Human Development and the Social Determinants of Health

The social determinants of health are important factors that human beings face from conception to old age, that affect their overall health. These include socio economic realities that make a person more or less likely to experience certain health challenges, depending on a person’s exposure to positive and negative life factors related to specific social determinants. I will focus on 6 social determinants of health from class readings that I feel have had a profound impact on my own life. These are; education, employment and working conditions, housing, income and income distribution, race and social safety net.

As a social determinant of health, education is very important. People with higher education levels are healthier overall, and are typically also able to access better healthcare. People who are able to add to their credentials through further professional training experience easier pathways to maintaining the positive aspects of other social determinants of health that are directly related to access to education such as level of income, working conditions, physical health and employment security. Education as a social determinant has had, and continues to have significant impacts on my ability to achieve better statuses within other realms of health for myself and my family. As a child of immigrants to the United States, I had to navigate some precarious learning conditions as an inner city student in the New York State Public School board. My parents did not have higher education and were new to a community that was experiencing severe under-resourcing and marginalization. Areas that contained predominantly black-attended public schools, experienced regular criminalization of its student bodies. Ultimately, this affected my goals for the future, from what type of postsecondary education I would seek, to ultimately my desired career path. I had no choice but to account for how difficult mitigating other social determinants in my life would be. One area of disadvantage related to impact on my health specifically comes from childhood in New York as a teenager. In NYS it is standard for youth to be tested based on curriculum that has been approved for each school year. It was made clear that the reason for updated textbooks and learning materials was to educate children based on the most up to date curriculum that had been presented with each school year. In my case, and that of other inner city students who attended the same schools as I did, most of the texts that we read and learned from were handed down from other schools within the city. Though we were almost never educated using up to date materials, we were still mandated to take the same exams as those students who were. We were tested on the same material, subsequently leading to lower test scores for many students who attended school in communities of color. As an adult I painfully concluded that the NYS school system had been succeeding rather than failing, since it was apparent that its goal was never to lead Black youth into successful foundations for academic futures, as one would think. As an immigrant to Canada who is now a single mother of multiple children on their own educational journeys, I continue to face hardships that have hindered easy access to education credentials that would catalyze future success in other aspects of my life.

Employment and Working Conditions are important because they greatly affect our mental and physical health. Since we spend much of our time at our places of work, those who face precarious situations involving their work-life are at greater risk for issues that ultimately affect other social determinants of one's health. Work dimensions have been developed by researchers in order to identify factors which contribute to shaping health outcomes. These dimensions include; employment security, physical conditions at work, work pace and stress, working hours and opportunities of self expression and individual development at work. (World Health Organization and Calouste Gulbenkian Foundation., 2014) The work dimensions identified by researchers have been integral components of employment and working conditions which is a very impactful social determinant of my own personal health. Aspects of work life such as environment and conditions have influenced my life in both negative and positive ways. Some of my negative experiences with employment dimensions such as work pace and stress, working hours and opportunities of self expression and individual development at work have stood out to me as having a direct impact on my mental and even physical health. One of my first jobs as a youth was at a local McDonalds in New York, where the manager would yell, scream and even single out staff-members, sometimes so much that customers would even ask her to stop, if they overheard. This affected the way I viewed hierarchy as well as the ideas I developed around how to deal with situations where I felt unsafe in the workplace. For a while after this, even though I knew her behavior wasn't particularly normal, I didn't think of it as irregular. I also recall working for bosses who made me feel inferior to them for reasons related to one underlying issue or another. These issues varied from age range and length of and experience, to male privilege, white privilege, misogynoir, and even credentialism. With regard to self expression and individual development at work, a specific dimension related to employment and working conditions as a social determinant of health, I can recall another negatively impactful experience, where I completed a work assignment and someone noted at the staff meeting that I was “actually quite articulate”. This immediately confused my reaction process, because it seemed as though something that was meant to be cheery or funny, also doubled as an insult to my intelligence, or the way others perceived it. I wondered why he would say that, and even after the meeting, I felt upset with myself for not addressing the matter immediately. My mental health and comfort level at work was intensely affected by that incident and it prevented me from participating in some additional opportunities for self-expression or individual development. I have also had experiences with work that I feel have impacted the same work dimensions that I noted, in some effective and positive ways. The work position that I have now, allows me to do work that I love in the community, so the work pace and stress that I have, is pretty much handled through my own time management attempts. I am able to set my own schedule within reason and to work less or more on given days, as long as I am meeting deadlines and project deliverables by actioning the plan that my project operates under. This position also allows space for me to meet with service providers as well as community members who are interested in coming together to regularly share thoughts on mobilization strategies related to gender based violence, social change and intersectional feminism, with a collective goal of coming up with a design that is reflective of the needs of our own city. This makes me feel empowered and fulfilled since I am working to make positive change in the community where I live, and I am able to learn, grow and even attend school full time to increase my credentials while working in a safe and welcoming space.

