Features, What The Health

Let’s Talk Determinants

Image of Elizabeth Serieux PhD, MPH
By Elizabeth Serieux PhD, MPH

WHAT do you think determines our health? Take a minute and think about this and see how many things you can come up with. If you’re near pen and paper, phone, tablet or computer, go ahead and write them down — yes, seriously! Now, see if there are any connections between the items you have written down (you see, it does help if you have an actual list to look at!).

As I’m sure you’ve realized, our health is affected by quite a few factors. These factors include our individual characteristics and genetic makeup, our behaviours, physical environment, social environment and economic environment. Together, these different environments make up the contexts under which our lives unfold; they are the conditions in which we are born, grow, play, work and age: they are the social determinants of health.

The word “social” is defined by the Oxford Dictionary as “relating to society and living together in an organized way”. This definition implies that we have a certain level of control over the way in which we “live together” and, therefore, by extension, over the things that determine our health.

Essentially, as a collection of individuals living together, we have considerable influence over the health status and the quality of life of our population. Therefore, while personal responsibility exists, no individual on his/her own is entirely responsible for good health or poor health. The social determinants, our “agreed upon” conditions of life have a much bigger impact on our health than we previously realized and this is a much more advantageous situation than if our genes were solely responsible for our health status.

While we (for the most part) are unable to change our genetic makeup, we can change the conditions in which we live as a collective. We owe it to ourselves to recognize this and we owe it to ourselves to do it as strategically and efficiently as possible.

So where does our strategy begin? Well, with the areas that have the biggest impact, that deliver the biggest “bang for the buck”. Last week, we identified those areas as socio-economic status, food, stress, early life conditions, unemployment, conditions of work, social support, social exclusion, addiction and transport. Let’s look at each of these areas a little more closely.

So, what exactly do we mean by socio-economic status? Essentially, socio-economic status (or SES) refers to the combined social and economic status of a person or a family as measured by education, income and occupation. It makes sense that individuals with higher levels of all of the preceding will have better health literacy and so will be better able to navigate the “healthscape.”

They will also be better able to afford the resources that promote health and wellness. So, it clearly is in the best interest of our society to promote education and to ensure that there is a livable minimum wage. Our education system and economic policies are typically not included when we think of our health system, but they are in fact an integral part of it and so any strategy to improve health and quality of life must include them.

Let’s look at food – how is that a social determinant of health? Let’s start at the very beginning: food is necessary for life. We have to eat to live. However, good health requires more than just food; it requires that we eat nutritious food and this in turn requires that we have access to nutritious food. Access means that the nutritious food must be physically available and also that it must be within our means to purchase this food. So, our ability to find and buy nutritious food has an enormous impact on our health and quality of life.

We know that an unhealthy diet and poor nutrition are leading risk factors for diabetes, hypertension, heart disease and a whole host of other chronic illnesses. Further, we know that as a society we have extremely high rates of these diseases. So how does our “foodscape” affect this? Is it relatively easy — or relatively difficult — for us to obtain nutritious food at a reasonable cost?

Saint Lucia, like many other countries in the world, is going through a nutrition transition, a shift in population food consumption patterns largely based on two factors: (1) changes in the type of foods being consumed and (2) changes in the way in which food is obtained and prepared.

In summary, as a population we have moved away from the consumption of fresh, whole foods and towards consumption of more processed, packaged foods. The global industrialization of the food supply has caused a significant shift in what we think of as “food” and it is generally easier and cheaper to obtain these “food products” than it is to obtain real, whole food that is closer to nature, healthier and more nutritious.

While these “foods” seem to have the advantage, in that they are convenient and inexpensive, this is nothing but an illusion and our progress as a nation depends on our ability to shatter this illusion that we’ve been sold and to define our own, better reality, together.

Next time, more on food and the other social determinants of health. Thank you for reading. Send us your thoughts at [email protected].

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