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Social determinants of health: The Canadian facts. 2nd edition

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Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A
Book / booklet
Publication Date: 
11 Aug 2020

Excerpted from introduction

A health care system – even the best health care system in the world – will be only one of the ingredients that determine whether your life will be long or short, healthy or sick, full of fulfillment, or empty with despair. – The Honourable Roy Romanow, 2004

The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living and working conditions they experience. These conditions have come to be known as the social determinants of health (Figure 1.1). The importance to health of living conditions was established in the mid-1800s and has been enshrined in Canadian government policy documents since the mid-1970s. In fact, Canadian contributions to the social determinants of health concept have been so extensive as to make Canada a “health promotion powerhouse” in the eyes of the international health community. Reports from Canada’s Chief Public Health Officer, the Public Health Agency of Canada, and Statistics Canada continue to document the importance of the social determinants of health.

But this information – based on decades of research and hundreds of studies in Canada and elsewhere – tells a story unfamiliar to many Canadians. Canadians are only now becoming more aware that our health is shaped by how income and wealth is distributed, whether we are employed, and if so, the working conditions we experience. Furthermore, our well-being is also determined by the health and social services we receive and our ability to obtain quality education, food and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living and working conditions are – for better or worse – imposed upon us by thequality of the communities, housing situations, our work settings, health and social service agencies, and educational institutions with which we interact. The COVID-19 crisis has dramatically placed these issues in front of Canadians as those who are already disadvantaged are not only more likely to contract and succumb to COVID-19 but are also the ones bearing the brunt of its adverse economic effects.

There is much evidence that the quality of the social determinants of health Canadians experience explain the wide health inequalities that exist among Canadians. How long Canadians live and whether they experience cardiovascular disease, adult-onset diabetes, respiratory disease and a host of other afflictions is very much determined by their living and working conditions. The same goes for the health of their children: differences among Canadian children in their surviving beyond their first year of life, experiencing childhood afflictions such as asthma and injuries, and whether they fall behind in school are strongly related to the social determinants of health they experience.