Determinants of Health

In the previous unit we discussed the World Health Organization’s definition of health and how relevant it is in today’s society. This week we will take a look at the determinants of health as they relate to population health in both Canada and individual provinces by providing a summary of curated resources.

The World Health Organization defines the determinants of health as environmental factors and circumstances that contribute to the health of individuals and communities. Included in these factors are: the social and economic environment, the physical environment and a person’s individual characteristics and behaviors. (WHO, 2019)

Health Canada (2018) identified the determinants of health in more detail to include the following:

Income and social status

Employment and working conditions

Education and literacy

Childhood experiences

Physical environments

Social supports and coping skills

Healthy behaviors

Access to health services

Biology and genetic endowment

Gender

Culture

Further reading on the broader determinants of health allows us a more detailed look specifically at the social determinants of health which include social and economic factors that affect a person’s health outcomes such as: income, education, employment and discrimination. These are often common in the indigenous population. (Health Canada, 2018).

There is a lot of focus on the social determinants of health in both the literature and through a variety of associations such as the Canadian Nurses Association, the Canadian Medical Association and the Canadian Public Health Association. The Canadian Nurses Association makes reference to the importance of nurses including the determinants of health in their assessments and to understand the impact these factors can have on a client’s health. (Canadian Nurses Association, 2019). The Canadian Medical Association has identified addressing health inequalities as a pillar of their Health Care Transformation initiative by which physicians can take steps to address the problems on behalf of their patients. (Canadian Medical Association, 2013)

When comparing the determinants of health named by the Canadian Public Health Association with those expressed by the Canadian Government you will notice that the CPHA have included 14 determinants of health where the Canadian Government described 11. Although very similar some differences that you will note include: Social supports and coping skills are separated into social exclusion and social safety network, employment and working conditions are broken down into unemployment/job security and employment/working conditions, and the CPHA specify aboriginal status. (Canadian Public Health Association, 2019)

In 2007 the province of Nova Scotia identified a population health approach as the best way to improve health for Nova Scotians by changing the social and physical environments. One of the key elements to a population health approach is to address the determinants of health and their interactions to look at wider social, economic and environmental factors. Some of the initiatives to address the determinants of health in Nova Scotia included: establishing a transportation society, creating the Housing services division of Community Services, and a youth out of school initiative. (Nova Scotia Department of Health Promotion and Protection, 2007)

Since that time the Nova Scotia Department of Health and Wellness produced the Nova Scotia Health Profile in 2015. This document includes both the determinants of health and health status indicators. The statistics presented in this document showed that Nova Scotia has a higher percentage of the population with less than a high school diploma, a higher unemployment rate, higher rate of obesity, lower life expectancy, and higher rates of cancer, diabetes, hypertension, arthritis, heart disease, respiratory disease, and smoking. (Nova Scotia Department of Health and Wellness, 2015)

Also in 2015 the healthcare system in Nova Scotia changed as it transformed from 9 district health authorities into one called the Nova Scotia Health Authority. During this transition the province maintained the individual community health boards which participate in health planning by engaging communities to discover what is needed to improve health and to determine what is important to their health. These community health boards have also adopted a population health approach and rely on the determinants of health throughout their planning process. (Nova Scotia Community Health Boards, 2019).

The importance of incorporating the determinants of health and a population health approach is prevalent in Nova Scotia as evidenced by the province maintaining and integrating all of the community health boards that exist as they value the contributions they can make at improving the health of the community.

References

Canadian Medical Association. (2013). Health Equity and the Social Determinants of Health: A Role for the Medical Profession. Retrieved from

https://policybase.cma.ca/documents/Policypdf/PD13-03.pdf.

Canadian Nurses Association. (2019). Social determinants of health. Retrieved from

https://www.cna-aiic.ca/en/nursing-practice/evidence-based-practice/social- determinants-of-health

Canadian Public Health Agency. (2019). What are the social determinants of health? Retrieved from https://www.cpha.ca/what-are-social-determinants-health.

Health Canada. (2018). Social determinants of health and health inequalities. Retrieved from

https://www.canada.ca/en/public-health/services/health-promotion/population- health/what-determines-health.html.

Katz, A., Chateau, D., Enns, J.E., Valdivia, J., Taylor, C., Walld, R., & McCulloch, S. (2018). Association of the social determinants of health with quality of primary care. Annals of Family Medicine, 16 (3), 217-224.

Nova Scotia Department of Health and Wellness. (2015). Nova Scotia Health Profile 2015. Retrieved From https://novascotia.ca/dhw/publichealth/population-health-profile.asp.

Nova Scotia Department of Health Promotion and Protection. (2007). Healthy People, Healthy Communities: Using the Population Health Approach in Nova Scotia. Retrieved from https://novascotia.ca/dhw/publications/Public-Health-Education/Healthy-People- healthy-Communities-Population-Health-Approach.pdf.

Nova Scotia Community Health Boards. (2019). Community partnerships and a voice for a healthier future. Retrieved from https://www.communityhealthboards.ns.ca/#welcome.

World Health Organization. (2019). Health Impact Assessment. Retrieved from

https://www.who.int/hia/evidence/doh/en/.