Blog #3 Social Determinants of Health

October 14, 2019

In my previous blog post the concept of health and what it truly means was described. This led my thinking towards understanding that health is not merely a lack of medical illness but a more fulsome picture of one’s being. This concept is supported through the understanding of the social determinants of health. The Government of Canada (2019) describes the idea that there are many factors that have an influence on our health in addition to those genetic precursors that we are born with. Social Determinants of Health can be understood as factors that relate to one’s place in society specifically related to income, education and employment (Government of Canada, 2019). Furthermore, the Government of Canada (2019) identifies the main determinants of health to be: income and social status; employment and working conditions; education and literacy; childhood experiences; physical environments; social supports and coping skills; healthy behaviours; access to health services; biology and genetic endowment; gender; culture; and race (Government of Canada, 2019).

The concept of determinants of health would suggest that there are inequalities amongst Canadians in terms of accessing healthcare services and one’s ability to be healthy. Health inequality is defined by the Government of Canada (2019) as "inequalities that are unfair or unjust and modifiable". This concept resonates with me as a mental health nurse who provides care for those directly affected by the social determinants of health. In my opinion, a lack of adequate income paired with inefficient safe and secure physical environment has been one of the most detrimental gaps in accessing healthcare services for my clients. The rural community that I work in is currently facing a housing crisis where there is very limited affordable housing available resulting in an increased homeless population.

From a provincial perspective in Ontario, there are constantly new initiatives being put in place but for some reason homelessness continues to grow. According to Province of Ontario (2019) the research has shown that long-term approaches to ending homelessness are more cost-effective than emergency responses. This has led to investing in more affordable housing to enable people to realize their full potential in the future (Province of Ontario, 2019). The initiative to create more affordable housing throughout the province will improve health outcomes by meeting one’s basic requirements for living, safe and secure physical environments. This will inevitably have a greater impact on the healthcare system by decreasing system use.

There is no question that mental illness is directly related to determinants of health, and therefore has an impact on the costs related to our healthcare system. In Canada, the costs to society of healthcare utilization, lost productivity due to absenteeism from work and long-term disability, and deterioration in health related quality of life is estimated to be $51 billion per year (Lim et al., 2008). The Canadian Mental Health Association (2019) explains that the three most significant determinants of mental health are social inclusion, freedom from discrimination and violence, and access to economic resources. This knowledge puts Ontario in a place to act prophylactically in terms of putting resources in place to support positive mental health. CMHA (2019) lists a number of ongoing provincial wide support programs to increase the outcomes of determinants of health including BounceBack Ontario; E-QiP, Enabling the Mind, Mental Health Matters and more.

Identifying and supporting social determinants of health has been a priority in Ontario through different action plans and initiatives. However, there are still numerous gaps within our province and many patients have poor access to healthcare services. Although Ontario is making efforts to meet the healthcare needs of it’s citizens, there is still much room for improvement and recognition of the impact that social determinants of health has on our health outcomes, but also on our society as a whole.

References

Canadian Mental Health Association. (2019). Provincial programs. Retrieved October 12, 2019, from Canadian mental health association Ontario: https://ontario.cmha.ca/provincial-programs/

Government of Canada. (2019, June 28). Social determinants of health and health inequalities. Retrieved October 12, 2019, from Government of Canada: https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Lim K-L, Jacobs P, Ohimnaa A, et al. (2008). A new population-based measure of the economic burden of mental illness in Canada. Chronic Diseases in Canada, 28(3): 92-98.

Province of Ontario. (2019, October 2). Ending homelessness in Ontario. Retrieved October 12, 2019, from Ontario.ca: https://www.ontario.ca/page/ending-homelessness-ontario