Nursing 4210 - Health: Transitions

Learning Activity #7 (Online)
Social Determinants of Health

Appendix A

DETERMINANTS OF HEALTH

Twelve fundamental human characteristics have been identified as key determinants in the level of each person’s health by Health Canada and other international health authorities. The influences of these key health determinants are summarized below:

Income and Social Status

Income and social status are primary health determinants since they correlate with health quality. People with comfortable incomes have better access to higher quality housing, nutrition, safer neighbourhoods and schools, and have more control over their life decisions. The degree of control people have over their life circumstances, especially stressful situations, and their discretion to act are the key influences. Higher income and status generally results in greater control and discretion. Limited options and poor coping skills for dealing with stress increase vulnerability to a range of diseases through immune and hormonal system pathways. Income inequality promotes a poverty of opportunity or life chances. It is difficult for people with poor incomes to get the requisite education to get them out of poverty. It is difficult to have future goals and aspirations when a person is not able to meet their daily basic needs, since they are naturally preoccupied with their survival.

Social Support Networks

Support from families, friends and communities is important to help people solve problems and deal with adversity. It also helps people develop a sense of mastery and control over life circumstances. Meaningful social relationships bring a sense of caring, respect, satisfaction and well-being which act as buffers against health problems. When problems do occur, the social support gives emotional strength to heal.

Support from families, friends and communities is associated with better health. The health effect of the support of family and friends who provide a caring and supportive relationship may be as important as risk factors such as smoking, physical activity, obesity, and high blood pressure. The values and rules of a society affect the health and well-being of individuals and populations. Social stability, recognition of diversity, safety, good relationships and cohesive communities provide a supportive society that reduces or removes many risks to good health.

Education and Literacy

Education is closely tied to socioeconomic status: effective education for children and life-long learning in adults are key contributors to health. Education equips the individual to effectively problem solve and gain a sense of control and mastery. It also improves a person’s ability to access health information and to receive an adequate income.

Employment and Working Conditions

Unemployment, underemployment, and stressful or unsafe work are associated with poor health. People who have some control over their work environment and fewer stress related demands are healthier and tend to live longer than those who work in stressful and riskier work conditions. Work provides more than an income – it is also important for a sense of identity and purpose, social contact and gives opportunities for personal growth.

Social Environments

Social support from the broader community is important to health. Civic vitality is reflected in the institutions, organizations and informal giving practices created to share resources and build attachments with others. Values, norms, social stability, recognition of diversity, safety, good working relationships and cohesive communities helps reduce health risks for community members. Social or community responses can augment an individual’s repertoire of coping strategies which boosts health.

Five indicators of a supportive social environment are described in the reading: access to social support, personal security, volunteering, participation in community organizations and charitable donations.

Physical Environments

The natural environment can act as a health threat when contaminant levels are unsafe, reducing the quality of air, water, food and soil. Housing, indoor air quality, and the design of communities and transportation can also influence the health of the community.

Personal Health Practices and Coping Skills

These refer to the practices that an individual can do to prevent disease and promote self-care, cope with challenges, and develop self-reliance, solve problems, and make choices that enhance health. Includes personal life choices which are greatly influenced by the socioeconomic environments in which people live, work, play and learn. Coping skills are the skills people use to interact with the world around them, to deal with events, challenges and stresses of everyday life. Effective coping skills help people to be self-reliant, solve problems and make informed choices that enhance health.

Healthy Child Development

A young person’s development is greatly influenced by the housing they live in, the nutrition available, neighbourhood, family income, level of parents’ education, access to recreational activities, genetic makeup, access to dental and health care. Positive stimulation early in life improves learning, behaviour and health into adulthood. A loving, supportive attachment bond between parents and babies in the first 18 months of life helps children to develop trust, self-esteem, emotional control and equips them to have healthy relationships with others.

Biology and Genetic Endowment

Provides an inherited predisposition to a wide range of individual responses that affect health status. Can predispose individuals to certain diseases or health problems. Active living and lifelong learning are identified as sound practices that help keep health sound and reduce the potential for predisposition to disease.

Health Services

Services designed to promote health, prevent disease, and restore health and function contribute to population health.

Gender

Refers to the socially determined roles, personality traits, attitudes, behaviours, values, relative power, and influence ascribed by society to the two sexes, male and female. Many health issues are a result of gender-based social status or roles. Men are more likely to die prematurely largely as a result of heart problems, injury, cancer or suicide. Women live longer but suffer more depression, stress overload, chronic conditions such as arthritis, and domestic violence. The feminization of poverty refers to the fact that poverty affects women more than men, especially women raising a family on their own.

Culture

Dominant cultural values may give rise to marginalization, stigma, a loss or devaluing of native language, and cultural practices and a lack of culturally appropriate health care. Culture influences a person’s beliefs, attitudes, values, and behaviours. This process begins in the family and is transmitted from generation to generation. Canada has become intensely multicultural and will be even more so in the future. It is therefore imperative that nurses provide culturally sensitive care. This requires that they identify their own cultural perspective, have knowledge about different cultural groups, and acquire effective communication skills.

Culture and ethnicity come from both personal history and wider situational, social, political, geographic, and economic factors. They influence how people link with the health care system, their access to health information, and their lifestyle choices. Multicultural health issues demonstrate how necessary it is to consider the interrelationships of physical, mental, spiritual, social, and economic well-being at the same time. Dominant cultural values largely determine the social and economic environment of communities.

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