Chappel writes that, “Housing is an absolute necessity for living a healthy life and living in unsafe, unaffordable or insecure housing increases the risk of many health problems”. Housing is a significant social determinant of health because it is so closely related to the rest of our personal wellness. In Canada, lack of economic resources is in large part, the reason for housing related issues in the country. The Canadian government has reduced the public funding spent on affordable housing and has ultimately supported actions that have left low income and modest income residents, without realistic opportunities to obtain reasonable, affordable housing. Since so much of our health is connected to housing, Canada is regularly identified by international authorities as failing to fulfill its commitments as a signatory to numerous international human rights agreements that guarantee the provision of shelter.

Housing is how humans are able to keep ourselves, our families and belongings safe, fed and clean. Through my experiences both personally and professionally, I have learned that precarious housing situations can lead to a plethora of other issues related to mental health. As Canada’s housing prices continue to rise, adding stress to those who are already facing high competitive rents, many people like myself, feel they have been “priced out” of owning a home. For someone like me who is a single earner taking care of four children at home. The idea of never being able to own a home is frightening, and discouraging for me. Homes are traditional ways of building generational wealth in families and many immigrants to Canada, including myself, would greatly benefit from the opportunity to become a homeowner, securing some sort of capital which can be used in the future. Currently, the social determinant of housing influences my potential to be healthy in mixed ways. I live in a large 2 bedroom apartment with my children. Even though the apartment is spacious, there are still 5 of us who live here. Over the past few years, I have had to turn my dining room into an area sectioned off with folding faux bamboo dividers, where my bed, shelves and dresser now sit. My boys share the larger bedroom, and my 14 year old daughter is the only person in our home with her own actual room. This weighs heavily on me, as I know that living space is essential to my ability to get good rest and function well enough to be successful at work, school and parenting. I know that having access to sufficient living space is important for families like mine, since children benefit from having adequate spaces to play, eat, sleep, and study. Because I live in a city where people like me have exceedingly been priced out of home ownership, and rent prices have significantly increased over the past five years, I am often anxious about moving and wanting to provide better living arrangements for my kids. This affects my mental health and confidence, especially when I begin to consider other factors that are increasing as rapidly as rent prices, like the crimes involving vehicles, shootings and assaults. Securing housing can be a complicated task, full of mixed emotions. For people in cases like mine, navigating the housing crisis often comes with anxiety related to the need to protect and provide for a family, and at the same time accompanied by a feeling of gratitude for simply being housed.

