Concepts Of Health And Its Determinants

Introduction

Understanding the concepts of health and its determinants is crucial for success in the Medical Council of Canada Qualifying Examination Part I (MCCQE1). This comprehensive guide will explore these concepts from a Canadian perspective, aligning with the CanMEDS framework and MCCQE1 objectives.

Defining Health in the Canadian Context

The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." However, in Canada, we often take a more holistic approach.

Social Determinants of Health in Canada

Social determinants of health are the economic and social conditions that influence individual and group differences in health status. In Canada, we recognize several key determinants:

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 Behaviors
8. Access to Health Services
9. Biology and Genetic Endowment
10. Gender
11. Culture
12. Race / Racism

The Canadian Approach to Health Equity

Health equity is a core principle in Canadian healthcare. It means that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status, or other socially determined circumstance.

Population Health Approach in Canada

The population health approach focuses on improving the health status of the entire population and reducing health inequities among population groups. This approach is central to Canadian public health practices.

Key features of the Canadian population health approach include:

• Addressing the broad range of factors and conditions that have a strong influence on our health
• Applying research to identify systematic variations in their occurrence and the causes of health inequities
• Considering both the aggregate health experience of the entire population and the health experiences of sub-populations

Health Promotion in Canada

Health promotion is the process of enabling people to increase control over, and to improve, their health. In Canada, health promotion strategies often follow the Ottawa Charter for Health Promotion:

1. Build Healthy Public Policy
2. Create Supportive Environments
3. Strengthen Community Actions
4. Develop Personal Skills
5. Reorient Health Services

Canadian Guidelines on Health Determinants

The Public Health Agency of Canada (PHAC) provides guidelines on addressing health determinants:

1. Focus on upstream factors
2. Use evidence-based interventions
3. Apply a health equity lens
4. Engage in multisectoral collaboration
5. Empower communities and individuals
6. Consider the impact of policies on health

Key Points to Remember for MCCQE1

• Understand the Canadian definition of health and how it differs from the WHO definition
• Know the 12 social determinants of health recognized in Canada
• Be familiar with the Canadian approach to health equity and the steps to address it
• Understand the population health approach and its application in Canada
• Know the five strategies of the Ottawa Charter for Health Promotion
• Be aware of PHAC guidelines on addressing health determinants

Sample Question

A 45-year-old Indigenous woman living in a remote northern community presents with poorly controlled type 2 diabetes. She reports difficulty accessing fresh fruits and vegetables and mentions that she cannot afford her medications regularly. Which one of the following social determinants of health is MOST likely contributing to her poor health status?

• A. Gender
• B. Culture
• C. Race / Racism
• D. Income and Social Status
• E. Access to Health Services

Explanation

The correct answer is:

• D. Income and Social Status

While all the options presented are social determinants of health that could potentially impact this patient's health status, the most significant factor in this scenario is Income and Social Status. The patient's inability to afford medications regularly and difficulty accessing nutritious food directly points to financial constraints, which fall under the Income and Social Status determinant.

Gender (A), Culture (B), and Race/Racism (C) are important determinants but are not as directly linked to the specific issues mentioned in the scenario. Access to Health Services (E) could be a factor given the remote location, but the primary issue described relates to affordability rather than accessibility.

This question highlights the importance of considering social determinants of health in patient care, particularly in the Canadian context where disparities can exist among different populations and geographic regions.

References

1. Public Health Agency of Canada. (2018). Key Health Inequalities in Canada: A National Portrait. https://www.canada.ca/en/public-health/services/publications/science-research-data/key-health-inequalities-canada-national-portrait-executive-summary.html (opens in a new tab)

2. Canadian Institute for Health Information. (2021). Health Inequalities. https://www.cihi.ca/en/health-inequalities (opens in a new tab)

3. Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. http://thecanadianfacts.org/ (opens in a new tab)

4. World Health Organization. (1986). The Ottawa Charter for Health Promotion. https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference (opens in a new tab)

5. Government of Canada. (2019). Social determinants of health and health inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html (opens in a new tab)