Money matters: social determinants of health

According to the Canadian Public Health Association (n.d), the social determinants of health (SDH) are the social and economic factors that influence people’s health. The following is a list of fourteen social determinants of health: 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, and disability.

How are social determinants measured?

The interaction between these differing dimensions creates a unique state of health for every individual. Some dimensions, such as social exclusion may be difficult to quantify or measure, compared to education and income distribution. Income is widely considered to be the most important social determinant of health (SDH), as it interacts with, and influences a number of other SDH pathways (Mikkonen, & Raphael, 2010).

Understanding that income may be the most important determinant I looked for a resource

which displays and compares this social determinant of health. I found a wonderful interactive map

on the Public Health Ontario website. The map allows the user to select the SDH of interest and

creates a heat map display based on individual health units.

I chose to compare three cities in Southwestern Ontario: my hometown, Woodstock; a perceived wealthy town, Stratford; and my current city of residence, London. I selected the Low Income Quintile measurement.

Here are the resulting heat maps:

Woodstock Ontario, Population ~40 900

Stratford Ontario, Population ~31 465

London Ontario, Population ~511 000

In comparing the three cities it is apparent London, with its significantly larger population also has a greater proportion of lower income households. I was surprised to see the prevalence of “most low income” areas. They appear to be centralized, but are not restricted to areas which are generally thought to be low income (Old East Village, Soho, Dundas/downtown).

How can income inequality be improved?

One strategy that is gaining popularity are “Living wage” campaigns. This campaign began in British Columbia and is being adopted in other provinces. Here is a fact sheet entitled “Living Wages are good for your health” which discusses the negative health impacts of low income, and argues living wages are good for improved health.

References

Canadian Public Health Association. (n.d.). What are the social determinants of health? Retrieved from https://www.cpha.ca/what-are-social-determinants-health

Mikkonen J, Raphael D. (2010). Social Determinants of Health the Canadian Facts. School of Health Policy and Management. Retrieved from https://thecanadianfacts.org/

Public Health Ontario. (2021). Social determinants of health map. Retrieved from https://www.publichealthontario.ca/en/data-and-analysis/health-equity/social-determinants-of-health

Living Wage for Families Campaign. (n.d.). Living wages are good for your health. Retrieved from http://www.livingwagecanada.ca/files/2913/8443/7004/Health-Fact-Sheet1.pdf