian Facts – Juha Mikkonen, Dennis Raphael
- Primary factors that shape health of Canadians are not medical treatments or lifestyle choices
but rather the living conditions they experience.
o These conditions = Social Determinants of Health
- These social determinants of health are often not under the personal control of people, and it
affects things like cardiovascular disease, adult onset diabetes, and even the health of their
- Government decisions at the municipal, provincial, and federal levels create policies, laws, and
regulations that influence these social determinants of health
- Despite evidence that social determinants of health impact health, the policy decisions by
Canadian government have not been made. Canada compares unfavourable to other wealthy
developed nations in its support of citizens through their lifespan
o Growing income gap, growing poverty, lowest spending on people with disabilities and
- Each of the 14 key social determinants of health in this article will we explained by seeing:
1. Why it is important to health
2. How we compare on the social determinant of health to other wealthy developed nations
3. How the quality of the specific social determinant can be improved
Stress, Bodies, and Illness
- Adverse social and material living conditions = high levels of physiological and psychological
- Stressful experiences come from coping with low income, poor quality housing, food insecurity,
inadequate working conditions, insecure employment, and various forms of discrimination
based on Aboriginal status, disability, gender, or race.
- Lack of supportive relationships, social isolation, and mistrust of others further increases stress
- Physiological level:
o Stressful situations provoke “fight-or-flight” reactions, which impose chronic stress on
the body if the person cannot recover in non-stressful environments.
o Continuous stress weakens resistance to diseases and disrupts the functioning of the
hormonal and metabolic systems.
Make people more vulnerable to serious illnesses such as cardiovascular and
immune system diseases and adult onset diabetes
- Psychological level:
o Stress and poor living conditions can cause feelings of shame, insecurity, and
o Life is often seen as unpredictable, uncontrollable, and meaningless
o Anxiety comes with uncertainty of future, and anxiety increases level of exhaustion o Coping with stress often causes people to adopt unhealthy behaviours such as smoking,
alcohol, or overeating carbohydrates.
- Stressful living conditions make it hard to take up physical leisure activity because one’s energy
is directed at solving the day-to-day problems of life, thus people take drugs to relieve stress.
- POLICY IMPLICATIONS
o The focus should be on the source of problems rather than dealing with symptoms:
improve living conditions
o Elected officials should commit themselves to implementing policy that ensure the good
quality social determinants of health for Canadians
Income and Income Distribution
- Level of income shapes overall living conditions, affects psychological functioning, and
influences health-related behaviours such as quality of diet, extent of physical activity, tobacco
use, and excessive alcohol use.
- Also determines food security, housing, and other basic prerequisites of health
- Two levels of relationship between income and health:
1. Observe how health is related to the actual income that an individual or family receives
2. Study how income is distributed across the population and how this distribution is related to the
health of the population
- Equal income distribution = best predictor of overall health in a society
- Income is especially important in countries that do not provide adequate social services: Canada
for example does not provide childcare, housing, post-secondary education, etc. While other
wealthy developed nations have them as citizen rights
- Low income predisposes people to material and social deprivation: the greater the deprivation,
the less likely families will be able to afford the basic prerequisites of health such as food,
clothing, and housing
- Deprivation also contributes to social exclusion by making it difficult to participate in social
- Wealthier people live longer, this is just fact on average
- Suicide rates among the poor are double the likelihood from the rich.
- Income inequality is huge in Canada, and this led to a hollowing out of the middle class where
more people are on either extremes of the spectrum
o Worse of all, its increasing.
- POLICY IMPLICATIONS
o Address income inequality
o Increase minimum wage, boost assistance levels for those unable to work
o Progressive taxation to reduce inequality
o Greater degree of unionized workplaces
- Higher education = healthier - Various pathways by which education leads to better health:
1. Level of education is highly correlated with other social determinants such as level of income,
employment security, and working conditions.
