Social Determinants of Health

As discussed, there are multiple factors that impact a person’s relationship with substances or potentially harmful behaviours. In addition to our own personal biology, genetics, and choices, there are social determinants of health that influence our well-being. In short, social determinants of health are “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” (World Health Organization [WHO], n.d.). Examples include income and social status, employment and working conditions, education and literacy, physical environments, race, gender, and sexual orientation (Public Health Agency of Canada [PHAC], 2024a). Social determinants of health largely operate at the systemic and structural levels and are impacted by the policies, norms, and systems that determine the social distribution of wealth, power, and resources.

They affect everyone, but not in the same ways. Therefore, there can be clear distinctions in health status between certain individuals and groups that emerge over time. Systematic differences in the health status of different groups are referred to as health inequities.

Research shows that, in many cases, social determinants of health can be more important than healthcare and lifestyle choices in influencing health. Below are a few examples of how the social determinants of health produce inequitable population-level health outcomes in Canada:

• Increased rates of substance use, depression, anxiety, self-harm, and suicidal ideation among Indigenous youth is associated with intergenerational and contemporary trauma, including the impacts of colonialism, the residential school system, systemic racism, and poverty (Hop Wo et al., 2020; Nutton & Fast, 2015; Spillane et al., 2023)
• Socioeconomic marginalization, measured through housing, employment status, education, criminal justice system involvement, and more, is strongly associated with being at risk for experiencing an opioid-related overdose (van Draanen et al., 2020)
• Discrimination is linked to chronic disease and other negative health outcomes. In a survey of University of Toronto students, racialized students had around 2.5x higher odds of experiencing poor general health outcomes in comparison to white students (Banerjee et al., 2022; Siddiqi et al., 2017)

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How can we support students who are disproportionately affected by social determinants of health?