The World Health Organization (WHO) defines the social determinates of health as the non-medical factors that influence health outcomes (World Health Organization [WHO], n.d.). These include income, education, employment, working conditions, food security, housing, early childhood development, social inclusion, and access to affordable and good quality health care. The WHO defines health inequity as the unfair and avoidable differences seen within and between different countries (WHO, n.d.). The WHO suggests that the social determinants of health may be more important than health and lifestyle choices in affecting health outcomes among populations.
The Government of Canada relates health inequities to specific circumstances unique to Canadian populations. For example, people living in remote or northern communities may not have the same access to more nutritious foods as those Canadians living in non-remote communities. This document recognizes that certain segments of the Canadian population including Indigenous peoples, Black Canadians, and immigrants may experience greater health inequities (Government of Canada, n.d.).
Manitoba Health, Seniors and Active Living is a department within the Government of Manitoba that guides the planning and delivery of health care services for Manitobans. In its position statement, health equity means “that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socio-economic status or other socially determined circumstance” (Manitoba Health, Seniors and Active Living (2018). Population groups within Manitoba that tend to experience poorer health outcomes and shorter life expectancies include Indigenous peoples, newcomers and refugees, visible minorities, people living in poverty, persons with disabilities and people experiencing long-term unemployment, homelessness or other types of economic and social marginalization (Manitoba Health, Seniors and Active Living (2018). Further to this point, First Nations, Metis and Inuit peoples face persistent health gaps resulting from historic and contemporary traumatic experiences related to racism and colonization (Manitoba Health, Seniors and Active Living (2018).
The Southern Chiefs’ Organization Inc. published a position statement on factors affecting the determinants of health for Manitoba’s 32 Southern First Nations. The paper outlines some grim statistics. The unemployment rate for First Nations living on reserve sits at 60 to 90%, with 70 to 90% of those unemployed living with serious mental health issues. Sixty-two percent of First Nations in Manitoba live in poverty, and even with income assistance, they remain well below the poverty line. Suicide rates are double that of the Canadian population and the youth suicide rate among First Nations is 5 to 7 times higher than the general population (Southern Chiefs’ Organization Inc., n.d.) This organization defines health as “the physical, spiritual, mental, economic, emotional, environmental, social, and cultural wellness of the individual, family, and community and identifies illness as a failure to maintain harmony and balance in all aspects of life” (Southern Chiefs’ Organization Inc., n.d.). The social determinants of health for Manitoba’s First Nations are similar to those of the WHO, however, the main focus is on the ability to obtain and sustain financial resources in order to maintain a holistic quality of life. It identifies unemployment as its most significant barrier as well as the inability to rely on traditional means of financial independence due to volatility in markets and ecological changes in the environment (Southern Chiefs’ Organization Inc., n.d.).
A study by Katz, Chateau, Enns, Valdivia, Taylor, Walld & McCulloch (2018), looked at the challenges that primary health care providers face in treating patient’s immediate health care needs when their overall well-being was also impacted by underlying social determinants of health. Using data from the Manitoba Population Research Data Repository, eleven social complexity factors were identified including mental health, poverty, involvement with the justice system, and newcomer status. The study found that 54% of primary care patients were living with at least 1 social complexity factor and 4% were living with 5 or more (Katz, et al., 2018). The authors argue there is a higher demand on primary care clinicians when caring for socially complex patients and recommend the use of interdisciplinary team-based models of care.
Identification and acknowledgement of the social determinants of health among populations is only a beginning. As noted in the responsibilities outlined by every government body, work must focus on developing and adopting good public policy in order to promote positive health outcomes, reduce health inequities, and strengthen its response to the social determinants of health. Manitoba has the highest Indigenous population in Canada (Southern Chiefs’ Organization Inc., n.d.). According to Manitoba Health, Seniors and Active Living (2018), only 25% of overall health outcomes are influenced by the health care system and health services and the social determinants of health contribute up to 60% to a population’s health status. Given our province’s unique diversity, more efforts in the provision of health care need to focus on the needs of our First Nations peoples, new immigrants, and those living below the poverty line.
References:
Government of Canada (n.d.). Social Determinants of Health.
Katz. A., Chateau, D., Enns, J., Valdivia, J., Taylor, C., Walld, R. & McCulloch (2018). Association of the Social Determinants of Health with Quality of Primary Care. The Annals of Family Medicine, 16 (3) 217-224.
Manitoba Health, Seniors and Active Living (2018). Chief Provincial Public Health Officer Position Statement on Health Equity.
Southern Chiefs’ Organization Inc. Factors affecting Determinants of Health for Manitoba’s 32 Southern First Nations.
World Health Organization (n.d.). Social Determinants of Health.
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