Income is a crucial social determinant of health. Our level of income directly impacts the conditions in which we live, and ultimately our other social determinants of health. Income in Canadian society determines the quality of social determinants including food security, housing, education, early child development, and other prerequisites of health. (Raphael et al., 2020)Our access to income and socioeconomic advantage has a direct link to the physiological and psychological growth that we experience throughout our lifetimes. This social determinant affects my potential to be healthy in a number of ways. While I was growing up, the income status of my family influenced the access that I had to extracurricular activities, or even things that other children considered to be part of everyday life. My family wasn't able to afford our first computer until I was 14, and when we finally purchased one, we all shared it. Based on my recollections, different social determinants were distinctly affected, or not affected by my parents lack of access to high or even middle class income. For example, my parents were pretty successful at providing healthy food options, but they did not have money to secure funding for my future education. Income level also has a direct impact on what I can provide to my children. As someone who has been raised in North America, I have strong knowledge of resources and how to search for them. I have registered my children for multiple free programs through which they have thrived. My daughter, for example, started playing the violin when she was 7 years old, at a community center where I had been volunteering. I signed her up and was told that the only cost to me would be $20 per school year. Since then, she has advanced to become a member of a number of orchestras including the Oscar Peterson School of Music, and has been playing the violin for nearly 8 years. I have been fortunate enough to circumvent the difficulties of many single mothers like me, who have multiple children and whose socioeconomic status paired with intentions for advancement requires them to work hard. For many mothers, finding balance between achieving professional success and providing children with opportunities to explore their hobbies, strengths and talents in addition to school and other daily needs, can be difficult.

Canadian society is a multicultural one, where people of various races coexist in given communities. Because a person’s race has been proven to increase the possibility of discrimination and experiences of racism, it directly impacts social determinants of health. Discriminatory practice is linked to inequity in institutions such as the justice system and labor markets, as well as access to education and health care (Raphael et al., 2020). Canada has a growing racialized population as a very large percentage of new immigrants to Canada identify as being from racialized groups. It has been proven that racialized Canadians experience higher rates of problems related to employment and work status, which subsequently lead to negative effects on other social determinants of health. (Raphael et al., 2020). I have had personal experiences with treatment because of my race where I have been overlooked or expected to remain non-responsive when people have made negative comments and generalizations about my race.

The social safety net refers to a range of benefit programs and supports that protect citizens during various life changes that can affect their health. (Raphael et al., 2020 p45) Our social safety net references the benefits that we have in society that have positive impacts on our health. The social safety net is external to each person and consists of varied supports that the individual can access at given times during life stages of change and growth. Life changes that benefit from access to a strong social safety net include transitional periods of change such as parenting, employment and housing seeking, and retirement, as well as unexpected life events such as accidents and illness (Raphael et al., 2020 p45). When individuals face precarious issues the impact of the issues on the life of the individual can be great. Without access to a secure social safety net, other areas of social determinants of health are affected. When individuals have access to a secure social safety net, the impact on negative life events can be softened. Lack of access to a social safety net can increase economic insecurity and lead to psychological stress. In Canadian society a form of social safety net that has been created to aid in the provision of support for quality of life, is known as the welfare state. Through this system, residents have access to applications for monetary social assistance benefits, family allowances, pensions and more. (Raphael et al., 2020)

The social determinants of health that I chose to focus on for the purpose of this paper are very likely to impact the communities that I will be working with in the social service field. I know this, because I choose to work in communities that are very similar to my own, and to the one that I was raised in. Though trends in issues and barriers may change, and every individual has their own path, I think that being aware of my own social location and lived experience will continue to guide my interactions as a social service worker. Three of the social determinants of health in particular, education, income, and social safety net, can be easily reflected upon when considering the effects of social determinants on our overall health

Education is likely to impact the communities that I am working with in the field of social service. Since the level of education that people receive is a direct factor linked to other social determinants and even mental health and confidence levels, accessing education should be made easier for people who come from marginalized communities. People that I will be working with will identify with different communities and will also belong to different demographics. They will have varied levels of education and work experience, and some may need more help than others. Levels of completed education among clients may also impact needs and requests for assistance can vary based on the access to technology and literacy skills of the client.

