What are social determinants of health?
Social determinants of health — like income, education, housing, early childhood experiences, safe and nutritious food, social connection and having a loving family — play a strong role in whether or not we will stay well or get sick, how often we visit an emergency room, and even how long we will live.1,2
“Barriers people face to health are not always about health care,” says Dr. Dominik Nowak, Chief Medical Advisor, TELUS, who is also a family physician. Nowak recognizes that medical treatment is just one aspect contributing to people’s wellbeing. Social and economic factors that affect their health also play a significant role, as well as influence how people experience the healthcare system.
And what we know is that loneliness and social isolation can make us sick. Loneliness has been shown to be as damaging to our health as smoking 15 cigarettes a day,3 Nowak says. It also increases our risk of stroke and heart disease.4
Fortunately, there are ways we can address social factors that influence health.
Social prescribing is an approach to care that allows health professionals to refer or connect patients to non-clinical social supports in their community to address social factors. For one person, a social prescription might be a subscription to affordable and nutritious food. For another, it could be social connection by giving back, including volunteering at a hospital or community garden. And for someone else it could mean finding a bereavement group to help with a recent loss.
Social prescriptions are a way of addressing the underlying causes of disease. They recognize the importance of community in health, including the impact of social factors like supports or connection as key to improving people’s wellbeing and may help reduce their need for emergency room visits and other medical interventions.
“We need to shift the conversation from exploring what is the matter with you to what matters to you,” says Nowak. Social prescribing is not telling people what they need, but part of a collaborative process of exploring with people what health means to them. It means coming up with solutions to what barriers may be standing in their way, but also what strengths they can use to give back to others, he explains.
“Social factors contribute to more than 80% of our health and wellbeing,” Nowak says.
Research has shown that there are also other beneficial ways to form social connections. Volunteering, for example, has been shown to improve the health of the “giver” as well as the wellbeing of the community.
“Giving back is not just good of us, but good for us,” says Nowak. Giving back or volunteering does everything from improving mental health, mood, stress, and self-esteem, all the way to alleviating high blood pressure and lowering the risk of heart disease5. Participating in meaningful activities with others gives us purpose and connection.
The term “mutual aid,” rather than “volunteerism,” acknowledges that community engagement benefits us all, and that assuming that there is a “giver” of aid and a “receiver” is an oversimplification. Everyone benefits. Participating in community projects, and supporting others in your neighbourhood, is a great way to form connections, and help reduce feelings of isolation.6
Nowak says he is proud to be part of TELUS, where giving back to the community is integral to the organization’s social mission. With over 1 million acts of giving each year, TELUS team members have volunteered over 12 million hours over 20 years. These initiatives include neighbourhood cleanups, fundraising and staffing food security programs, all the way up to special activities like musical therapy for people at end of life.
1. Canadian Medical Association. (2022). Social determinants of health. Retrieved June 29, 2022 from www.cma.ca/social-determinants-health
2. Government of Canada. (2022). Canada.ca. Social determinants of health and health inequalities. Retrieved June 29, 2022 from www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
3. Loneliness equivalent to 15 cigarettes a day
4. Nowak, D. (2022, February 17). Dr. Nowak: Sometimes the most important prescription has nothing to do with medication. A good social prescription can be transformative, shifting the conversation between a patient and a doctor from asking 'What’s the matter with you?' to 'What matters to you?' Retrieved June 27, 2022, from https://www.healthing.ca/wellness/dr-dominik-nowak-social-determinants-of-health/
5. Giving back to the community
6. Ballon, D. (2018-2019, December/January). The Joy of Giving. Best Health Magazine. Retrieved June 27, 2022, from https://dianaballon.com/wp-content/uploads/2018/12/VOLUNTEERING-4.pdf