Definition of Social Determinants of Health
Social Determinants of Health
Studies establish that health inequalities directly associate with social inequalities. Health inequalities are the result of various factors or conditions in which people work, grow, live, and age (WHO, 2010). According to WHO (2010), these conditions relate to social determinants of health, hence they interact with each other throughout the course of a person’s life. The social determinants of health influence the health status of an individual, and behavior and lifestyle choices that produce illness and health (Pathak et al., 2012). Studies offer strong evidence which factors, external to the health care system, influence health (Raphael, 2009).
There are different definitions and descriptions of the social determinants of health (SDOH). World organizations like the World Health Organization (WHO) or the Canadian Public Health Association (CPHA) or social scholars like Blane, Brunner, and Wilkinson (1996) have varied definitions of SDOH. Blane, Brunner, and Wilkinson in 1996 first defined SDOH from a socio-biological and environmental point of view and identify biology, health care, genes, and lifestyle (Raphael, 2009). Further, they identify that inequalities in the quality of social determinants like education, employment, housing, social acceptance, and income later translate to disease-related processes. Reviewing literature reveals that different scholars and policy makers identify different conditions as definitions for social determinants of health.
To the CPHA, the SDOH includes social status and income, education, social support network, social environments, biology and genetics endowment, employment and working conditions, physical environments, healthy child development, gender and culture, personal health practices, coping skills, and health services (Raphael, 2009). The Canadian government indicates that these factors are social determinants of health since they influence the health of a population. The CPHA identifies that factors like working conditions and living are very important to the health of a population. This is because the factors determine the health status in term of health services, human biology, environment, and lifestyle. They also influence the spending on health care and the contributions to health care and medicine.
This description of SDOH is similar and slightly different from that given by the WHO. To the WHO SDOH are the conditions a person is born, grows, works, ages, and lives in. These conditions also include the health system, and are under the influence of distributions of power, money, and resources at the local, national, and international level. This description is similar to CPHA’s definition, but considers all living, growth, working, and aging conditions at all levels. The CPHA’s definition considers specific conditions in the birth, growth, work, and health system for an individual at the national level. In light of this, the WHO identifies nine SDOH as early child development, globalization, social exclusion, and employment conditions. Others include health systems, evidence and measurement, priority public health conditions, women and gender equity and urbanization. From the list, there are marked differences with the SDOHs identified by the CPHA. The CPHA considers factors like disability, race, aboriginal status, social safety network, housing, food insecurity, education, and income factors not present in the WHO’s list. On the other hand, the WHO consolidates factors into conditions not considered by Canada like globalization, priority public health conditions, evidence and measurement, and urbanization.
The WHO like the CPHA identifies early childhood development as a critical social determinant of health. To the WHO, early childhood is a time between prenatal development to eights of age, and is the most important foundation for their life. WHO identifies that this period determines development in terms of physical, social, health, cognitive, and emotional domains that influence success in school, learning, socialization, economic participation, and citizenry. This is similar to the CPHA description of early childhood as a determinant of health, but unlike the WHO, the CPHA identifies early childhood including neonatal or prenatal stage. This is because early childhood experiences have long-lasting and immediate psychological, biological, and social effects on the health of an individual (Adamson, 2008).
Employment and working conditions are determinants of health. According to Pathak et al. (2012), employment offers an individual a source of income, food, and safety security, a purpose, identity, chance for personal growth and social relations. The loss of employment implies the loss of these benefits, creating mental, physical, and psychological stress on the individual. CIHI (2004) also identifies that it is the working environment, which is hostile to the individual as it creates stress reducing the quality of life. This condition is different in definition as given by the WHO, as it considers working conditions mainly in terms of wages. To the WHO, low wages prevents workers from meeting their basic needs, decrease their devotion to work, weakens job security. Working conditions to the WHO also entail dangerous and dirty workplaces. The other difference is that Canada further splits working conditions to consider unemployment and job security as a social determinant of health. According to PHAC (2003), job security is the subjective perception of risk depending on an individual’s job situation, labor market conditions, and economic environment. Therefore, job security currently implies the ability for an individual to secure a reliable income from any diverse work employment (Pathak et al., 2012). Food security is the accessibility to affordable and nutritious food sources (Mikkonen & Raphael, 2010). Pathak et al. (2012) identifies that lack of access to food sources is prevalent among families in the low-income social bracket. These families have poor nutrition and health due to lack of food security.
