Assess the Relationship between Diversity and Health

As with sex and gender, diversity can have a profound influence on health and well-being. Sometimes the impact is direct and obvious. For example, people living with disabilities face health challenges that people without disabilities do not. But diversity also affects health in ways that may be less obvious or direct. For instance, screening equipment for breast and cervical cancer is often not built to accommodate people with disabilities, thereby increasing their risk of living with an undiagnosed cancer.

As we saw earlier, it can be helpful to deal with the range of differences among and between people by organizing them into categories. This is also true when assessing the impact of diversity on health and well-being. One classification framework that has become important in Canada as well as elsewhere in the world is referred to as the “social determinants of health”. According to the World Health Organization, the social determinants of health consist of all the “circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.” [1]

The story of “Jason”, a young boy in hospital, helps us understand how the social determinants can affect health and well-being:

“Why is Jason in the hospital?
Because he has a bad infection in his leg.

But why does he have an infection?
Because he has a cut on his leg and it got infected.

But why does he have a cut on his leg?
Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on.

But why was he playing in a junk yard?
Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them.

But why does he live in that neighbourhood?
Because his parents can’t afford a safer place to live.

But why can’t his parents afford a safer place to live?
Because his Dad is unemployed and his Mom is sick.

But why is his Dad unemployed?
Because he doesn’t have much education and he can’t find a job.

But why …?”
[2]

These are only a sample of the questions and answers that might apply to Jason and his family. We could ask why Jason’s cut couldn’t be treated earlier, before it got infected, so that he didn’t have to go into hospital. Perhaps the answer is that his family lives in a remote community that doesn’t have a health care practitioner or lives in a city where they can’t get a family doctor. We might also ask if there are other factors, such as racism, that influence where Jason lives or the fact that his father is unemployed.

While many researchers and policy makers agree that the social determinants are critically important in health, they haven’t necessarily agreed on a specific list. For example, the following two lists have much in common, such as income and health services, but there are also notable differences – one list includes Aboriginal status and food security while the other does not

  1. Income and Social Status
  2. Social Support Networks
  3. Education and Literacy
  4. Employment/Working Conditions
  5. Social Environments
  6. Physical Environments
  7. Personal Health Practices and Coping Skills
  8. Healthy Child Development
  9. Biology and Genetic Endowment
  10. Health Services
  11. Gender
  12. Culture
    [3]
  1. Income and Income Distribution Education
  2. Unemployment and Job Security
  3. Employment and Working Conditions
  4. Early Childhood Development
  5. Food Insecurity
  6. Housing
  7. Social Exclusion
  8. Social Safety Network
  9. Health Services
  10. Aboriginal Status
  11. Gender
  12. Race
  13. Disability
    [4]

Whether we decide to use a list or not, thinking about the social determinants of health helps us to focus on the relationship between diversity and health. Different people face different risks of illness and have different types and amounts of resources to deal with illness when it strikes.

Sources:  [1] World Health Organization. (n.d). Social determinants of health: Key concepts. http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html. See also WHO, (2008). Closing the gap in a generation: Health equity through action on the social determinants of health, Executive Summary, http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf; [2] Federal, Provincial and Territorial Advisory Committee on Population Health. (1999).Toward a Healthy Future: Second Report on the Health of Canadians. http://www.phac-aspc.gc.ca/ph-sp/report-rapport/toward/pdf/toward_a_healthy_english.PDF; [3] Public Health Agency of Canada. (n.d.): http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php#determinants; [4] Mikkonen, J. & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts: http://www.thecanadianfacts.org

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