2001 December Report of the Auditor General of Canada
Exhibit 9.2—What are the determinants of health?
Biology and genetic history. The genetic endowment of the individual, the functioning of various body systems, and the processes of development and age are fundamental determinants of health. Biological differences in sex and socially constructed gender influence health on an individual and population basis.
Culture. Some groups face additional health risks due to a socio-economic environment that is largely determined by dominant cultural values. This limits access to culturally appropriate health care and services.
Education. Health status improves with level of education, including self-ratings of positive health or indicators of poor health such as activity limitations or lost work days. Education increases opportunities for income and job security and equips people with a sense of control over life circumstances—key factors that influence health.
Employment and working conditions. Those with more control over their work circumstances and fewer stress-related demands on the job are healthier. Workplace hazards and injuries are significant causes of health problems. And unemployment is associated with poorer health.
Gender. Many health issues are a function of gender-based social status or roles. Women, for example are more vulnerable to gender-based sexual or physical violence, low income, and lone parenthood. Measures to address gender inequity and gender bias within and beyond the health system will improve population health.
Health services. Health services, particularly those designed to maintain and promote health and prevent disease, contribute to population health.
Healthy child development. The effect of prenatal and early childhood experiences on subsequent health, well-being, coping skills, and competence is very powerful.
Income and social status. This is the single most important determinant of health. Many studies show that health status improves at each step up the income and social hierarchy. As well, societies that are reasonably prosperous and have an equitable distribution of wealth have the healthiest populations, regardless of the amount they spend on health care.
Personal health practices and coping skills. Social environments that enable and support healthy choices and lifestyles, as well as people's knowledge, intentions, behaviours, and coping skills for dealing with life in healthy ways, are key influences on health.
Physical environments. Physical factors in the natural environment such as air, water and soil quality are key influences on health. Factors in the human built environment such as housing, workplace safety, community, and road design are also important influences.
Social environments. Social stability, recognition of diversity, safety, good working relationships, and cohesive communities provide a supportive society that reduces or avoids many potential risks to good health. Studies have shown that low availability of emotional support and low social participation have a negative impact on health and well-being.
Social support networks. Support from families, friends, and communities is associated with better health. Some experts conclude that the health effect of social relationships may be as important as established risk factors such as smoking, physical activity, obesity, and high blood pressure.
Source: Health Canada