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Determinants of Health

  • Writer: agoldstein160
    agoldstein160
  • Oct 14, 2018
  • 5 min read

Determinants of Health – A Federal Focus


According to the Government of Canada, there are many factors which influence one’s health (Government of Canada, 2018). The Federal government identified ten influencers, known as the determinants of health, including (Government of Canada, 2018):

  1. Income and social status

  2. Employment and working conditions

  3. Education and literacy

  4. Childhood experiences

  5. Physical environments

  6. Social supports and coping skills

  7. Healthy behaviours

  8. Access to health services

  9. Biology and genetic endowment

  10. Gender

  11. Culture

The Federal Government has pledged to address health inequities across the country, with the intended outcome of improving upon the social determinants of health. The resources and activities outlined on the website (Government of Canada, 2018) provides direction at a federal level. Three of these described areas of focus include:


  1. Strengthening the evidence base to inform decision-making by collecting and analyzing data on unique populations within Canada.

  2. Engaging beyond the health sector through meaningful intersectoral collaboration guided by the Canadian Council on Social Determinants of Health. One priority of this work is to improve the health of aboriginal populations.

  3. Sharing knowledge of action across Canada through the Rio Political Declaration on Social Determinants of Health (2015).


Determinants of Health – a Provincial Focus


To fully understand the determinants of health in Nova Scotia, one must first understand the provincial context.


Nova Scotia


Nova Scotia, a founding province of Canada, is completely surrounded by ocean – no point within the province is further than 60km away from coastline (Nova Scotia Facts, n.d.).


The population of Nova Scotia is 921,725 and 42% of the population lives in Halifax (Nova Scotia Health Profile, 2015). The province is 98% Canadian; five percent are immigrants, five percent identify as a visible minority, and four percent identify as aboriginal (Nova Scotia Health Profile, 2015). Nova Scotia is one of the oldest provinces, proportionally, in Canada (Stats Canada, 2018).


Nova Scotia is also economically disadvantaged. Total household income is lower than the national average and a higher percentage of families live within the low-income level (Steele, 2017). Nova Scotia has higher rates of lone-parent families (Nova Scotia Health Profile, 2015), and childhood victims of violence (Stats Canada, 2017) than the Canadian average. Nine percent of the population is unemployed, but certain rural areas within the province are as high as 14.7%. These values are well above Canadian averages (Nova Scotia Health Profile, 2015).


Interestingly, self-perceived ratings of physical and mental health were comparable to Canadian standards. Nova Scotians have a lower perceived level of life stress than Canadians (18% vs. 23%) and have a higher sense of belonging to their communities (Nova Scotia Health Profile, 2015).


Even so, when compared to the national averages, Nova Scotia has higher rates of (Nova Scotia Health Profile, 2015):

  • Obesity

  • Injury Mortality

  • Cancer (both new cases per year, and mortality rates)

  • Chronic Disease (e.g. diabetes)

  • Unhealthy Behaviours (e.g. heavy drinking)


Nova Scotia also has lower rates of:

  • Exclusive Breastfeeding at 6 months

  • Fruit and Vegetable Consumption


Addressing the Determinants of Health


Nova Scotia is currently experiencing a period of provincial reform. On the surface, the purpose of many of these changes appear to address inequities across the province. The two biggest reforms are in health and education.


The first example of provincial reform occurred within the education sector. Over the past year, there has been a change in the organizational structure of the school districts and reporting processes (Education Changes, 2017). An early education program (Pre-Primary, 2017) was implemented in 2017. Within Halifax, the first schools to offer the program were those located within the low-income neighbourhoods. Also, beginning in September 2018, new inclusive education supports for students were added (Education and Early Childhood Development, 2018) for those children requiring extra supports for success.


The second example of reform occurred in the health care sector. Starting in 2015 ten health authorities were amalgamated into a single health authority for adults and one for children. At the same time, a provincial Health Report (Nova Scotia Health Profile, 2015) was released, outlining many of the provincial determinants of health, comparing Nova Scotia to Canadian outcomes. As outlined above (see “Nova Scotia”), the province did not stack up.


