You've Come a Long Way, Baby: Social Determinants of Health

The Determinants of Health are the broad factors that determine the health of groups and individuals. The Social Determinants of Health (SDoH) are “nonmedical factors that influence health outcomes”. The Canadian government explains SDoH as a “group of social and economic factors within the broader determinants of health. These relate to an individual's place in society, such as income, education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, LGBTQ and Black Canadians.” The SDoH are more impactful for health than actual healthcare. However, most people think that healthcare is the most important (Venkatapuram, 2022).

I am summarizing a presentation on Social and Structural DoH by Dr. Gaynor Watson-Creed. The “But Why” story brought back memories of learning about public health in the 90’s. Simplified from Werner and Bower’s 1982 version, it works well to conceptualize the complex layers and larger issues at the root of problems.

Watson-Creed’s most interesting points included:

• Structural Determinants are the SDoH that are deeply hidden in our institutions and function without our awareness. For example, racism has set up the institutional structures that favour those of a certain skin colour. This is evidenced in prison populations, rates of poverty, food insecurity, housing, school graduation, chronic diseases, and premature death.

• 40% of the Nova Scotia’s budget is spent on healthcare, yet we get 13-25% health impact in return. Areas that have a larger impact on public health receive much less funding.

• Two of the most important SDoH are graduation from Grade 12 and the childhood learning environment.

• Many of the SDoH are based on 2 fundamental needs: being welcomed (for example, a lack of breast-feeding areas shows that babies are not always ‘welcomed’) and feeling loved (a secure attachment to stable adult relationships and environments) such as from parents, teachers, and coaches.

• Aside from Primary, Secondary, and Tertiary, there is Primordial Prevention: preventing the risk factors from existing.

We have made some great strides in public health in relation to the DoH. However, it brings to mind the phrase used for cigarette advertising to women, "You've come a long way, Baby": recognition that advances have been made, but articulated in a way which demonstrates that society's values and beliefs still have a long way to go.

References

Center for Disease Control. (2022, December 8). Social Determinants of Health at CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/about/sdoh/index.html

Conference of Deputy Ministers of Health (Canada) (Ed.). (1999). Toward a healthy future: second report on the health of Canadians. The Committee. https://publications.gc.ca/collections/Collection/H39-468-1999E.pdf

Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health, 100(4), 590–595. https://doi.org/10.2105/AJPH.2009.185652

Public Health Agency of Canada. (2001, November 25). Social determinants of health and health inequalities [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Venkatapuram, S. (2022). Going global with social determinants of health: some reflections. BMJ Global Health, 7(6), e009799. https://doi.org/10.1136/bmjgh-2022-009799

Watson-Creed, G. (2022, September 28). Social and Structural Determinants of Health - Where Health Really Comes From. Dalhousie Health Law Institute Seminar Series, Schulich School of Law. https://www.youtube.com/watch?v=ijrKdggJDdQ

Werner, D., & Bower, B. (1982). Helping Health Workers Learn: A book of methods, aids, and ideas for instructors at the village level (1st ed.). Hesperian Foundation. https://www.researchgate.net/publication/274853938_Helping_Health_Workers_Learn

WHO. (n.d.). Social determinants of health. World Health Organization. Retrieved October 12, 2023, from https://www.who.int/health-topics/social-determinants-of-health