The Social Determinants of Health
The phrase "social determinants of health" refers to the flow of capital through the population and its effects on the social and economic state of society as they relate to individual and family health. (SDOH). These are factors like net income, development prospects, public policy, and societal wealth that have an impact on people's lives and means of subsistence. Not included in the list are the individual risk factors, such as hereditary makeup and behavioral tendencies, which can influence the likelihood of health deterioration due to bodily ailments or injury. In this research we intend to discuss two social determinants, i.e., housing and income that affect the health of citizens of Canada and review the data collected to suggest policy reform to improve these two social determinants so that he health index of Canadian population can be improved and livelihood of the Canadian citizens can be restored. [15]
The Impact of Public Policies on Social Determinants
Some theorists propose that the governing body of any given land decides the distribution of social determinants through public policies. As these public policies are determined by politicians these determinants are also greatly impacted by the political climate of the land. WHO, The World Health Organization states that the disparity in health deterioration statistics should not be regarded as normal occurrence but has to be taken as a result of bad social policy, poor economical politics and unjust distribution of wealth that is where rich individuals get richer and poor individuals getting poorer.
Defining Social Determinants of Health
There is no single definition of the social determinants of health, but there are commonalities, and many governmental and non-governmental organizations recognize that there are social factors which impact the health of individuals. [8]
Housing
Poor Quality of Housing and Homelessness
The two factors that affect Canadian housing situation are poor quality of housing and homelessness. [4] Housing quality is paramount to the health of any individual. Life in deplorable houses in terms of security, affordability and safety will act as a catalyst for health related issues. Thus, economic depravity becomes a relevant factor in housing crisis that is commonly experienced by Canadian populace.
International Criticism of Canada's Housing Situation
Canada, as an active participant in international human rights activites, is a part of various international human rights memorandums that promise propoer shelter provisions. And yet, it is consistently hailed as not fulfilling these promises by international authorities. In 2007 Miloon Kothari observed in 'United Nations: Special Rapporteur on the Right to Adequate Housing; 2007; during his Preliminary Observations of Mission to Canada that wherever he went in the country, he found a large number of homeless and ill housed population. He noted that quite a considerable number of people have passed away as a direct resul of this nation- wide housing crisis. United Nation has strongly condemned Canadian government for providing inadequate housing to its people in its recent periodic review of Canada’s compliance with the International Covenant on Economic, Social and Cultural Rights and called on Canadian government to declare national emergency. The deep impact, this situation is having on the livelihood of female, elderly and child population of Canada is deemed problematic by United Nations.
The Impact of Housing on Health
Living space is one of the crucial factors in health management of individuals. Quality of the house defines the quality of life and material experience of a person. Houses with unreasonable number of residents tend to facilitate transference f respiratory and other ailments. Considerable numbers of Canadian households, especially the ones on aboriginal reserves, do not have basic sanitation and drinkable water. This is called a major health risk by any human rights standard. A person’s residence defines his expression of identity and self worth. Unsustainable housing costs put a burden on resources that would, otherwise, be used to improve other social determinants of health. Despairing household situations invite unhealthy and dangerous coping mechanisms such as substance abuse. Mold, lead poisoning, irregular heating or poor ventilating venues, pesticides and overcrowded households all catalyze health hazards. Individuals raised in depraved households are more likely to have depraved health both as children and adult. Humidity, for instance, causes respiratory distress and can become enhancer of already present adverse respiratory conditions. Separation of poor housing from other promoters of poor health such as pre-existing illnesses and poverty is hard as all these elements are usually found together. Yet research has been conducted that takes all these elements independently and have found that a lack of reasonable housing quality in a person’s life directly results in poor health of the individual.
The Housing Crisis in Canada
Canada has been undergoing a housing crisis since twenty years. In the past two decades, house rents have grown to well exceed the average living expenses per person; this is more significant in urban areas as compared to the rural areas. Renters are spending close to one third of their incomes on housing; this is called unaffordable even by the government of Canada. Cities in Canada have an average renter sending 43% of his income on rent with 42% in Toronto, 43% in Vancouver and 36% in Montreal. Around twenty percent residents of cities spend more than fifty percent of their income on housing, which puts them dangerously close to the risk of homelessness.[16]
The Impact of Housing on Homelessness and Low-Income Individuals
33% of Canadians fall in the low income line and are the renters. Rents are increasing much more rapidly than the average household incomes. Thus the housing sector has been experiencing stagnation.
