The World Health Organization (2023) defines the social determinants of health as "non medical factors that influence health outcomes" and are the primary cause for health inequities. The Government of Canada (2001) defines twelve factors to consider:
Income and social status
Employment and working conditions
Education and literacy
Childhood experiences
Physical environments
Social supports and coping skills
Healthy behaviours
Access to health services
Biology and genetic endowment
Gender
Culture
Race/ Racism
There is a specific emphasis on experiences of discrimination, racism, and historical trauma. This is in consideration of large minority groups in Canada such as Indigenous peoples, the LGBTQ community, and Black Canadians. Interestingly, there is no informational page for the public on the Government of British Columbia website regarding social determinants of health on a provincial level. There is a page under Health Information Standards that aims to "provide consistency and guidance for social determinants of health information data collection within British Columbia's health care community" (Ministry of health, 2021). It is meant to support health care providers with a way to capture required data in electronic health records.
Another population that face stigmatism and discrimination in Canada are obese individuals. Puhl and Heuer (2009) found that weight discrimination occurs in comparable rates to racial discrimination in the United States. Most people, including health care providers, carry fat-phobic beliefs. These could include beliefs around how obese people are obese due to personal neglect of their health, are less disciplined and are incapable of adhering to health recommendations. However, research shows that the social determinants influence ones' health more than lifestyle choices (World Health Organization, 2023). There is a much deeper and complex system impacting one's weight than simple caloric balance and self motivation. These could include things such as medications, genetics, childhood upbringing, and substance use. There are other factors that impact weight that include social determinants of health such as socioeconomic status, ethnicity, and social support such as marital status (Institute of Medicine, 2004). The discrimination that obese people face also could contribute to avoidance of clinical care and therefore limited access to health care if weight continues to be a source of embarrassment and shame.
As health care providers, we all have a role to play in making health care more accessible and reducing barriers to adequate health care. The social determinants of health are deep rooted issues, however health care professionals can start with learning and acknowledging their own biases, such as fat-phobia, to contribute towards a healthier, happier population.
References: Government of Canada. (2001, November 25). Social determinants of health and health inequalities [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html Institute of Medicine. (2004). Factors That Influence Body Weight. In Weight Management: State of the Science and Opportunities for Military Programs. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK221834/
Ministry of Health (2021, January 26). B.C. Social Determinants of Health Standards. Province of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/health-information-standards/standards-catalogue/bc-social-determinants-of-health-standards
Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: a review and update. Obesity (Silver Spring, Md.), 17(5), 941–964. https://doi.org/10.1038/oby.2008.636 World Health Organization. (2023). Social determinants of health: Overview. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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