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SOCIAL
DETERMINANTS
of HEALTH
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HTH SCI 1RR3

2023
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 Land Acknowledgement
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McMaster University recognizes and

acknowledges that it is located on the
traditional territories of the Mississauga and
Haudenosaunee nations, and within the lands
protected by the “Dish with One Spoon”
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wampum agreement.

That wampum uses the symbolism of a dish to

represent the territory, and one spoon to
represent that the people are to share the
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resources of the land and only take what they

need.
https://healthsci.mcmaster.ca/docs/librariesprovider59/resources/mcmaster-university-land-acknowledgment-guide.pdf?sfvrsn=7318d517_2
 Agenda
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1. Check ins
2. Course overview
3. Unit 1 Aims
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4. What are the Social Determinants of Health (SDoH)?

5. Why care about the SDoH?
6. Which SDoH will we learn about in 1RR3?
7. Some housekeeping for this class
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8. Plan for next week.

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1. Check in
 2. COURSE OVERVIEW
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Purpose:
1. Introduce the Social Determinants of Health
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2. Critically examine health inequities

3. Prepare learners to collaborate with clients,

communities, and interprofessional teams in a
meaningful way – requires self-reflection and critical
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engagement
 COURSE LEARNING OUTCOMES
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Upon completion of this course, learners will be able to

demonstrate:

A broad understanding of the major factors that

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determine the health of populations in Canada

• An awareness of the structure of the Canadian health
care system at the federal, provincial, territorial, and
municipal levels, including their funding sources, mandates
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and regulation.
 LEARNING OUTCOMES (cont’d)
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• An appreciation for the intersectional nature of health

inequities (e.g., race, class, and gender).
• A beginning understanding of colonialism and the rights
and entitlements of Indigenous people.
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• Foundational understanding for providing culturally safe

(respectful engagement; understand power imbalances)
and humble (self-reflection; understand personal and
systemic biases) care – especially to differently
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marginalized/underserved groups
 Required Textbook
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Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social
Determinants of Health: The Canadian facts (2nd ed.). Ontario Tech
University Faculty of Health Sciences and York University School of
Health Policy and Management.
The publication is freely available at http://www.thecanadianfacts.org/
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● In addition to the weekly readings, be sure to review the required

media files in the syllabus
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 EVALUATION MEASURES
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Online test #1 Online test #2 Final Exam

October 2, at 7pm November 1, at 7pm During exam period
Units 1, 2,3 Units 4, 5, 6 Units 7,8,9,10,11
With some questions
40 questions from units 1,2 & 3 With some questions from
units 4,5,6
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Multiple Choice 50 questions

30% of course grade Multiple Choice 90 questions
30% of course grade 80 Multiple Choice & 10
scenario based
40% of course grade
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* Online proctoring system (Respondus) will be used for online tests.

Instructions will be posted on avenue to Learn
 3. Unit 1 Aims
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At the end of this unit: Learners will have developed

• their understanding of the course material, learning

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format and evaluations of student learning.

• a beginning understanding of societal forces and factors

that contribute to health inequities.
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3. WHAT ARE THE SDoH?

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 An Introductory video
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A REQUIRED MEDIA FILE:

https://www.youtube.com/watch?v=8PH4JYfF4Ns
 4. What are the SDoH?
Stress Bodies and Illness Geography, Health Services
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Indigenous ancestry Housing, Immigration

Disability Income & Income distribution
Early Child Development Race
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Education Social safety net

Employment & working Social exclusion
conditions Unemployment & Job Security
Food Insecurity Globalization
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Gender
Source: Raphael, 2et al 2020
 WHAT GOES INTO YOUR HEALTH?
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Text
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most beyond individual control

 IMPROVING LIFE CHANCES
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gyghbhb
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https://publichealthonline.gwu.edu/blog/equity-vs-equality
 THE WHO CONCEPTUAL FRAMEWORK
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Text
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Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health: Social determinants o
f health discussion paper 2. Geneva, Switzerland: World Health Organization Press.
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5. WHY CARE ABOUT THE SDoH?

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 We care about SDoH because -
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“What good does it do to treat

people’s illnesses, to then send them back to
the conditions that made them sick”
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Monique Bégin (2020)

Source: Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The
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Canadian facts (2nd ed.) pg 8

 How do conditions make people sick?
The Psychobiological stress response
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Source: Raphael, D. ( 2016). Social Determinants of Health :Canadian

perspectives (3rd Edition) Toronto, ON: Scholars’ Press Inc. pg. 39
 T

SO WHY STUDY THE SDoH?

