SOCIAL DETERMINANTS OF HEALTH

Social Determinants of Health: Canadian Perspectives

Social Determinants of Health: Canadian Perspectives

Introduction

Despite Canada's reputation as a leader in developing and promoting health promotion and population health concepts, implementation of public policies in support of health has been woefully inadequate (Raphael, 2004). The continuing presence of income, housing, and food insecurity among Canadians has led to Canada being the subject of a series of rebukes from the United Nations for failing to address child and family poverty, discrimination against women and Aboriginal groups, and most recently the crisis of homelessness and housing insecurity.

The contrast between words and actions has also been apparent in the area of the social determinants of health. Canada's rich history of policy declarations regarding the importance of public policy for addressing the economic and social conditions underlying health has contributed to the social determinants of health concept. Canadians have managed two of the International Commission on the Social Determinants of Health's knowledge hubs - early childhood and globalisation and health and Canadians have made significant contributions to various aspects of the Commission's mandate. Yet on the ground, living conditions continue to deteriorate for many Canadians. As just one example, Statistics Canada recently reported that over the past 10 years the only group of Canadians showing income gains has been the top 20% whose incomes have increased substantially. The incomes of the other 80% of Canadian have stagnated. Analyses of Canadian failures to address the social determinants of housing, employment security, food security, social exclusion, and poverty among others are available (Raphael, 2004).

Income

Income is defined as money received (e.g., from wages, interest, child support, Temporary Assistance to Needy Families), whereas wealth consists of assets accumulated. Another way to define wealth is net worth, or assets (e.g., home ownership, stocks, cars, leftover income after expenses) minus debts. Typically, when talking about social factors in the Canada, the media focus on income. However, wealth statistics paint a more accurate picture of determinants and inequality. In addition, income cutoffs for federal programs such as food stamps do not accurately portray the amount of money actually needed for Canadian families to meet basic needs. (Raphael, 2004)

Social Exclusion

In recent years the term social exclusion has gained much popularity in political dialogues on social policy issues in developed countries outside the Canada (Hills, Grand and Piachaud, 2002). In the late 20th century, the European Union adopted “social cohesion and social inclusion” as its theme; and “social exclusion” became part of the UN standard vocabulary to address the broad range of issues related to global inequality and injustice.

One view of social exclusion focuses on the lack of monetary resources and the material deprivation of individuals (Raphael, 2004). Causes of poverty, joblessness, and economic hardship, as well as their resulting pathologies, receive primary attention. Some critics allege that often social exclusion is actually a euphemism to avoid the sensitivity of the “P” word for political convenience. For example, the initial adoption of the term in the United Kingdom was to highlight the failure of the ...