2. Higher education makes it easier to enact larger changes in the Canadian employment market. If
their employment situation suddenly changes, they can get a new job easily. Also, people attain
better understanding of the world and they become more able to see and influence societal
factors that shape their own health
3. Increases overall literacy and understanding of how one can promote one’s own health through
- Caveat: lack of education itself is not the main factor in causing poor health, it is the manner by
which education influences the population’s health is shaped by public policies. If childcare was
available to all, education wouldn’t be as much of a problem.
- Overall state of Canada’s education is good comparatively to other countries, however those
who do not have a post-secondary education their children fare considerably worse in terms of
health. Lack of childcare programs has major influence on many children’s intellectual and
o High tuition fees make it so some children can’t go to university or college
- POLICY IMPLICATIONS
o Adequately funded schools
o Control the tuition of post-secondary education so it doesn’t exclude low-income
Unemployment and Job Security
- Employment provides income, sense of identity, and helps to structure day-to-day life.
- Unemployment leads to the opposite: material and social deprivation, psychological stress,
adoption of health-threatening coping behaviours.
- Job insecurity has been increasing in Canada during the past decades, only half of working aged
Canadians have had a single full-time job for over 6 months or more
o Increase of precarious forms of work (part-time, self-employed, temporary work)
- Canada scores very poorly on the employment protection index by the OECD
- Precarious work is on the rise in the past two decades, this trend is associated with more intense
work life, decreased job security and income polarization between rich and poor.
- Unemployment’s relation to poor health:
1. Material deprivation and poverty
2. Losing a job is a stressful event that lowers one’s self-esteem, disrupts daily routines, and
3. Unemployment increases the likelihood of turning to unhealthy coping behaviours such as
tobacco use and problem drinking
- Insecure employment is often intense work with non-standard working hours, which is
associated with higher stress, body pains, and higher risk of injury.
o Negative effects on personal relationships, parenting effectiveness, children’s behaviour - Women overrepresented in precarious work.
- POLICY IMPLICATIONS
o Provide basic standards of employment and work for everyone
o Power inequalities between employers and employees need to be reduced through
stronger legislation governing equal opportunity in hiring, pay, training, and career
o Unemployed Canadians must be provided access to adequate income, training, and
o New vision of what constitutes healthy and productive work
o More research for a up-to-date picture of job security in Canada
Employment and Working Conditions
- Important because we spend so much time in our workplaces, those vulnerable to lower income
and education also likely to have worse working conditions
- Work dimensions which shape health outcomes:
1) Employment security
2) Physical conditions at work
3) Work pace and stress
4) Working hours
5) Opportunity for self-expression and individual development at work
- High stress jobs = high blood pressure, cardiovascular diseases, and development of anxiety and
- Imbalances between rewards and demands lead to significant health problems, if they think
they’re not being rewarded properly, leads to problems.
- Statscan found 35% of workers thought they experienced too many demands or too many hours
- In 1994, Only 4 / 10 Canadians said they had a lot of freedom on how to work, which has
decreased since 1989 which was 54%
- Workplace injuries often not reported due to costs in reporting these accidents for both parties
o 30% of Canadians feel they are not safe at work
o 33% of Males working 40 hours or more
o 12% of Females working 40 hours or more
- In contrast, many countries of the EU have full time work set at 35 hours.
- Unionizing members is a good way to go, they make more money and have more opportunities
in their job
- POLICY IMPLICATIONS
o Balance rewards and demands
o Improve conditions on those with high-strain low-income jobs
o Unionization of workers
o Employees should be provided with opportunities to influence their work environment
o More research
Early Childhood Development - Strong immediately and longer lasting biological, psychological, and social effects upon health
- “Latency effects”: how early childhood experiences predispose children to either good or poor
health regardless of later life circumstances
o EX: Low birth weight babies
- “Pathway effects”: situation when children’s exposures to risk factors at one point do not have
immediately health effects but later lead to situations that do have health consequences
o Not an immediate health effect to lack readiness for school, but the lack of education
that comes from this can hurt health
o To reduce relations between parents SES and children’s education high quality
education needs to be in place
- “Cumulative Effects”: longer a child lives under conditions of deprivation the more likely they
are to show adverse health and developmental outcomes. Accumulated disadvantage can lead
to cognitive and emotional deficits such as incompetence and emotional immaturity.
