Why a Conference on Social Determinants of Health?
Increasing evidence is accumulating that while medical and lifestyle choices affect the state of Canadians’ health, by far the greatest influences upon health concern how communities and societies are organized to support health.i These aspects of societies and communities – how income is distributed, availability of education, housing, food security, degree of support for early childhood development, the availability and type of employment, and the extent to which citizens are socially excluded from participation in society – are termed social determinants of health.ii These issues are the focus of many policy initiatives in Canada but to date there had been little systematic attempt to bring together Ñ within a social determinants of health perspective Ñ those working in the diverse fields associated with these issues.iii
Identifying the Key Social Determinants of Health
In 1986 the Ottawa Charter for Health Promotion outlined the prerequisites for health as being peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity.iv More recently, the Canadian Institute for Advanced Research identified determinants of income and social status, social support networks, education, employment and working conditions, physical environments, social environments, biology and genetic endowment, personal health practices and coping skills, healthy child development, and health services.v Finally, a 1998 WHO Task Force explicitly identified key social determinants of health of social status and income, stress, early life, social exclusion, work, unemployment, social support, addiction, food, and transport.vi Based on this and other work, the following social determinants of health were the focus of the proposed conference: early life, education, employment, food security health services, housing, income and social status, social exclusion, the social safety net, and unemployment.
Speaker after speaker identified how the social determinants of health have been decaying over the past decade in Canada. This has occurred as a result of government decisions that have systematically weakened social infrastructure and investment in populalation health. Such actions threaten the sustainability of the health care system. The complete presentations and proceedings of the conference are being posted at Information about the new School of health Policy and Management at York University is available at http://www.atkinson.yorku.ca/SHPM
i. Evans, R. G., Barer, M. & Marmor, T. R. (1994). Why Are Some People Healthy and Others Not?: the Determinants of Health of Populations. New York: Aldine de Gruyter.
ii. Marmot, M.G. & Wilkinson, R.G. (eds.) (1999). Social Determinants of Health. Oxford: Oxford University Press.
iii. Raphael, D. (2000). Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health, 10, 193-216.
iv. World Health Organization (1986). Ottawa Charter on Health Promotion. Geneva: WHO.
v. Health Canada. (1998). Taking Action on Population Health: A Position Paper for Health Promotion and Programs Branch Staff. Ottawa: Health Canada. On-line at http://www.hc-sc.gc.ca/main/hppb/phdd/resource.htm.
vi. Wilkinson, R. G., & Marmot, M. (1998). Social Determinants of Health: The Solid Facts. Copenhagen: World Health Organization. On-line at http://www.who.dk/healthy-cities/.