Social Determinants of Health

Aboriginal status:

The health of Aboriginal Canadians – First Nations, Dene, Metis, and Inuit – cannot be separated from their history of colonization. Practices such as the removal and sanctioning of their land and cultural genocide through residential schools have led Aboriginal Canadians to live in unfavorable social conditions that result in poorer health.  For example, Aboriginal Canadians present higher rates of certain diseases and mental health problems, as well as increased infant mortality. Research has shown that two-spirit people report higher rates of abuse, psychological trauma, and mental health problems than their heterosexual indigenous counterparts. They are prone to experience dual marginalization due to their ethnoracial identity and their sexual or gender diverse identities.

Disability:

People with mental and/or physical disabilities require support and opportunities to participate fully in Canadian life. Oftentimes, however, they experience employment issues due to a lack of working conditions that meet their needs; this, in turn, greatly impacts on their income. Canada ranks low in regard to benefits for people with disabilities compared to other developed and wealthy nations. Meanwhile, a considerable amount of Canadians with a disability rely on those benefits.

Early life development:

Early life experiences have a long-lasting effect on individuals. Children who go through adverse situations and whose basic needs are neglected are more likely to develop health complications in the future, including certain diseases, lower learning and educational achievement, and mental illnesses. In 2008, at least 15% of Canadian children lived in poverty, a major reason why children are deprived of their basic needs. Many LGBT youth experience abuse and family rejection and discrimination, which can greatly impact health and mental health trajectories. 

Education:

Well-educated people tend to be healthier than those with a lower level of education because they often have better working conditions and a higher income. Also, people with a higher education better thrive in their working environments, participate in politics more often, and have access to more information about health. Although Canada fairs well in regards to education compared to other countries, high tuition fees and lack of quality early education programs create gaps in education among economically advantaged and disadvantaged individuals. (Mikkonen & Raphael, 2010) School climate also plays an important role in health and educational outcomes. Victimization in the form of bullying toward LGBTQ youth, which is common in middle school and high school, has been associated with their lower academic outcomes and self-esteem, unexcused absences from school and overall negative mental health indicators. 

Food Insecurity:

Individuals who experience food insecurity struggle to have an adequate diet in terms of quantity or quality. In other words, they have difficulty accessing nutritious food on a regular basis. This creates health problems such as malnutrition and chronic illnesses related to obesity, including diabetes and cardiovascular disease. In 2009, it was estimated that around 1.1 million Canadian households suffered from food insecurity – many of which contained children. (Mikkonen & Raphael, 2010) A recent report from the US concluded that LGBT-identified individuals at are greater risk for food insecurity and reliance on nutrition assistance programs (e.g., “food stamps”) than the overall population.

Health services:

Since the 1984 Canadian Health Act, all provinces in Canada provide health services to their populations in a universal manner when considered medically necessary. However, since this Act does not provide a detailed list of insured services, coverage varies across provinces. Factors such as waiting times, lack of coverage for medication, and the need for private insurance to cover uninsured procedures and additional costs, leave lower-income Canadians facing barriers to healthcare. (Mikkonen & Raphael, 2010). Also, for LGBTQ2 folks, particularly transgender people, lack of specialized healthcare provider knowledge and discrimination from health professionals can create a barrier for them to seek affirmative and effective medical services.

Gender and Sexual Orientation:

Gender shapes our health, too, often through discrimination and social expectations regarding men's and women's roles in society. Women are less likely to work full-time jobs and to be eligible for unemployment benefits. They frequently carry more responsibility for raising children and lacking affordable childcare. Also, women tend to be paid less than men regardless of occupation. On the other hand, men experience more extreme forms of social exclusion, leading to homelessness and severe substance use; also,  their suicide rate is higher than women's, and they are more likely to be incarcerated. LGBTQ2-identified individuals also experience discrimination based on their gender identity, gender expression, and sexual orientation: Trans identities, gender nonconformity, and non-heterosexual attractions and relationships are heavily stigmatized in many societies, impacting on other social determinants of health and leading to health problems.  (Mikkonen & Raphael, 2010)

Housing:

Housing is an absolute necessity to lead a healthy lifestyle. Factors such as reduced access to clean water, overcrowding in small spaces, and lack of sanitation services can cause diseases to spread. Also poor quality housing creates stress, and high housing costs reduce resources available to cover other basic needs. Canada is experiencing a housing crisis, with increasingly expensive rents and a high risk of homelessness for those in the lower income brackets, especially in cities such as Vancouver, Toronto, and Montreal (Mikkonen & Raphael, 2010) LGBTQ2 youth have higher rates of housing insecurity due to family rejection after coming out; in 2015, a national survey found that approximately one in four homeless youth (28%) accessing Canadian homelessness services identified as LGBTQ2. Some other studies have reported that up to 40% of homeless youth in Canada identify as LGBTQ2. Also, homeless LGBTQ2 youth face discrimination within homeless shelters. Toronto has recently opened Canada’s first shelter for LGBTQ+ identified youth- learn more here: https://www.egalecentre.ca/

Income and income distribution:

Money is needed to purchase basic goods and services such as food, clothing and housing. If governments do not fund basic services and benefits, income becomes more important to people’s health. In Canada, between 1971 and 2001, people living in the wealthiest neighbourhoods lived on average two to four years longer than those living in the poorest neighbourhoods. Suicide was found to be almost twice as common in low income neighbourhoods than high income ones. Moreover, diabetes and heart attacks in adults are by far more common in low income Canadians. (Mikkonen & Raphael, 2010). Several studies have concluded that LGBTQ-identified people may be receiving a lower income than their heterosexual, cisgender counterparts. For example, a recent analysis of various peer-reviewed studies showed that gay men earned 11% less than straight men. An online survey conducted by a financial company in the US in 2016-2017 found that gay and lesbian people reported making, on average, less money than their heterosexul peers. Such a wage gap has been linked to experiences of stigmatization and discrimination, as well as lack of legal protections.

Race:

Recent data show that Canadians of color have higher unemployment rates and lower incomes than Canadians of European descent. The health of Non-European immigrants also shows deterioration compared to Canadian-born population and European immigrants. These are the result of the experiences of racism in Canadian society. Racism is expressed through institutions and laws that do not meet the needs of Canadians of colour, as well as through prejudice, suspicion, devaluation, and scapegoating directed toward them. Moreover, racism can become internalized, and people of colour may experience hopelessness, helplessness and resignation, all which end up affecting their health. (Mikkonen & Raphael, 2010).

Therefore, health inequities require social justice because these differences in health outcomes are human-made, resulting from how our societies are organized. They are the result of a lack of social policies/programmes, economic and political  strategies that favour capitalist and individualist models over social   (World Health Organization, 2010). 

Health inequities can be present in both mental health and physical health. Common mental health issues such as anxiety and depression can be related to social inequities Stigmatization and discrimination are a significant cause of health inequities. These impact LGBTQ2 folks’ living conditions, education and employment opportunities, social and romantic relationships, family ties, housing opportunities and risk of homelessness, access to healthcare, self-esteem, and levels of stress.