Nelson (B.C., Canada) Daily News (pg. 2)
February 21, 2006


By Helen Lutz

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 health."

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 exercise.

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".