This experience has given rise to a serious homelessness situation in Canadian urban Diaspora. Homeless people can take up health issues eight to ten times more than people with homes. This is due to high rent prices and a serious scarcity of rental options with reasonable rents. Canada is also experiencing a boom in part time and ill paid jobs that do not come with health insurance or social security of any kind.
Canada has low paying paid employers at 23 percent that is one fourth of the entire population and is one of the highest rates in the western world.[6] This puts Canada in a situation where insecure housing is an ever increasing element of Canadian economy. Individuals are depending more and more on motels, shelter system and streets. Insecure housing is directly related to poor income circumstances and effects health conditions directly.
Income and Income Distribution
Income and Income Distribution
The Correlation Between Income and Health Outcomes
Andrew Jackson noted in 2009 that health research has clearly shown a direct correlation between income, social economic status and health outcomes, with a clear increase and life and health with an increase in income.
The Significance of Income in Health Management
The significance of income in health related statistics is self explanatory. It is the most significant social determinant for health related studies. Income of a person determines the life style he lives, his mental health and his health maintenance and life expectancy. [1] The food he eats, his physical activity, his nicotine, caffeine or alcohol use are all correlated with his income. This correlation is goes both directions. The income of an individual will be affected by his health and ths his ability to earn money. And adversely, low income has an effect on masses and that affect is to be studied as well. Societies with equal wealth distribution have turned out to be healthier than societies that have income inequality on a mass scale. [5]
Income and Health Care in Canada
Income is a defining factor of health management in countries where basic health care is not fully covered by the government. Canada provides its citizens with free education till 12 grade, basic medical services and libraries. But citizens are paying for childcare, housing and college degree, retirement and recreation from their own income. Many Western countries provide for these services as a part of basic citizen rights for free. As Canadian citizens pay for many of, generally speaking, basic common rights, they feel depraved of material and social comforts. As this depravation increases among masses, it leads to citizen’s inability to pay for food, housing and proper clothing. This also leads to a depravation of participating in social, cultural and educational activities. [3]
Income Inequality in Canada
Social exclusion has long term effects as it leads to an isolated unfulfilled life. Studies show that men living in the wealthiest twenty percent districts of Canada have a life expectancy of four years more than men living in the poorest twenty percent districts of Canada , with women’s life expectancy increasing by two percent with the quality of their neighborhoods. The death rates in the wealthiest districts were fund to be 28% less than the death rates in poorest districts. Inhabitants of poorest districts were twice as likely to commit suicides as the individuals living in the wealthiest districts. Heart attacks and diabetes was far more prevalent among low income Canadians.
Canada has shown the second largest increase in income equality among thirty developed nations from 1990s to mid 2000s; according to Organization for Economic Co-Operation and Development (OECD).[9] Market incomes have declined for the poorest sixty percent as a result even though income remained the same for the top twenty percent. Raising income inequality has lead to an increase in the decline of the Canadian middle class. The income divide has increased from 1980-2005 with most Canadian families either falling in the high class or below the poverty line.
Wealth inequality in Canada has worried the international economical screening bodies as it proves evidence of financial security much better than the income index. Personal wealth index in Canada is even worse than the income index. Thirty percent of Canadian population has no net worth according to census from 1984 to 2005. In fact, the masses have accumulated debt at an increasing rate. But the net worth of top ten Canadians has increased $659,000 in constant dollars since 1984.
Conclusion
Robert Evans said in 1999 that continuous stress with no end in sight will eventually start deteriorating one’s health and will have its tool on a person’s organs and thus, will invite multiple diseases.
One may wonder how poor income or housing may affect psychological or physical well being of an individual. Well being of an individual is affected by the income and housing related adversity because lack of shelter and lack of financial independence puts chronic stress on a person’s mind. Such constant stress for long periods of time will eventually deteriorate a person’s health. When the individual does not find relieve in any way, he develops lifelong illnesses. Research has proven that stress will impact a person’s immunity and reduces the regularity of metabolic and hormonal functions in human body. [2]
Policy Implications
The Honourable Carolyn Bennett said in 2009 that if we are successful in increasing public consciousness and encourage political will, only then will we find the skeletal reform to receive better funding for social determinants in the very complicated federal government system.
