Chapter 4: The Chief Public Health Officer's report on the state of public health in Canada 2008 – What makes and keeps us healthy

Social and Economic Factors that Influence Our Health and Contribute to Health Inequalities

What makes – and keeps – us healthy

If good health is not shared equally by Canadians, then understanding the many factors – or determinants – that contribute to health and differences in health status is essential to identifying and implementing solutions to this challenge.

Age, sex and heredity are key factors that determine health. The choices we make also matter, but these choices are influenced by environments, experiences, cultures and other factors (the determinants of health). And for some, even when the best choices known are made, their health outcomes are limited by these other factors.

Economic and social drivers such as income, education and social connectedness have a direct bearing on health.^{145, 167} These socio-economic determinants strongly interact to influence health and, in general, an improvement in any of these can produce an improvement in both health behaviours and outcomes among individuals and/or groups.

Those with very low incomes, for example, often lack resources and access to nutritious food, adequate housing, safe walking paths and working conditions, which can impact negatively on their health.⁷ As well, they may face financial and life stress, which – over time – can have health consequences such as high blood pressure, or immune and circulatory complications.¹⁴⁵ On the other hand, those who have adequate income and employment are likely to experience health outcomes that are less dependent on material needs but are nonetheless affected by the demands they face at home and at work and the degree to which they have control and decision-making influence in those settings. Generally, the degree to which people feel they have control over their circumstances is related to how healthy they are. Increased exposure to stress, as well as a lack of resources, skills, social support and connection to the community can contribute to less healthy coping skills and poorer health behaviours such as smoking, over-consumption of alcohol and less healthy eating habits.^{7, 122}

The structure of society also influences health through the distribution of public goods and resources. In fact, the extent to which these are equally shared across the population has been shown to influence the health of the population.2 Social support, social networking and connection to culture can protect against the health affects of living in disadvantaged circumstances. As well, having a good start in life can help set the trajectory for a healthier life. Research now shows that many challenges for adults (e.g. mental health issues, obesity, heart disease, criminality, low literacy) have roots in early childhood. Providing children with environments that are stimulating, supportive and include positive parental involvement – particularly during the first six years of life – can influence health (e.g. by mitigating poor health outcomes in later life).²¹²

The following socio-economic determinants of health will be discussed in further detail in this chapter. The order of this discussion reflects the importance of the broader economic and social context for health behaviours, access to health care and ultimately the health of the population.

The determinants include:

• income;
• employment and working conditions;
• food security;
• environment and housing;
• early childhood development;
• education and literacy;
• social support and connectedness;
• health behaviours; and
• access to health care.

Table 4.1 shows both measured statistics and self-reported indicators of key socio-economic factors that influence the health of the overall population. These statistics are collected from sources such as the census, filed income and tax records, scientific monitors (e.g. air quality instruments), and police/enforcement records for criminal and/or violent offences. The self-reported indicators in this table rely on information provided by individuals on health behaviours (e.g. daily smoking, sexual practices), access to health care (e.g. visiting a physician), food security and having a sense of community. What follows is a description of these key factors, how they affect different groups of Canadians and how they vary across the population.

Also included in this chapter are interventions that show how these factors can be impacted through specific policies and programs. They have been developed and delivered by different sectors of Canadian society − including the public health sector − that have been working together, as well as independently, applying growing knowledge and experience of what affects health and quality of life to reduce inequalities. For some interventions, evidence exists regarding their demonstrated value. Others have been identified as ‘promising’ but have not been fully studied or evaluated to prove their effectiveness. An effort has been made to highlight activities across a range of age groups, populations and environments across Canada.

* Denotes self-reported data
Note: Some data may not be comparable. More detailed information can be found in
Appendix D: Definitions and Data Sources for Indicators.
Sources: Public Health Agency of Canada using data from Health Canada, Statistics Canada, Canada Mortgage and Housing Canada and Environment Canada.