I think that on a micro level of social service, the issue of education can be addressed by working with clients and communities to advocate with school boards and individual schools to orientate parents so that they are aware of the best ways to advocate for their children. It is also important to connect children, youth and adults to agencies that can provide access to free or low cost education opportunities such as tutoring and training. As a micro level social case worker, providing resources and available funding to help cover costs of education if possible. At the mezzo level, it is important that agencies and service providers are coming together to share the trends that they are identifying among clients and communities surrounding educational needs and barriers. The information gathered at the local and community level can inform the development of new community programming aimed to aid in the provision of education. Organizations that serve the community can use the information and requests given by the community itself, to optimize the design and impact of programming that is truly beneficial to the needs reflected.

At the macro level of society, I think that education and the needs related to it should be studied and explored further. Further research should be done on the needs of parents trying to understand the current school system both for their children and themselves, as well as the needs of newcomer students, and those who have come to Canada with pre-existing credentials. The information collected through these explorations can inform the funding streams that influence project development in the non profit, social service and educational sectors. Parents and students who need extensive access to learning tools and services, can be provided with those options through funding opportunities developed from evidence based practice and genuine public need. For example, in the past there have been many reports of racism in peel schools at the micro level (Pasieka, 2023). Because of this, there had been much concerns raised about mismanagement at the mezzo level, of incidents involving racism. Subsequently, at the macro level, the Ministry of Education was forced to impose directives on the school board to ensure that true attempts to address racism were being made. The same can be said for cases with racism in the health care systems as well as policing institutions. Issues that span the micro, mezzo and macro levels, often interplay and benefit from transplanting information for the benefit of a social cause.

Having a social safety net has an impact on the quality of life, overall health, and long term success of people living in Canadian society. As I will be dealing with people at varied intersections of adversities, it is important that I am aware of the benefits of having a social safety net, so that I can contribute to the structure of the social safety net, if my client permits. In the line of work that I do now, it is important for me to know where to refer people who need access to basic needs such as counseling, crisis and safety planning, food banks, clothing, resume assistance, legal advice, financial literacy workshops, and even volunteering opportunities and the chance to get involved in community activities and events. At the micro level we can make changes to a clients social safety net by providing adequate resources and encouraging safe interactions with others. We can refer clients to agencies that can help with needs like finding food banks or vouchers,and applying for social assistance funds. In addition to referrals for monetary support, social service workers who work with clients one on one, may want to refer them to places where they are able to seek services like counseling, group counseling, or even begin volunteering. At the macro level social safety nets and their construction in relation to social locations can be studied to create practices and frameworks related to the exploration of one's social safety net and strategies to widen it if necessary.

People who I work with in the social service and non profit sector, will often be from lower income communities and sometimes identify with marginalized communities that have historically faced challenges with lower income and unemployment as a result of oppression. People who are struggling with income may also be experiencing issues with areas like housing and food insecurity. Their children’s access to education could be affected by income status. It is important for me to note how income interplays with other social determinants of health and the ways in which this could be affecting my clients. For this reason it would be beneficial for me to be knowledgeable on the most current monetary support options available to my client base, and also resources that can aid in activities like employment seeking and readiness.

I believe that as a social service worker, my greatest contribution to the community will show in my role as an advocate for the people that I serve. I will strive to continue doing my best to work toward positive shifts in the psychosocial and socio-economic statuses of clients and community, toward transformative justice and a better quality of life, access to higher education and community safety and most importantly, for simple things, like happiness.

References

Pasieka, C. (2023, January 21). Peel regional police ask for nearly $46-million budget increase | CBC News. CBCnews. Retrieved April 3, 2023, from https://www.cbc.ca/news/canada/toronto/peel-regional-police-ask-for-nearly-46-million-dollar-budget-increase-1.6721303

Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). The Social Determinants of Health: The Canadian facts. https://thecanadianfacts.org/. Retrieved April 4, 2023, from https://thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf

World Health Organization and Calouste Gulbenkian Foundation. (2014). Social determinants of mental health. World Health Organization.

Seniors painting at a live instructions session at Peel Living Association. Photo Taken by: Carrie Campbell 2017)