Some time ago, I recall hearing about a study where the participants played a game of Monopoly that was rigged in their favor. Despite knowing this fact, the pre-ordained winners of the game, when interviewed after its completion, attributed their success to superior game play. The losers lost, in the winners’ opinions, not because the game was altered, but because of their personal mistakes or limitations. I believe this cognitive dissonance is at play as we consider our performance in life, in health, in achievements.
This study and the video above came to my mind as we dug deeper into the social determinants of health. To what degree do those who are disadvantaged end up living a life where their potential is not fully realized due to factors outside of their control? This question is not just about education, or economics, as highlighted in the video. It is also about health: population health and individual health. It’s about some things we, as individuals, can change, but so many that will take collective will to shift.
Our personal health is an alchemy of all of these inter-related and complex factors known as the social determinants of health.
Health is not simply treating the issue we face in the doctor’s office, the hospital bed or under the x-ray. It is about context – context of history, context of family, context of culture, context of home; context of community. What is in your genetics (race)? What trauma did you experience (early childhood experience)? Are you connected with your history, your people (social safety net, social exclusion)? Where do you live (food insecurity, housing)? Where do you work, study and play (employment, working conditions, health services, education)? Our personal health is an alchemy of all of these inter-related and complex factors known as the social determinants of health. Mikkonen & Raphael (2010) identify 14 of these:
- Aboriginal status
- Disability
- Early life
- Education
- Employment and working conditions
- Food insecurity
- Health services
- Gender
- Housing
- Income and income distribution
- Race
- Social exclusion
- Social safety net
- Unemployment and job security
The dawning awareness of these issues has highlighted challenges across nations and provided an available direction for improvements across the globe. In Canada, the provincial and federal governments have taken this information and committed to making meaningful change. Governments, communities and individuals are using this information to launch initiatives and make program and legislative alterations that will create positive effects in the near and long term. These promise to create measurable improvements in the return on investment for the significant funds directed toward health intervention in Canada. The excitement is building! As health care providers, we need to be aware of where we can effect change and truly provide the kind of help that makes a difference. Perhaps one of the key areas to create that difference is to help those around us to have compassion for the challenges our neighbors often have to overcome.
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References
Life of Privilege Explained in a $100 Race – Please Watch to the End (2017, October). Retrieved October 14, 2018 from https://www.youtube.com/watch?v=4K5fbQ1-zps
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts.
Toronto: York University School of Health Policy and Management.
What determines health? (n.d.) Retrieved October 12, 2018 from https://albertahealthycommunities.healthiertogether.ca/about-healthy-communities/what-determines-health/