o Can also create a sense of inefficacy, which is a strong determinant of poor health
- State of early child development in Canada is cause for concern, the indicator that is most
obvious is whether they are living under deprivation, which is measured by the percentage of
children living in “straitened living circumstances” or under the LICO (low income cut-off)
- Child poverty figure is 15% provided by Canada’s pre-tax LICO.
o Child poverty defined as living in families that have access to less than 50% of the
median family income of that nation
- Canada is 20/30 place in child poverty
- Only 17% of Canadian families have access to regulated child care, OECD published a report that
rates Canada as LAST among 25 wealthy developed nations in meeting early childhood
o Also one of the lowest spenders on childhood education
- POLICY IMPLICATIONS
o Guarantee affordable quality child care for all families
o Support and benefits to families through public policies, higher wages and social
o Improved early childhood development in terms of improved community quality of life,
reduced social problems, and improved Canadian economic performance
- Those who experience food insecurity are unable to have adequate diet in terms of quality or
o Uncertain if they can gain food in socially acceptable ways
o Barrier to adequate nutritional intake, fewer servings for fruits / vegetables, milk
- Estimated 2.7 million Canadians experience food insecurity, 5.2% report child-level food
insecurity. - Food insecurity is more common among households with children, especially common in
households by lone mothers, aboriginal households.
- Events that may move a Canadian family into experiencing hunger:
o Another mouth to feed
o Change in the number of parents
o Loss of job
o Change in employment hours
o Health of an adult or child declining
- Dietary deficiencies are linked with increased likelihood of chronic diseases and stress and
feelings of uncertainty
- Malnutrition during childhood has long-term effects on a child’s physiological and psychological
development. Often mothers cut back on their own food intake to feed their children.
o Parents unable to protect children from the psychological effects of household food
- Household food insecurity an excellent predictor of Canadians reporting poor or fair health as
compared to good, very good, or excellent health.
o 80% more likely to have diabetes, 60% more likely to have high blood pressure, 70%
more likely to have food allergies
- May produce a range of behavioural, emotional, and academic problems
- Food banks may help as food insecurity is almost always caused by a lack of economic resources
- POLICY IMPLICATIONS
o Increase minimum wage and social assistance so people can afford an adequate diet
o Make sure healthy foods are affordable
o Provide affordable housing and childcare so they have money for food
o Facilitate mother’s employments through job supports, etc.
o Better monitoring systems to produce up-to-date accounts of food insecurity in Canada
- Poor quality housing and homelessness clear threats to the health of Canadians
o Housing ABSOLUTE necessity for living a healthy life, thus living in unsafe, unaffordable
or insecure housing increases the risk of many health problems.
- Housing is a public policy issue, governments have a responsibility to provide citizens with
prerequisites of health.
o Canada routinely identified as not fulfilling provision of shelter listed in multiple human
- Housing influences health in many ways:
o Qualitatively different material environments depending on housing quality
o Overcrowding allows for transmissions of disease
o Some homes (reserves mostly) lack clean water and basic sanitation
o Housing provides a platform for self-expression and identity, which you can’t do without
a house. o Living in poor housing creates stress and unhealthy means of coping
o Presence of lead, mold, poor heating, vermin, etc. can call adversely affect health
- Children who live in low quality housing have greater likelihood of poor health in both childhood
and as adults
- Studies show poor housing is an independent cause of adverse health outcomes
- Canada is experiencing a housing crisis: over past 20 years rents have risen well beyond cost of
living especially in cities.
o Proportion of those who have to spend 30%+ of total income on rent (definition of
unaffordable housing used by government) has risen, high in Canadian cities.
- Most low-income Canadians are ren