Social Determinants of Health

Global Perspective

The World Health Organization affirms that the conditions in which people live directly affect the quality of their healthi. These conditions are known as social determinants of health (SDH). The World Health Organization defines SDH as the living conditions in which people are born, grow, live, work, and age. These conditions are shaped by the distribution of money, power, and resources at national, provincial, and local levels. SDH are most responsible for health inequities – the unfair and systemic differences in health status between different population groups.

The Fourteen Social Determinants of Health (SDH) for Canadiansii 

  • Income and Income Distribution
  • Education
  • Unemployment and Job Security
  • Employment and Working Conditions
  • Early Childhood Development
  • Food Insecurity
  • Housing
  • Social Exclusion
  • Social Safety Network
  • Health Services
  • Aboriginal Status
  • Gender
  • Race
  • Special Needs

Canadian Perspective

Many people are surprised to learn that the primary factors that shape the health of Canadians are the living conditions they experience, not medical treatments or lifestyle choicesiii. Social determinants of health have been shown to have strong effects upon the health of Canadians, even more so than health behaviours such as eating habits, physical activity level, tobacco use, or alcohol useiv.

While all SDH affect students, we know that socio-economic status plays a particularly significant rolev. Even in a country as wealthy as Canada, health and illness follow a social gradient: the lower people’s socio-economic position, the poorer health they will likely face.

Family Perspective

While some social determinants of health relate to children and youth themselves, others are more directly associated with their biological parents. There is clearly a genetic component to health. For example, we can inherit a disease such as cystic fibrosis or have a genetic propensity towards mental health issues. In other words, we are “born into” some SDH, such as our gender, race, aboriginal status, or special needs.

Social determinants of health also involve our families’ experiences. It is important to remember that students are children and youth, and as such, they have varying degrees of control over their SDH. For instance, students have no control over their socio-economic status, the home and neighbourhood in which they live, the food purchased for their consumption, or the healthcare provided them. At a certain age, students may have increased control over the amount of time spent engaging in physical activity. But educators must remember that the ability to participate in community athletics, as when students play organized sports, is very much tied to a family’s disposable income.

Individual Perspective

Social determinants of health affect all students, in terms of whether they are physically and emotionally healthy as well as the extent to which they will have the personal resources required to overcome obstacles and achieve personal aspirations. As youth move through secondary school and grow into adulthood, it becomes increasingly important that they recognize what aspects of living are within their control. Through health learning they can see how critical-thinking and decision-making skills enable them to make choices that result in good or improved health. Educators can help teach students those skills and personal strategies. Once they have learned and practiced such living skills, students can foster their own well-being in the face of stressful and challenging life circumstancesvi. Since SDH affect student learning, educators should consider them when planning both content and strategies for health education and when assessing student performance.

Theory into Practice - Consider accessing school board and local public health data to gather information about the Social Determinants of Health (SDH) that may impact the lives of students. Consider using this information to support students in learning strategies to influence the SDH that are within their control to improve their personal health.

i CSDH (Commission on Social Determinants of Health). (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, World Health Organization. Retrieved from: https://www.who.int/social_determinants/thecommission/finalreport/en/

ii, iii Mikkonen, J., & Raphael, D. (2010). Social determinants of health: The Canadian facts. Toronto: York University School of Health Policy and Management.

iv Raphael, D. (2009). Social determinants of health: Canadian perspectives (2nd ed.). Toronto: Canadian Scholars’ Press.

v Canada Public Health Association (CPHA). (2012). What are the social determinants of health? [web page content] Retrieved from: https://www.cpha.ca/what-are-social-determinants-health

vi Ontario Ministry of Education. (2015). The Ontario Curriculum, Grades 9 to 12: Health and Physical Education (revised), page 12. Retrieved from: http://www.edu.gov.on.ca/eng/curriculum/secondary/health9to12.pdf