Nelson (B.C., Canada) Daily News (pg. 2)  [Printer-friendly version]
February 21, 2006


When most people think of the things in their life that help to
prevent disease and maintain health, most respond with diet and
exercise, as well as their prompt and convenient access to health care
services, professionals and equipment. Though these beliefs are widely
held, and strongly touted in traditional medical literature, they are
not necessarily the things that truly keep us healthy. There are other
characteristics of our communities and societies that have
considerably more influence on our health than eating right and seeing
the doctor. Curious?

A great deal of evidence from Canada and other countries supports the
notion that the social and economic "circumstances of individuals and
groups are equally or more important to health status than medical
care and personal health behaviours such as smoking." These
circumstances are commonly referred to as the "social determinants of

According to Health Canada, "social determinants of health are the
socio-economic conditions that influence the health of individuals,
communities and jurisdictions as a whole. These determinants also
establish the extent to which a person possesses the physical, social
and personal resources to identify and achieve personal aspirations,
satisfy needs and cope with the environment." Social determinants of
health determine whether individuals stay healthy or become ill.

According to Dr. Dennis Raphael of York University, "Social
determinants of health are about the quantity and quality of a variety
of resources that a society makes available to its members." What
exactly are these determinants? Dr Raphael considers a number of
factors as playing a critical role in the health and wellbeing of
individuals, communities and society as a whole. These resources
include such things as conditions of childhood, income, availability
of food, housing, employment and working conditions, and health and
social services. It also includes issues of gender, class, racism and
other forms of social exclusion.

In terms of the health of larger populations, it is well recognized
that the size of the gap (or disparity) in social and economic status
between groups within a given population has an enormous affect on the
health status of the whole population. The larger this gap, the
greater the affect on the health status of all of us or more simply, a
chain is only as strong as it's weakest link. Taking a social
determinants of health approach to our work in health care and
communities is much different than the traditional focus on the risk
factors such as eating habits, cholesterol levels, tobacco use and

Making a change towards the social determinants of health approach is
challenging, and inherently political. After all, when we begin to
consider some of the more complicated issues within our community such
as poverty, housing quality, and employment opportunities for example,
then we must shift our attention to how we as community members
organize ourselves and make resources and supports available (or not)
to all of us.

In conclusion, if you're still looking for some tips to help improve
your health, here is the social determinants of health perspective
(adapted from Dr. Raphael's book "The Social Determinants of Health",
p.13): Don't be poor. If you can, stop. If you can't, try not to be
poor for long. Don't have poor parents. Own a car. Don't work in a
stressful, low paid manual job. Don't live in damp, low quality
housing. Be able to afford to go on a foreign holiday and sunbathe.
Practice not losing your job and don't become unemployed. Take up all
benefits you are entitled to, if you are unemployed, retired or sick
or disabled. Don't live next to a busy major road or near a polluting
factory. Learn how to fill in the complex housing benefit/asylum
application forms before you become homeless and destitute.

If you are interested in further reading about the importance of these
social and economic forces as predictors of our health, there are
resources available through a "Google" search of "social determinants
of health".