Social determinants of health: Are you familiar with them?

by CSSSPNQL | Jun 03, 2020
Whether in publications of the FNQLHSSC or those of other Indigenous organizations, when talking about the state of health of First Nations, it is common to refer to health and its social determinants...

But what exactly is a social determinant? Is it bad in terms of health? Is it something that is inevitable? It is neither of these things because social determinants can influence the health of populations both negatively and positively. Moreover, it is possible to act on these sources of social inequalities or health inequities by developing social policies, improving living conditions or strengthening individual and collective capacities to take action. 

But what do we mean by social determinants? According to the definition of the World Health Organization, “The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness.” By circumstance, we refer to the historical, political, economic and social contexts as well as to the physical and social environment in which the life courses of an individual or a social group take place. Social determinants are therefore much more than just variables according to which the health of an individual deteriorates. 

These determinants are called “social” regardless of whether they are political, historical, economic or organizational in nature, because it is not their origin as such that is social, but above all the process and its effects on individual and collective trajectories and living conditions. Colonization therefore had harmful consequences on the health and wellness of Indigenous peoples by introducing – in addition to abuse, repressive measures and injustices – mechanisms of exclusion, dislocation and loss of identity in which many social problems are rooted. This is also why self-determination and culture are seen as important social determinants of First Nations health that can contribute to improved health and wellness. 

It is indeed important to address the causes of the causes by acting on the determinants behind health inequities rather than solely focusing on behaviours or lifestyles that are harmful to health. The social determinants approach to health is opposed to the practice of “victim blaming”, which makes individuals or social groups responsible for their poor health, poverty or marginalization. 

In addition to culture and self-determination, other social determinants also impact the health and wellness of First Nations such as education, employment, income, gender and gender relations, social status, lifestyle, physical environment (housing and land use planning) and social environment (social networks and social participation) as well as the health care and service system. These determinants are often interconnected: a higher level of education is often associated with better employment, more income, improved housing conditions and so on, and therefore with better living conditions and health outcomes. It is also understood that the health and wellness of First Nations is not just the responsibility of health workers, it also depends on the commitment and collaboration of the players involved in several areas of intervention and at different levels. 

Finally, for First Nations, this perspective is combined with their own concept of health and wellness, which includes, in particular, “Indigenous ways of knowing and being, including concepts of spirituality, connectedness and reciprocity to the land and all life, self-reliance, and self-determination.”