HLTB41H3 Chapter Notes - Chapter 1: Food Processing, Canadian Living, Prussian Estates
Chapter 1: Social Determinants of Health: Key Issues and Themes
Introduction
-Social Determinants of Health: are the economic and social conditions that shape the
health of individuals, communities and jurisdictions as a whole !
-SDOH are the primary determines of whether individuals stay healthy or become ill (narrow
def of health)!
-SDOH determine the extent to which a person possesses the physical, social, and personal
resources to identify and achieve personal aspirations, satisfy needs and cope with the
environment (broader def of health)!
-SDOH are about the quantity and quality of a variety of resources that a society makes
available to its members!
-Important considerations include both their quality and their distribution amongst the
population !
-These resources include, but are not limited to:!
1. Conditions of childhood
2. Access to income
3. Education and literacy
4. Food
5. Housing
6. Employment
7. Working conditions
8. Health and social services
-an emphasis upon societal conditions as determinants of health contrasts with the traditional
health sciences and public health focus upon biomedical and behavioural risk factors such
as cholesterol levels, body weight, physical activity, diet, and tobacco and excessive alcohol
use !
-Since the SDOH approach sees god mainsprings of health as being how a society organizes
and distributes economic and social resources, it directs attention to public policies as
means of improving health !
-It also requires consideration of the political, economic and social forces that shape policy
decisions !
-Concern with the SDOH is not new!
-has been known since mid-19th century—that living conditions are the primary
determinants of health!
-And since then, there have been hundreds of studies that demonstrated that material and
social circumstances that people are exposed to in their homes, workplaces, and
communities are far more important to their health than so called lifestyle choices such as
smoking and alcohol consumption, eating fruits and veggies, or partaking in physical activity!
-The relationship bw living and working conditions and health outcomes applies across
developed and developing nations !
-Instead of efforts to improve Canadian living conditions, individualized approaches focused
on biomedical and behavioural risk factors—with some notable exceptions—dominate
governmental, media and disease association discussions and health promotion efforts !
-When living conditions are considered by govt authorities, it is usually to identify those
Canadians whose living conditions are said to put them at risk for making “unhealthy lifestyle
choices” rather than creating public policy to improve their living circumstances !
-Rather than improving the adverse living and working conditions people are experiencing,
activities focus on targeting the victims of these adverse conditions for behavioural change
-This is the case even though health behaviours are known to be less important determinants
of health than these conditions themselves!
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-The effect of all of this is to add insult (victim blaming) to injury (the experience of adverse
living and working conditions)
-There is significant public concern about the social determinants of health s/a income
inequality, precarious employment and a weakening social safety net, but the strong links bw
these and health are not generally recognized !
-Considering the ongoing barrage of lifestyle messaging that Canadians have been subjected
to for decades, it is not surprising that Canadians have limited awareness of the important
role SDOH such as, income, employment and working conditions play in determining
health !
-The mass media reinforces these understandings thought its uncritical reporting of any and
all studies of how a particular gene or behaviour (ie drinking coffee or white wine, eating
peanuts, consuming tomatoes, sleeping more than or less than 8h a night, watching too
much tv, playing computer games etc) either protects from or predicts various adverse
health outcomes!
A Historical Perspective on the Social Determinants of Health
-during mid-1800’s political economist Friedrich Engels studied how poor housing, clothing,
diet, and lack of sanitation led directly to the infections and diseases associated with early
death among the working-class people in England !
-He identified material living conditions, day-to-day stress, and the adoption of health
threatening behaviours as the primary contributors to social class differences in health !
-Rudolph Virchow identified how health threatening living conditions were rooted in public
policy making and emphasized the role that politics plays in promoting health and preventing
disease!
-Have received little attention in the past 40 years vs the biomedical and behavioural
approaches!
British Contributions
-1980 Black Report and 1992 Health Divide in the UK sparked interest in how social
conditions shape health !
-These UK reports described how lowest employment-level groups showed a greater
likelihood of a wide range of diseases and premature death from illness or injury at every
stage of the lifecycle !
-additionally, health differences occurred in a step-wise progression across the
socioeconomic range, with professionals having the best health and manual labourers the
worst !
-Skilled workers health was midway bw the extremes !
-These health differences emerged even though the UK had developed a universally
accessible health care system at the end of WW2!
-These two reports—and many more—stimulated the study of health inequalities and the
factors that determine these inequalities, and directed attention to the role that public policy
plays in either increasing or reducing health inequalities !
-Much of the best research and data on the links bw SDOH and health outcomes are British,
as are some of the best theorizations of how these factors influence health across the
lifespan !
-UK is also the source of many ideas about how to apply these findings to promote health!
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Canadian Contribution
-Canadians have actively theorized the relationship bw economic and social conditions and
health !
-1974 Federal govt “A New Perspective on the Health of Canadians”—identified human
biology, environment, lifestyle factors and health care organization as determinants of health !
-The document was important in outlining determinants of health outside of the health care
system !
-Another Canadian doc, “Achieving Health for All: A Framework for Health Promotion”
outlined reducing inequalities bw income groups as an important goal of govt policy !
-This would be accomplished by implementing policies in support of health in the areas of
income security, employment, education, housing, business, agriculture, transportation,
justice, and technology, among others !
-Health Canada’s 1998 Taking Action on Population Health: A Position Paper for Health
Promotion and Programs Branch Staff” states that:!
-Strong evidence indicating factors outside the health care system significantly affecting
health !
-These determinants of health include: income and social status, social support networks,
education, employment and working conditions, physical environments, social
environments, biology and genetic endowment, personal health practices and coping
skills, healthy child development, health services gender and culture !
-Canadian Public Health Association (CPHA) documents a similar story !
-1986 “Action Statement for Health Promotion in Canada” identified advocating for
healthy public policies as the single best strategy to affect the determinants of health!
-Priority actions include:!
-1. Reducing inequalities in income and wealth
-2. Strengthening communities though local alliances to change unhealthy living
conditions
-2000, the CPHA endorsed an action plan that recognized poverty’s profound influence
upon health and identified means to reduce it!
-Other CPHA reports document the health effects of unemployment, income insecurity,
homelessness and general economic conditions !
-Despite the contributions, there has been little if any penetration of these concepts into
Canadian public policy making !
-The discrepancy bw the Canadian rhetoric and action may be due to the dominant
ideologies that shape Canada’s economic and political systems
-The study of the SDOH therefore deals with three key problems:
9. What are the societal factors (income, education, employment conditions) that shape health
and help explain health inequalities?!
10. What are the societal forces (economic, social, political) that shape the quality and
distribution of these factors?!
11. What is it about Canada’s economic and political systems that make addressing the SDOH
through public policy so difficult?!
Box 1.1 Rudolph Virchow and the social determinants of health
-German physician Rudolph Virchow (1821-1902) !
-Made extensive medical discoveries !
-Known as the “Father of Modern Pathology”
-1848 was sent by Berlin to investigate the epidemic of typhus in upper Silesia!
-Report on the Typhus Epidemic Prevailing in Upper Silesia—argued that lack of
democracy, feudalism, and unfair tax policies in the province were the primary determinants
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