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Social Determinants: Finding Causes of Causes.

Dear CCP readers,


Written by: Varleen kaur

Edited by: Jacqueline Cheung


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


In this blog post, we aim to focus on the social determinants of health, and the impact of non-medical factors on health. The World Health Organization (W.H.O.) defines health simply as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” “Social well-being” is an important aspect of this definition that may not always occur when thinking about our health. If you would like to learn more about the current state of homelessness in Canada and the Greater Toronto and Hamilton Area (GTHA), welcome! If you are returning for more information about the particular challenges faced by youth experiencing homelessness and those with animal companions, welcome back! If you are new to our blog, welcome to the community and thank you for your interest in learning more about issues regarding the homelessness crisis in Canada and beyond - you are one step closer to becoming a changemaker in your community, and you are in great company.


The most important thing you need to know about your health may not be as obvious as you think. The World Health Organization's Commission on the Social Determinants of Health has defined the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.


This is a detailed list of all the social determinants affecting health:

  • Income and social protection

  • Education

  • Unemployment and job insecurity

  • Working life conditions

  • Food insecurity

  • Housing, basic amenities and the environment

  • Early childhood development

  • Social inclusion and non-discrimination

  • Structural conflict

  • Access to affordable health services of decent quality.

However, this is not an exhaustive list. Depending on what health means to you and where you live, there could be more factors.


Why is SDOH so important in public health?


Research has shown that SDOH could be responsible for 30-55% of health outcomes. It also shows that the contribution of non-health sectors to population health is greater than that of the health sector. For instance, children born to parents who have not completed high school are more likely to live in a setting that brings health barriers, such as a lack of safety, exposed trash, and inadequate housing. Additionally, they are less likely to have access to sidewalks, playgrounds, parks, recreation facilities, or libraries.


Another example could be addressing the social needs of patients from disadvantaged economic backgrounds. This can significantly decrease hospital re-admission rates since's possible that patients from underprivileged social backgrounds are underrepresented in care management programs. Overall this can allow hospitals to reduce avoidable readmissions and enhance treatment for their patients.


In addition to improving overall health, addressing SDOH is crucial for lowering health disparities frequently caused by social and economic disadvantages. Studies are also showing that legislative choices in a variety of public policy areas significantly impact the standard of these health-shaping living environments, which will eventually impact your health. Stress has a deleterious influence on health across the lifetime, and environmental factors may have effects that span multiple generations.



Initiatives to address SDOH:


The Public Health Agency of Canada established the Canadian Council on Social Determinants of Health to work with leaders from different sectors on the SDOH and improve health equity.


  • Focus on Health in Non-Health Sectors:

For instance, access to employment, affordable, wholesome food, and health care are impacted by the accessibility and availability of public transit. In addition to supporting healthier corner stores in low-income neighbourhoods, farm-to-school initiatives, community and school gardens, and larger efforts to support the production and consumption of healthy foods, nutrition programmes, and policies can help boost health. Early childhood education for children from low-income families and communities of colour is crucial to promote health equity, closing achievement disparities, and improving the health of low-income students.

  • Working to address food security:

One of the most important socioeconomic factors affecting health is food security. Many patient populations nationwide reside in food deserts, where it is challenging to buy food because of logistical or financial constraints. In either scenario, a lack of food is a major risk factor for chronic illness, most notably diabetes.

If you are interested in learning more about it, we also have a detailed blog on Food Security on our website; you can access it here.

  • Creating affordable housing:

The CCP has always been a big advocate for affordable housing, and we have published a couple of blog posts on the importance of affordable housing; you can check them out on our website. Connecting patients with affordable housing is a critical health need; governments have several options to achieve this. Housing benefits and social housing are the most prevalent types of housing assistance for low-income households. There is a possibility that housing policies will not help everyone and, in some situations, may make housing more expensive. For example, tax relief promoting property ownership primarily benefits higher-income households. Landlords may keep a portion of public housing subsidies, which would raise overall rents in tight housing markets.

  • Transportation:

The availability of reliable transportation networks enables individuals to securely and reliably go to regular locations like workplaces, schools, and restaurants serving wholesome food and healthcare services. Issues with transportation affect people's capacity to access necessary medical care. Non-emergency medical transportation, which addresses issues like the price of transportation and vehicle accessibility, could be very helpful, specifically in smaller towns and cities where infrastructure may be less developed.



Social Determinants are a very large topic, and the meaning of SDoH varies depending on the region of interest. For example, determinants may differ in western/developed countries as compared to developing countries.


Studies show that certain SDOH interventions like the ones mentioned can enhance health and well-being when used in the appropriate contexts and according to the population. Additionally, certain interventions may lower healthcare costs; nevertheless, good interventions might be cost-effective and worthwhile to implement even if they do not eventually result in large financial savings. The majority of research conducted to date has been on shorter-term outcomes, medically complicated groups, or populations that frequently require healthcare services. Studies on community interventions have also shown long-lasting positive impacts on health. However, as we concentrate our efforts on SDOH, more research is necessary to evaluate the effects of various strategies on multiple groups. We need to strengthen the evidence base for informed decision-making.

We at CCP are working to address issues that can impact the health and well-being of youth and youth facing homelessness. Our goal is to inspire youth to believe their future goals are attainable and teach them how to reach them.



References:

1- Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014 Jan-Feb;129 Suppl 2(Suppl 2):19-31. doi: 10.1177/00333549141291S206. PMID: 24385661; PMCID: PMC3863696.


2- Institute of Medicine (US) Committee on Assuring the Health of the Public in the 21st Century. The Future of the Public's Health in the 21st Century. Washington (DC): National Academies Press (US); 2002. 2, Understanding Population Health and Its Determinants.Available from: https://www.ncbi.nlm.nih.gov/books/NBK221225/


3- Osypuk TL, Joshi P, Geronimo K, Acevedo-Garcia D. Do Social and Economic Policies Influence Health? A Review. Curr Epidemiol Rep. 2014 Sep 1;1(3):149-164. doi: 10.1007/s40471-014-0013-5. PMID: 25984439; PMCID: PMC4429302.


4- Canadian Council on Social Determinants of Health. (2015). A review of frameworks on the determinants of health. Ottawa, ON: Canadian Council on Social Determinants of Health. Retrieved from http://ccsdh.ca/images/uploads/Frameworks_Report_English.pdf.


5- Andermann A; CLEAR Collaboration. Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ. 2016 Dec 6;188(17-18):E474-E483. doi: 10.1503/cmaj.160177. Epub 2016 Aug 8. PMID: 27503870; PMCID: PMC5135524.




  • The CCP Team

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