Unit 3 - Health of Canadians

What is Health?

In 1948, the WHO defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". Today, we should explore updated definitions.

VanderWeele et al. (2019) define "well-being" as a one's ability to flourish, with flourishing literally meaning to "grow" or "prosper", and propose the Flourishing Index as a measure of well-being. The Flourishing Index divides factors contributing to flourishing into six domains: happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, close social relationships, and financial and material security. In order to determine one's position in the Flourishing Index, a number from 0 (lowest response) to 10 (highest response) is assigned for each of the following questions:

Here is a link to the VanderWeele et al. (2019) paper: https://academic.oup.com/milmed/article/183/suppl_3/204/5194600

Using health during the Covid-19 pandemic as an example, we can expect that the well-being of people on average has decreased during the pandemic when going by the Flourishing Index. Many people, while not necessarily having any physical changes in their health, have felt a decreased sense of well-being during the pandemic due to restrictions in their ability to socialize with friends and participate in activities that produce happiness. Many people have also experienced financial instability and worries about monthly living expenses, safety, food, and shelter.

Bradley et al. (2018) also make insightful suggestions towards a contemporary definition of health here: https://academic.oup.com/milmed/article/183/suppl_3/204/5194600

References:

Bradley, K. L., Goetz, T., & Viswanathan, S. (2018). Toward a contemporary definition of health. Military Medicine, 183(3), 204-207.

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.

Vanderweele, T. J., McNeely, E., & Koh, H. K. (2019). Reimagining health—Flourishing. The Journal of the American Medical Association, 321(17), 1667-1668.

Social Determinants of Health

Social determinants of health are the economic and social conditions that shape the health of individuals, communities, and jurisdictions (Raphael, 2009).

Organizers at a York University conference identified the 12 social determinants of health as:

Aboriginal status
early life
education
employment and working conditions
food security
gender
health care services
housing
income and its distribution
social safety net
social exclusion
unemployment and employment security
(Raphael, 2009)

The Registered Nurses' Association of Ontario also has an interesting brochure about social determinants of health:

https://rnao.ca/sites/rnao-ca/files/rnao_sdh_brochure_2013.pdf

In an article by Bryant et al. (2011), the authors look at measures of these determinants in Canada over time. They use the Gini coefficient, a number used to measure the degree of income inequality present. The authors show that income inequality has risen in the 2000's when compared to the 1980's and 1990's.

The authors then compare measures of the social determinants of health, such as infant mortality rate, between Canada and other countries such as France, Germany, and the USA. They find that Canada often lags behind the European countries in the these areas.

In order to strengthen the social determinants of health in Canada and address health inequities, the authors suggest a two-fold plan: decisive political and professional leadership in order to shift public policies, and confronting the global shifts in capitalism.

Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy, 101(1), 44-58.

Raphael, D. (2009). Social determinants of health: Canadian perspectives, 2nd edition. Canadian Scholars' Press.