The best way to develop health conditions in Canada is to increase income and financial security that has been consistently deteriorating for the past fifty years. Canada has previously worked rigorously to increase economical stability, from the great depression to World War II when public pensions, unemployment insurance, Medicare and federal and provincial programs including initiatives for affordable housing.
But Canada has been lagging in social reform for the past decades; to the point that now it is considered a lagging behind country among Western civilization. Canadian government has to be pushed to create public policy that promotes economic reform and strength. Canadian nation should unite behind the banner of reform and urge government through institutions, organizations and agencies that promote health and fight illness promoting cultures.
Unionization of the Canadian workforce is a main policy recommendation of this paper. Unionized Canada will make health insurance, job security and better wages much easier and readily doable. Canadian population needs immediate reform in terms of job security for the masses.
Unions have been found to be strongest in welfare states such as Norway, Denmark, Finland and Sweden. They have the lowest poverty rate in comparison with liberal capitalist societies such as United Kingdom, United States, New Zealand, Canada and Australia.
European nations, even though do not have high unionization, yet there is a general culture in the workplace to provide workers with decent pay, health insurance, pension plans and all other securities fathomable.[13] Government also incentivizes to provide various privileges and takes welfare of the workers seriously.
Canada needs to begin a unionized industrial sector and a government much more aware of the perils of the workers that are underpaid and much more receptive to their problems.
Policy Implications for Income Distress
Solution needs to become the focus rather than the symptoms. The living experience of people needs to improve in order to provide them with better health care and healthier selves.
Government body needs to engage in policy enforcement to make sure that social determinants of health for every Canadian are addressed and improved drastically.
Taxation policies need to reform with a focus on progressive tax benefits for the less fortunate that will help improve health prospects.
A unionized workplace shall help with the income inequality among the masses and may promote emergence of the middle class from the burdens of taxations that have been placed in the past five decades.
In recent years, an agreement has been formed between all the researchers that income inequality is the key element that seems to define the health of a person and needs to be addressed by the politicians and government. [17]
The lowest bottom of Canadian population will greatly benefit from welfare benefits for the unemployed and homeless and results will show immediately on the data and research. [14]
Policy Implications for Housing Distress
Income and housing needs to become more correlated with employment strategy health management policy and public health all becoming correlated.
Canadians should have excess to quality housing at reasonable prices and provinces should make available housing ease stipends that make the
Low income Canadians should receive special incentives by the government that help with funding of their home ownership possibilities and housing department should promote mix housing strategies to discourage urban segregation.
Canadian government was recently advised to put one percent of their annual budget for those who are needy and poor. This will rapidly help improve the conditions of the nation and increase economic prosperity in the region overall.
There are many suggestions given to the Canadian nation as well as its government and yet every single Canadian is still paying forty percent of his or her salary as taxes. Canadian government has to show strong reform to improve these conditions.
The Hon. Monique Bégin, PC, FRSC, OC, who is the Member of WHO Commission on Social Determinants of Health and is also Former Minister of National Health & Welfare once discussed the situation y stating that World Health Organization’s Commission on Social Determinants of Health published a report discussing how the poorest third world countries such as Bangladesh, Sri Lanka and India also have the worst health conditions. That a person’s health is directly affected and related to the life style they live. If a person does not have financial stability then the person will also have adverse health condition to go along with the financial disparity. Canada celebrated its prosperity when United Nations called it 'the best country in the world to live in' and got carried away in its celebration for so long, it started ignoring gathering statistics that were showing that Canada was lagging behind in economic prosperity.
As economic prosperity started drying out, so the health of the Nation deteriorated as well. That was new knowledge for the general Canadian population that always assumed that as the ninth wealthiest country in the world they were wealthy enough to stay healthy forever. But that has turned out to be not true. This wealth has covered up the socio-economic anxiety, the diminishing employment sector, reducing mental health index of mass populace and truths of poverty that the average Canadian is facing every day. Canada is one of the biggest providers of health care and yet, the social security that is needed for sustained long term health for mass population is nowhere to be found. If one is to go back to the same hospital due to terrible living conditions than what is the point of that hospice care being free?
The statistics mentioned above are expected to be a wakeup call for politicians, government and economists of Canada who need to address the despairing gaps in economic plans that run the country right now.
A detailed analysis of the economic conditions of the country based on provinces, regions and status variations are in order so that the problems can be faced and dealt with.
This paper reviewed the work done so far by WHO to show that the health of any nation is dependent on economical equality of that nation. In a country where middle class is disappearing, time for drastic action is now.
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