Brownell & Butler-Jones – social determinants

Certainly we know that once you’re sick you want the health care system, right? You want to be able to see a doctor, or you want the facilities of a hospital if there’s something that a hospital can do for you. But, there’s the recognition that there’s a lot more out there that determines our health than health care. Things like socioeconomic status. And within socioeconomic status we have education level, whether or not the parents—if we’re talking about kids here—the parents are employed, what kind of income they have. These are the social factors within a child’s life that are going to have an impact on their health:  now and in the future. 

It’s everything from education to income to employment to the environment to a whole range of factors that we know influence the choices.  So in an old health promotion concept, it is about making healthier choices easier choices, and we know that the choices are limited often by your involvement, being marginalized, not having the skills in terms of parenting etc, so there’s a whole range of factors that can influence how a child develops, what resources they then have as they go through the school system or as they grow, and ultimately their success as adults is so often determined in those early years. 

At the end of the day when you look at all of the factors it’s really quite striking. Once you’ve got, when you look internationally, once you got the basics in place: you’ve got a roof over your head, food in your belly, you’re not drinking contaminated water, you’ve got the clothes on your back, you’re employed or involved in the community in some way; that you feel part of that community, once you’ve got those basics in place, clearly all of those make a tremendous difference. 

And so, once you’ve got the basics in place though the two things that seem to make the biggest difference is our ability and sense that the decisions we make we actually have an influence over our future; that our decisions are not taken away from us; that what we do actually does matter, and therefore we’re more likely to make good decisions.  

And secondly that we have people that care about us and that we care about.  

People who are engaged, people who have relationships, if you look at the difference between those who are most isolated versus those who are well connected, the most isolated die at twice the rate at any age, male or female, than those who are well connected. And we know in terms of that ability to make decisions, when you take decisions away from people, when you basically institutionalize them whether it’s in the reserve system, whether it’s in terms of institutions for the aged, whatever it is, if we take away their decisions then there’s less sense of purpose.