Determinants of Health

It would seem that there is broad agreement that Social Determinants of Health (SDH) can be more important than health care or lifestyle choices in influencing overall health and that the lower the socioeconomic position, the worse the overall health of the individual.  Interestingly however, there is not one agreed upon list of what those determinants should be.  Below is a table outlining the specific determinants, from a provincial, national and global perspective (Ontario Health, Government of Canada, World Health Organization, and the Canadian Mental Health Association).  Only four determinants were consistent across all four organizations – Education, Early life and Employment, Working conditions and Health Services.  I tried looking a little closer to home to see what was available around health in my own community.  I came across the City of Hamilton’s Public Health department’s Community Health Status Report for 2024, whose primary goal is to guide public health planning and service delivery.  They provide an overview on 13 topics (not labelled SDH), that are the focus for public health as they begin the journey of enhancing their approach to population health assessment and planning.  These topics include: Geography and Population, Social Circumstances Influencing Health, General Health, Healthy Pregnancy and Births, Child and Youth Health, Immunization, Infectious Disease, Environments and Health, Mental Health, Substance Use, Injury and Violence, Healthy Living, and Chronic Disease.  The report was created with input from various community organizations, including the Hamilton healthcare organizations.  This was a fascinating resource specific to the city in which I live and work.  It speaks to the community I help to care for in my professional life and the people I see in our buildings every day.  It was also incredibly sobering when reviewing some of the statistics.  It definitely made me think about our services and how we are supporting our community when it comes to acute care.  Are we aligning our services with the reality of our community?  Are we doing enough for underserved populations?  Are our buildings accessible enough?  Are we supporting the right programs in the hospital and in the community?  It is interesting to start and think about how my experience working in acute care is shaped by public health and vice versa.  Reviewing the report was a confirmation of some of things I see (increase in accidental poisoning – drug overdose), the importance of some of the programs I oversee (Endoscopy – cancer of the colon, rectum and anus is the 4th leading cause of premature death in Hamilton), and the reality that our system will continue to be taxed moving forward (Hamilton’s population is projected to continue to grow, and age).  This report is a must save resource for this course, and for future consideration in my professional life as we continue to consider our acute care services and our collaborations with various community resources and services.  When it comes to Social Determinants of Health, I think a community approach makes the most sense – this is the true reflection of the reality any one individual is living, and can differ by province, country or continent. 

	CMHA	WHO	Ontario	Canada
Education	X	X	X	X
Early Life	X	X	X	X
Employment & working Conditions	X	X	X	X
Food Insecurity	X	X	X
Health Services	X	X	X	X
Gender & Gender Identity	X		X	X
Housing	X	X
Income & Income Distribution	X	X		X
Race	X			X
Sexual Orientation	X
Social Exclusion	X	X		X
Social Safety Net	X
Unemployment & Job Security	X	X
Disability	X		X
Aboriginal Status	X		X
Structural Conflict		X
Physical Environment				X
Biology and genetic endowment				X
Culture				X

References:

Social determinants of health and health inequalities (2024, July 18).  Government of Canada.  Retrieved February 18, 2025, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Social Determinants of Health Framework and Resource Guide (2024, December 13).  Ontario Health.  Retrieved February 18, 2025, from https://www.ontariohealth.ca/system-planning/social-determinants-of-health-framework-and-resource-guide

Social Determinants of Health (2025).  Canadian Mental Health Association.  Retrieved February 18, 2025, from https://ontario.cmha.ca/provincial-policy/social-determinants/

Hamilton Public Health Services. Hamilton’s Community Health Status Report. Hamilton: City of Hamilton; 2024.