Answer: to further understand..
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§ SOCIETAL FACTORS § SOCIETAL FORCES

§..that shape health and §..that shape the quality
help explain health and distribution of these
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inequities factors
§(e.g. income and §(e.g. social and political
employment) forces)
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 The SDoH: TIPS FOR BETTER HEALTH
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(society-oriented vs. individual-oriented)

1. Don’t be poor. If you can, stop. If you can, try not to be poor for too long.
2. Don’t have poor parents.
3. Own a car. beyond individual
4. Don’t work in a stressful, low-paid manual job. control
5. Don’t live in damp, low-quality housing.
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6. Be able to afford to go on a foreign holiday and sunbathe.

7. Practice not losing your job and don’t become unemployed.
8. Take up all benefits you are entitle to, if you are unemployed, retired,
sick or disabled.
9. Don’t live next to a busy major road or near a polluting factory.
10. Learn how to fill in the complex benefit/asylum application forms before
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you become homeless or destitute.

Source: Raphael, D. (2016). Social Determinants of Health : Canadian Perspectives (3rd

Edition) Toronto, ON: Canadian . Scholars’ Press Inc. .pg 19
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6. Which SDoH will we be covering?

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 INCOME AND HEALTH
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o Income inequality is a great difference in income

distributions within the population which results in a
small percentage of the population having a high
concentration of income
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o Many Canadian studies have

linked higher incomes with
more favorable health
outcomes for people
with higher incomes
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(Raphael, 2020)
 An example of inequalities
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< 1km apart!

(10-minute walk)
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Hamilton Spectator. (2019). Code Red: Ten Years Later.

Retrieved from https://projects.thespec.io/codered10/
 WORK AND HEALTH
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o Longer hours, high-stress work, o Those with more control over

and job insecurity associated their work environment live
with poorer health outcomes longer/healthier lives
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(Source Raphael, 2016)

 An example of course materials
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Precariat: precarious (insecure) + proletariat (working-class) Security =

control (Required media file for Unit 4 )
 EDUCATION AND HEALTH
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o Early childhood education and care is linked to better adult

health
o Education provides a sense of control over life
circumstances
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Raphael, 2020, Chapters 4 and 7)

 Another model for understanding
SDoH: BARTLEY TYPOLOGY
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MATERIAL PSYCHOSOCIAL POLITICAL ECONOMY

access to food, stress, sense of
control, family distribution of power
housing, education and
environment, social affect on distribution of
recreation
support economic resources
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CULTURAL/ LIFECOURSE
BEHAVIOURAL events/processes before
beliefs, norms, birth and during childhood
values (health and social
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circumstances)

Income is an excellent marker for a

cluster of other life circumstances;
https://www.cdc.gov/violenceprevention/acestudy/index.html mediated by education
 FOOD HOUSING & HEALTH
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6.9 Million people (18.4%) are food insecure in Canada (2021 census)

Food bank clients doubled in Toronto in 1 year (2022-2023)

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Hamilton numbers increased by 40% (2022-2023)

In 2021, 1 in 10 households were in core housing need (10%)

Why are food insecurity and housing insecurity linked?

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Sources: Proof 2022 & Raphael 2020

Statistics Canada - https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2022056-eng.htm
 GENDER AND
HEALTH
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o Gender inequality vs inequity

(unfair)
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o Gender overlaps with all the

SDoH

What stories have you seen in media recently

that might be examples of gender
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bias/discrimination ?
 Examples of unit resources
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Unit 7. Gender and health - preparatory Media File: Kimberle Crenshaw. (2016). The Urgency of
Intersectionality. Ted Talk. (16 minutes) *see syllabus
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 Racialized Communities and
Health
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o Racialized groups are more

likely to live in poverty (economic
exclusion)
Limited research data linking
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o
health and race
o Some studies emerged as a
result of the inequities that were
highlighted during the first two
years of the pandemic.
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Raphael, 2020
 Ethno-Racial Differences with
Covid -19 in Toronto 2020
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https://www.toronto.ca/home/covid-19/covid-19-latest-city-of-toronto-news/covid-19-status-of-cases-in-toronto/
 Ethno-Racial Differences with
Covid -19 in Toronto 2021
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 Indigenous Communities
&Health
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Indigenous peoples
subjected to SDoH
inequities experience
poorer health outcomes
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o Also results in difficulty

