Social Determinants of Health: Inequities Exposed During the COVID-19 Pandemic

This week I have been researching "Determinants of Health" for #MHST601. I found that the Government of Canada (2022) outlines 12 Determinants of Health (elements that have an impact on an individual's, or society's overall health) as follows:

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

12. Race / Racism

Raphael and colleagues (2020) described in detail a similar (though more specific) list of Social Determinants of Health (SDH) which was credited to a Toronto conference that was held in 2002:

1. Income and Income Distribution

2. Education

3. Unemployment and Job Security

4. Employment and Working Conditions

5. Early Child Development

6. Food Insecurity

7. Housing

8. Social Exclusion

9. Social Safety Net

10. Health Services

11. Geography

12. Disability

13. Indigenous Ancestry

14. Gender

15. Immigration

16. Race

17. Globalization

In reviewing these descriptions of SDH, I became very interested in exploring how certain ingrained societal health inequities in Ontario became more apparent during the COVID-19 pandemic. Working in the hospital setting throughout the pandemic, I noticed firsthand how certain inequities, which I had been aware of previously, became impossible to ignore. This became my learning focus for the week.

First I reviewed an article from Sundaram and colleagues (2021), who researched how SDH affected rate of testing and rate of positive testing for COVID-19 in Ontario. Interestingly, certain SDH were found to impact an individual's likelihood of getting tested; for example, higher levels of air pollution, lower household income, visible minorities, and younger age were all linked to lower rates of COVID-19 testing overall (Sundaram, 2021). Of the people who were tested, correlation was noted between the following SDH and likelihood of a positive COVID-19 test: "essential worker status, number of people living in a household, and educational attainment" (Sundaram, 2021, E732).

I then reviewed an article by Xia and colleagues (2022), who measured concentration of positive COVID-19 cases geographically according to SDH in several large Canadian cities. Through their aim to help develop policies related to "hotspot" focus for lockdowns and vaccine roll-outs during the pandemic, the authors identified that several SDH were affiliated with high concentration of positive COVID-19 testing, with the most impactful factor listed as visible minority status (Xia et al., 2022).

I found a webpage from the Ontario Hospital Association (2022) summarizing the research that I was looking for, and outlined clearly what I had found to be true: that while the COVID-19 pandemic has affected each one of us to some degree, certain populations, especially low-income, racialized communities, and those with poor housing conditions, have been much more impacted.

When I review the lists of SDH at the beginning of this blog post, I think of how deeply each of these factors influenced the health of the patients I treated with COVID-19. I remember the messaging we gave during different waves of lockdown: stay home, don't go to work when you are sick, limit the number of contacts you have. It occurs to me now that many of my patients didn't have an option to stay home, needing to work to provide for their families, often without paid sick leave. Many patients lived in overcrowded conditions where distancing was impossible, such as in communal housing (Long Term Care homes and Retirement Homes especially) or multigenerational homes. After reflecting on the research I have done this week, I don't believe that the policies and messaging aiming to curb the spread of COVID-19 addressed these very important SDH, which I consider to be a significant shortfall. I am interested in learning more about how health policies can be adjusted to consider SDH in order to address the inequities affecting the delivery of healthcare in Canada moving forward.

References:

Canada, P. H. A. of. (2022, June 14). Government of Canada. Social determinants of health and health inequalities - Canada.ca. Retrieved October 13, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health: The Canadian Facts, 2nd Edition. Retrieved October 13, 2022, from https://thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf

Sundaram, M. E., PhD., Calzavara, A., M.S., Mishra, S.,M.D.PhD., Kustra, R., PhD., Chan, A. K., M.D., Hamilton, M. A., B.S., Djebli, M., B.S., Rosella, L. C., PhD., Watson, T., M.P.H., Chen, H., PhD., Chen, B., M.Sc, Baral, S. D., M.D., & Kwong, J. C., M.D. (2021). Individual and social determinants of SARS-CoV-2 testing and positivity in Ontario, Canada: a population-wide study: CMAJ. Canadian Medical Association Journal, 193(20), E723-E734. https://doi.org/10.1503/cmaj.202608

Xia, Y., Ma, H., Moloney, G., Velásquez García, H. A., Sirski, M., Janjua, N. Z., Vickers, D., Williamson, T., Katz, A., Yu, K., Kustra, R., Buckeridge, D. L., Brisson, M., Baral, S. D., Mishra, S., & Maheu-Giroux, M. (2022). Geographical concentration of covid-19 cases by social determinants of health in 16 large metropolitan areas in Canada – a cross-sectional study. Canadian Medical Association Journal, 194(6), E195–E204. https://doi.org/10.1101/2021.07.23.21261039

Research and information on COVID-19: Social Determinants of Health. Ontario Hospital Association. (n.d.). Retrieved October 15, 2022, from https://www.oha.com/news/research-and-information-on-covid-19-social-determinants-of-health