Moreover, the WHO considers a factor like income and economic status as driven by employment conditions in terms of wages received. This is different with the definition given by the CPHA that considers income and economic status as a separate determinant of health. According to Mikkonen & Raphael (2010), low income causes social and material deprivation, leading to lack of affordability of basic needs like clothing, housing, and food, which are the foundations of good health. Income levels also affect psychological constructs of health behaviors, since material deprivation prevents parts of a population from participating in educational, cultural, and recreational activities (Mikkonen & Raphael, 2010). Income level is related with food security, which affects nutrition, child development, and housing. Interestingly, as the WHO considers wages as a working condition that influences job security and therefore, food security for workers, the CPHA considers food security as a condition on its own.
A notable difference between definition of social determinants of health between the WHO and CPHA is the introduction of globalization as a factor by the WHO. WHO considers globalization since it is a transnational economic integration that drives people to work and live across borders. According to the WHO, globalization through liberalization of trade, reorganization of labor markets, production, finance, and economic restructuring improves the lives and health of people through new opportunities. This factor is not a consideration in the CPHA’s definition of social determinants of health.
Housing as a SDOH includes the design and physical structure of a house, psychological and social features, and the civic, social, and physical characteristics of the individual’s neighborhood (Moloughney, 2004). Social environment as a SDOH entails social safety network and social exclusion. The health of individual increases with the social safety network associated with social programs like hospitals, schools, police department, and emergence response (Pathak et al., 2012). This is different from the description given by the WHO that considers social the social environment in the broad concept of social exclusion. To the WHO social exclusion entails multi-dimensional processes driven by interacting power relationships from dimensions like social, political, cultural, and economic at different levels including community, household, individual, global, and country. According to the CPHA social safety network entails an individual’s health improves with social stability, safety, cohesive community, social recognition, diverse, and good working relations (Adamson, 2008). Alternatively, an individual, who is socially secluded from their peers, family, community, or workplace, lives like the homeless in a poor social environment, will experience poor health (Pathak et al., 2012). These definitions imply that the shared experiences and issues in the family and community provide an individual with a support system.
This research finds that income is a vital social determinant of health to Canadians. This is because income level affects and determines other factors like education, food, housing, and childcare, among others. Income as a SDOH is the financial power to provide a quality life in terms of better food, housing, healthcare, education, safety, and consequently, better health. Education and literacy as a SDOH is the level of knowledge and skills that enables an individual to secure a well paid job, gain social recognition, and make informed choices that lead to improved health. Employment and work conditions entail a secure and safe source of income that supports the health and safety of an individual. From the descriptions given by the different sources, it is evident that a lack of employment implies reduced economic power and therefore, a source of stress, which leads to poor health. The link between these determinants are influences of early childhood care with personal growth and development, quality education, social, psychological, and mental development, and the successful entry into the workforce. This implies that factors like income, social status, and education correlate and influence various determinants like early childhood development, housing, food security, social exclusion, and health status.
Factors such as race, aboriginal status, gender, and health services help in determining the health of an individual. It is evident that the manner in which the society categorizes persons in terms of race, gender, aboriginal status, social status, and culture determines their health status. The review of literature indicates that individuals in certain communities or groups face health risks associated with the socio-economic environment determined by social values. These social values are like race, gender, culture, income, socio-economic status, social exclusion, and social safety network. The health status of a population improves with social status, income, education, and literacy. This is because these factors improve the knowledge of a population, thereby improving well-being. In the end, the definitions indicate that conditions associated with social determinants of health are in correlation and interact in a complex way. The definitions support the premise that social determinants of health are interrelated and influence the health status of a population.
References
Adamson, P. (2008). The childcare transition: Innocenti report card 8. Florence: UNICEF. Innocenti Research Centre.
Canadian Institute for Health Information (CIHI). (2004). Improving the health of Canadians.
Mikkonen, J., & Raphael, D. (2010). Social determinants of health: The Canadian facts. Toronto: York University School of Health Policy and Management.
Moloughney, B. (2004). Housing and population health: The state of current research knowledge. Canadian Population Health Initiative, Canadian Institute for Health Information. Retrieved 30th January 2013 from http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_284_E&cw_topic=284&cw_rel=AR_1129_E.
Pathak, S., Low, M.D., Franzini, L., & Swint, M.J. (2012). A Review of Canadian Policy on Social Determinants of Health. Review of European Studies, vol. 4 no., 4, 8-22.
Public Health Agency of Canada (PHAC). (2003). What makes Canadians healthy or unhealthy? Retrieved 30th January 2013 from http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php#education.
Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives. Toronto: Canadian Scholars’ Press.
World Health Organization (WHO). (nd.). Social determinants of health. Retrieved 30th Jan, 2013 from http://www.who.int.www5.sph.uth.tmc.edu:2048/social_determinants/en/.