accessing appropriate
health-related services
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Note price of
water vs. pop
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https://thenarwhal.ca/this-ontario-first-nations-boil-water-
advisory-has-been-in-effect-for-25-years/
 PHYSICAL ENVIRONMENT &
HEALTH
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Climate change impacts

our physical environment
Some environmental
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factors may seem

unrelated to health but
play significant roles in
our health (e.g.,
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agricultural practices)
 A few impacts of climate
change
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Nov 2019: “Between 200 million and 300 million people could be
forced to migrate due to the effects of climate change by the end of the
century, as long as we’re not able to keep the temperature rise below 2
degrees Celsius as set out by the Paris Agreement.”
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Every year since 2008, 21.5 million people are displaced by extreme
weather events
https://global.ilmanifesto.it/climate-refugees-could-reach-300-million-a-population-without-rights/
 REMINDER: WHY ARE WE
STUDYING THE SDoH?
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To better understand:
1) SOCIETAL FACTORS
o (e.g., income and
employment) that
shape health and help
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explain health
inequities
2) SOCIETAL FORCES
o (e.g., social and
political) that shape the
quality and
distribution of these
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factors
 How can we act on our knowledge
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of SDoH?
● Action arenas- Consider:
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○ As a student
○ As a nurse
○ As a citizen
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 POLICY AND SDoH
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Bottom line: Policies impact health equity and well-being

Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health: Social determinants of health discussion paper 2. p7&8
p Geneva, Switzerland: World Health Organization Press. Retrieved from https://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf
 Why do nurses need to know about
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SDoH?

As you learn about interviewing patients, families

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●
and communities think about what you need to
consider to ensure people will enjoy the best
health they can in their homes and communities.
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References used in this

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presentation are cited on the

slides
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 Unit 1 Critical Thinking
Questions
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1. Reflect on the degree of familiarity you had with

the idea of living and working conditions as
primary determinants of health prior to today.
When you thought of health and its determinants
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what did you think of?

2. Can you think of examples from the news in
which the social determinants has affected
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somebody’s health (or the health of a

population)?
 Housekeeping for this class
§ Student accommodations - ensure that the
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course planner is aware

– Contact your tutor & the course planner Dr Olive
Wahoush - wahousho@mcmaster.ca
§ How to reach your tutor and office hours
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§ Check for updates regarding covid and

attending your setting
§ If sick - follow the policy and guidelines of your
site.
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§ Does everyone have the course text ?

 PLAN FOR UNIT 2
Review key terms
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Complete required readings (6) and media file (1)

Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of
Health: The Canadian facts (2nd ed.). Ontario Tech University Faculty of Health
Sciences and York University School of Health Policy and Management. (Chapter 12:
Health Systems)
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Canadian Institute of Health Information (2023). Primary Health Care defined - web
page. https://www.cihi.ca/en/topics/primary-
care#:~:text=This%20type%20of%20care%20typically,end%2Dof%2Dlife%20care

Health Canada (2023). Canada health act annual report 2021-2022.

https://www.canada.ca/content/dam/hc-
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sc/documents/services/publications/health-system-services/canada-health-act-
annual-report-2020-2021/canada-health-act-annual-report-2021-2022-eng.pdf see
CHAPTER ONE - Pages 5 through 19
 PLAN FOR UNIT 2, cont’d.
Ontario (2023). Apply for OHIP and get a health card. Published first April, 2017
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https://www.ontario.ca/page/apply-ohip-and-get-health-card#section-2

World Health Organisation (2023). [Factsheet] Universal health coverage (UHC).

https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

Government of Canada. (2023). Provincial and Territorial Drug Benefit Programs. Lists
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those with Pharmacare and those with drug benefit plans.

https://www.canada.ca/en/health-canada/services/health-care-
system/pharmaceuticals/access-insurance-coverage-prescription-medicines/provincial-
territorial-public-drug-benefit-programs.html

REQUIRED MEDIA FILES:

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Romanow, R. (2011). Acting today saving tomorrow: Need to shift emphasis in health
and health care. [Video]. YouTube. http://www.youtube.com/watch?v=EnY_YIgLhTI (8
minutes)
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THANK YOU FOR

PARTICIPATING!
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