The Plan


The response to the health report was a provincial plan, created by the Department of Health and Wellness, to address the determinants of health (NS priorities, n.d.) Their plan outlines four areas of focus, including:


  1. Healthy Eating: Nova Scotia rates of diet-related chronic conditions, including cancer, diabetes, cardiovascular disease and obesity are among highest in the country. In response to this, the province has developed a provincial health eating strategy with four identified actions. These actions include: breastfeeding, children and youth, fruit and veggie consumption, and food security. (Healthy Communities, Healthy Eating, n.d.)

  2. Injury Prevention and Control: Injury is the leading cause of preventable death for Nova Scotians under the age of 45. Nova Scotia was the first province in Canada to adopt a comprehensive injury prevention strategy in 2004. This strategy was refocused in 2010 to focus on: senior falls, suicide and attempted suicide, and road safety (Healthy Communities, Injury Prevention, n.d.).

  3. Reducing Health Disparities and Inequities: This work falls into the domain of the Nova Scotia Department of Public Health. A protocol was developed in 2014, which outlines the focus of work on understanding the situation in Nova Scotia, analyzing the social and policy context, partnering with appropriate resources and building capacity within the province (Public Health, n.d.)

  4. Sexual Health: This work is related to healthy development and communicable disease prevention and control. Sexual health is a determinant that spans a lifetime, therefore several areas within Public Health are involved in moving this work forward (Healthy Communities, Sexual Health, n.d.)

Conclusion


The Nova Scotia efforts to address their determinants of health are in line with the Canadian pledge of addressing health inequities. Nova Scotia is addressing these inequities in a locally meaningful context. As it can take many years for the effects of policy change and political reform to be felt, only time will tell us the impact of the efforts being made in Nova Scotia.


References


Education and Early Childhood Development (2018). New Inclusive Education Supports for Students. News release on May 8, 2018. Accessed October 13, 2018 from: https://novascotia.ca/news/release/?id=20180508006


Education Changes (2017). Accessed on October 13, 2018 from: https://novascotia.ca/educationsystem/



Healthy Communities, Healthy Eating (n.d.). Accessed on October 10, 2018 from: https://novascotia.ca/dhw/healthy-communities/healthy-eating.asp


Healthy Communities, Injury Prevention (n.d.). Accessed on October 10, 2018 from: https://novascotia.ca/dhw/healthy-communities/documents/Nova-Scotias-Renewed-Injury-Prevention-Strategy.pdf


Healthy Communities, Sexual Health (n.d.) Accessed on October 10, 2018 from: https://novascotia.ca/dhw/healthy-communities/sexual-health.asp


Nova Scotia Facts, n.d. Accessed on October 8, 2018 from: https://studynovascotia.ca/nova-scotia-facts/


Nova Scotia Health Profile (2015). How Healthy Are We? Accessed on October 8, 2018 from: https://novascotia.ca/dhw/publichealth/documents/Population-Health-Profile-Nova-Scotia.pdf


Nova Scotia Priorities (n.d.). Accessed on October 10, 2018 from: https://novascotia.ca/dhw/healthy-communities/


Nova Scotia Health Equity Protocol (2014). https://novascotia.ca/dhw/publichealth/documents/05-Health-Equity-Protocol.pdf Accessed October 8, 2018


Pre-Primary (2018). Accessed on October 13, 2018 from: https://www.ednet.ns.ca/pre-primary


Public Health (n.d.) Accessed on October 13, 2018 from: https://novascotia.ca/dhw/publichealth/documents/05-Health-Equity-Protocol.pdf)





Steele, W. (2017). 2016 Census: Income. Nova Scotia Finance and Treasury Board. Accessed on October 10, 2018 from: https://www.novascotia.ca/finance/statistics/archive_news.asp?id=13155&dg=&df=&dto=0&dti=3

 
 
 

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