Prepared by Leanne Mireault and Tom Dorland
The main determinants affecting the health of British Columbians are geography, socioeconomic status and poverty, education level/access, and aboriginal identity. According to a 2016 report published by the Provincial Health Services Authority (PHSA) there is a ten-year variance in life expectancy across the province, with the shortest life expectancies occurring in the northern and central regions. These more remote and isolated areas, which include the majority of BC’s indigenous populations, also correspond with lower socio-economic status (PHSA, 2016). Martin et al. (2018) notes that while 18% of Canadians live in rural or remote areas, only 3% of medical specialists reside in these areas. This in itself obviously puts rural dwelling British Columbians at a disadvantage: if they have a stroke, for example, they have a lot farther to travel before being able to access a neurologist. In my work at Vancouver General Hospital, we receive patients from all over the province who are transported to us to receive care that they are unable to receive in their own local hospitals.
According to the Health Officers Council of BC (HOCBC,2008), our province has the highest rate of overall poverty, and especially child poverty, in the country. The poorest regions of BC are concentrated in the rural and Northern areas and the notorious downtown east-side of Vancouver (PHSA, 2016). Incidences of heart disease, diabetes and mental illness including addiction are much more prevalent in the lowest quartile of incomes and show a step-wise decrease in prevalence with increased income (HOCBC, 2008). Some of these chronic illnesses can be explained by the increased rate of smoking, reduced physical activity, poor diet and obesity; all of which are present at greater rates in those with low socioeconomic status (HOCBC, 2008).
Rates of high school completion as well as rates of post-secondary education also have significant impacts on health outcomes in the province. For example, smoking rates were found to be 20% greater in individuals who did not complete high school, compared to the rest of the population (PHSA, 2016). This has well known impacts on later health with higher incidences of lung cancer and COPD, among many others. One way that education impacts health outcomes is that education and improved literacy are associated with individuals being better able to evaluate or consider the long-term outcomes of health-related behaviours (Raphael et al., 2020). A more obvious outcome of completing high school and university is the correlation between greater education attainment future socioeconomic status, which as already stated, has a huge impact on health outcomes (Raphael et al., 2020).
British Columbia mirrors the rest of Canada in the fact that its Indigenous Peoples experience poorer health outcomes including higher rates of mortality at all ages, compared to non-Indigenous populations (PHSA, 2016). Compared to Canadians that do not identify with having indigenous ancestry, Aboriginal Canadians have lower average incomes, poorer housing quality, higher rates of food insecurity, lower rates of high school completion, and higher rates of infectious diseases (Raphael et al., 2020).
One document that guides the prioritization of these determinants of health is called BC’s Guiding Framework for Public Health (Ministry of Health, 2017). This document outlines seven over-arching goals as well as performance indicators and targets for 2023. Each goal also lists provincial strategies of legislation in place that support the goal. For instance, the first goal is “healthy living and healthy communities” and one of the performance indicators is to increase the percentage of school-aged children that report that they are learning how to stay healthy in school from 51% to 90%. Other goals demonstrate prioritization on maternal and early childhood health as well as support for individuals with mental illnesses and substance abuse issues.
Similar to the BC, Public Health Ontario (PHO) has summarized the determinants of health for Ontario residents by collecting and presenting data on immigration status, income level, education, employment and aboriginal status (PHO, 2015). As of 2011 more than one quarter of all Ontario residents could be classified as being born outside of Canada, and Ontario was home to 53% of the total foreign-born Canadian population (PHO, 2011). As noted by Raphael et al. (2020) while the immigrant population initially measures as above average on most health measures compared to the rest of Canada, this trend reverses the longer an immigrant lives in Canada. Immigrants from non-European nations report higher levels of mental health issues and chronic illnesses compared to Canadian born residents (Raphael et al., 2020).
As in British Columbia, education and income levels are identified as important health determinants with 12% of Ontarians living in low-income households in 2011 (PHO, 2015). Closely connected to income is employment status, which was also identified as an important health determinant for Ontario. In addition to providing income, ones employment status also provides a sense of identity or purpose and provides structure to everyday life (Raphael et al., 2020). While obviously resulting in reduced socioeconomic status, unemployment can lead to increased physiological stress and the adoption of health-threatening behaviours including smoking or excessive alcohol consumption, all of which can result in poor health outcomes (Raphael, 2020). Ontario has a higher rate of unemployment than the national average, especially in the younger adult population, making this an important health determinant for the province (PHO, 2015). People identifying as aboriginal make up 2.8 percent of the population of Ontario, which is relatively less than the 5.9% in BC, but nonetheless aboriginal status remains an important determinant of health in both provinces (Statistics Canada, 2020).
In Ontario, one guiding document to prioritize health determinants is called the Health Equity Plan, prepared by Health Quality Ontario (2017). This plan lays the groundwork for an ongoing collaboration between boards of health and all partners and outlines five key priorities (Health Quality Ontario, 2017):
Provide system-level leadership through partnerships to improve health equity in Ontario.
Increase availability of information to enable better decisions to achieve health equity locally and provincially.
Evaluate and support the uptake of promising innovations and practices to improve health equity in Ontario.
Engage patients, caregivers, and the public in our efforts to address health equity.
Ensure health equity is addressed when patients transition across different care settings.
BC Healthy Living Alliance (2008). Healthy futures for BC families. Policy recommendations
improving the health of British Columbians. https://www.bchealthyliving.ca/wp-
Healthy Quality Ontario (2017). Health Quality Ontario’s health equity plan.
Ministry of Health (2017). BC’s guiding framework for public health. March 2017 update. BC
Healthy Living Alliance (2008). Healthy futures for BC families. Policy recommendations
improving the health of British Columbians. https://www.bchealthyliving.ca/wp-
Provincial Health Services Authority. (2016) Priority health equity indicators for British
Columbia: Selected indicators report. http://www.bccdc.ca/pop-public-
Public Health Ontario. (2015). Ontario’s Population: Determinants of Health.
Raphael, D., Bryant, T., Mikkonen, J., & Raphael, A. (2020). Social Determinants of Health:
The Canadian Facts, 2nd Edition (2nd edition).
Statistics Canada (2020). Aboriginal peoples highlight tables, 2016 census. Statistics
Canada Website. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-
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