When a Pandemic Highlights the Social Determinants of Health

When people are asked what makes them healthy the responses are generally in regards to physical and mental health. Very few individuals take into consideration the social determinants of health (SDoH). According to the Canadian Public Health Association (n.d), the social determinants of health are “the social and economic factors that influence people’s health.” The importance of the SDoH is showing that extreme differences in income and wealth can have a negative effect on the health of a population.

Currently in Canada there are 14 social determinants of health that factor into the healthiness of a population. The following are considered to be apart of this model: income and income distribution, education, unemployment and job security, employment and working conditions, early childhood development, food security, housing, social exclusion, social/safety network, health services, aboriginal status, gender, race, and disability (Raphael, 2009). When you look at these 14 factors within a city you can depict the level of health present in the area.

I have worked at the bedside as a nurse on an acute medicine floor, and have been a frontline leader for a surgical care floor as well as an emergency department. Throughout my nursing career I have provided care for patients on both ends of the social gradient at many different stages of the patient’s life as well. Learning about SDoH within nursing school is one thing, but seeing first hand the challenges that are faced by patients who are of lower income is quite frustrating. Patients on the lower end of the social gradient tend to seek care at a much later stage, do not always have access to anything more than a walk-in clinic and do not have the resources for necessary equipment, medication and care to be provided when not in hospital. The level of care provided by myself was always equal no matter what the patient’s social situation was, however you could see that sometimes healthcare providers as a whole, did not always treat all of the patients the same. This then pushes that individual to have a negative experience within healthcare and not always seek medical attention when needed.

How do we change this? How do we get the SDoH to matter to those who make the policies and decisions of what is important to fund within our provincial system? Right now it feels as though Ontario is in a crisis. We have a housing market that is only going to increase the amount of homelessnes, the cost of utilities is rising as well as the cost of food. I feel as though the wage associated with all jobs is not keeping up with the demands of creating a healthy home. There is enough research to support that those lower on the social gradient do not fare well from a health standpoint. We automatically put an individual at a disadvantage because of where they are raised, the education system that they are a part of and the accessibility to healthy food, sports and activities. These all seem like relatively simple tasks to be able to make these things accessible to all, but with the government funding not at all focused on the SDoH within the province, it seems like the task would be worse than climbing Mount Everest.

Over the past two years the SDoH have been highlighted by the pandemic. Public Health Ontario (2020), found early on that the SDoH played an important role in risk of Covid-19 infection and that the social gradient, once again, showed that those at the lower end were more adversely affected by the virus. The research at the beginning of the pandemic showed that those individuals who were Black, Latino or other minorities had incredibly high rates of Covid-19 infection leading to possible death (Public Health Ontario, 2020). We knew that social distancing, wearing a mask, and proper hand hygiene were all ways to combat the virus pre-vaccinations being offered. When you look at the social gradient you will see that those who require shelters, are incarcerated, are Indigenous, or require assistance (vulnerable population), have a much higher incident rate, mortality rate as well as morbidity rate. I believe that this is because they have limited access to healthcare, they are in a congregate setting and don’t have access to hand hygiene products.

Overall, it is incredibly important when trying to measure health that all levels of policy makers, fund distributors and front line staff remember the social determinants of health. We have to continue to fight for the basic needs for a person to be discharged safely and continue to receive the best care we can provide.

References

A Report from the Office of the Chief Medical Officer of Health Health Inequities in New Brunswick. (2016). https://www2.gnb.ca/content/dam/gnb/Departments/h-s/pdf/en/Publications/HealthInequitiesNewBrunswick2016.pdf

Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.

Covid-19 – what we know so far about… social determinants ... (n.d.). Retrieved February 15, 2022, from https://www.publichealthontario.ca/-/media/documents/ncov/covid-wwksf/2020/05/what-we-know-social-determinants-health.pdf?sc_lang=en

Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto, Canada: York University School of Health Policy and Management.

Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives, 2nd edition. Toronto: Canadian Scholars’ Press.

Raphael, D. (2012). Tackling Health Inequalities: Lessons from International Experiences. Toronto: Canadian Scholars' Press.

Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social Determinants of Health: The Canadian Facts. Oshawa: Ontario Tech University Faculty of Health Sciences and Toronto: York University School of Health Policy and Management.

What are the social determinants of health? Canadian Public Health Association | Association Canadienne de Santé Publique. (n.d.). Retrieved February 14, 2022, from https://www.cpha.ca/what-are-social-determinants-health