Canada's Response to WHO Commission on Social Determinants of Health

Glossary

The following are explanations of terms used on this website. These explanations are meant to be guidelines only and are not formal definitions. Where applicable, sources appear in brackets at the end of the glossary explanations.

Aboriginal people(s): "Aboriginal people" is a collective name for the original peoples of North America and their descendants. The Canadian Constitution (the Constitution Act, 1982) recognizes three groups of Aboriginal peoples — Indians, Métis and Inuit. These are three separate peoples with unique heritages, languages, cultural practices and spiritual beliefs.

Please note that when you refer to "Aboriginal people," you are referring to all the Aboriginal people in Canada collectively, without regard to their separate origins and identities. Or, you are simply referring to more than one Aboriginal person.  By adding the ‘s' to people, and referring to “aboriginal peoples”, you are emphasizing that there is a diversity of people within the group known as Aboriginal people.

Definitions taken from the Department of Indian Affairs and Northern Development

Determinants of health: the range of personal, social, economic and environmental factors that determine the health status of individuals or populations (WHO, Health Promotion Glossary, 1998). The determinants of health can be grouped into seven broad categories: socio-economic environment; physical environments; early childhood development; personal health practices; individual capacity and coping skills; biology and genetic endowment; and health services.

Health disparities: differences in health status that occur among population groups defined by specific characteristics. For policy purposes, the most useful characteristics are those consistently associated with the largest variations in health status. The most prominent factors in Canada are socio-economic status, Aboriginal identity, gender, and geographic location.

Social determinants of health: Social determinants of health can be understood as the social conditions in which people live and work.¹ Dennis Raphael defines, “ the social determinants of health are the economic and social conditions that influence the health of individuals, communities and jurisdictions as a whole. They determine the extent to which a person possesses the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment. The resources include but are not limited to conditions for early childhood development; education, employment, and work; food security, health services, housing, income, and income distribution; social exclusion; the social safety net; and unemployment and job security.²

Health inequality: “…is the generic term used to designate differences, variations, and disparities in the health achievements and risk factors of individuals and groups…that need not imply moral judgment…[and may result from] a personal choice that would not necessarily evoke moral concern”.³ Some inequalities reflect random variations (i.e. unexplained causes), while others result from individual biological endowment, the consequences of personal choices, social organization, economic opportunity or access to health care. Public policy is concerned with health inequalities attributable to modifiable factors, especially those that are perceived as inequitable.

Health inequity: “…refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice…. The crux of the distinction between equality and equity is that the identification of health inequities entails normative judgment premised upon (a) one's theories of justice; (b) one's theories of society; and (c) one's reasoning underlying the genesis of health inequalities. Because identifying health inequities involves normative judgment, science alone cannot determine which inequalities are also inequitable, nor what proportion of an observed inequality is unjust or unfair.”⁴

Disadvantaged populations: populations that share a characteristic associated with high risk of adverse health outcomes (e.g. Aboriginal peoples, single mothers in poverty, women, homeless people, refugees). An approach to disadvantaged populations is the use of specific strategies targeted at that particular population. This is distinct from and over and above that of strategies aimed at reducing the gradient or range of underlying determinants of health that affect health on a gradient (e.g. income, education).

Population health: both a description and a concept that underlies the discussion of health disparities. “Population health strategy focuses on factors that enhance the health and well-being of the overall population. It is concerned with the living and working environments that affect people's health, the conditions that enable and support people in making healthy choices, and the services that promote and maintain health.”⁵ It is concerned with aggregate rather than individual health status and risk factors, and policies and strategies that address non-medical determinants affecting health throughout the life course.

Public health: “Public health is the combination of science, practical skills, and values directed to the maintenance and improvement of the health of all the people. It is a set of efforts organised by society to protect, promote, and restore the people's health through collective and social action. …Public health activities change with changing technology and values, but the goal remains the same - to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the populations.”⁶ This broad definition aligns more closely to “population health” and should be distinguished from the definition of the five core “public health” programs and services that are aimed at primary prevention and are provided by health departments, regional health authorities and local units: population health assessment, surveillance, disease prevention, health protection and health promotion.

Health sector: the policies, laws, resources, programs and services that fall under the jurisdiction of Health Ministries. The sector spans health promotion and preventive health, public health, community health services such as home care, drugs and devices, mental health, long-term residential care, hospitals, and the services generally provided by health care professionals (doctors, nurses, therapists, pharmacists, etc.).

Health care: the programs, services, procedures, therapies and interventions that treat and care for individuals with diseases, injuries and disabilities. Health care is the largest subset of the health sector.

Primary health care: The World Health Organization defines primary health care as “the principal vehicle for the delivery of health care at the most local level of a country's health system. It is essential health care made accessible at a cost the country and community can afford with methods that are practical, scientifically sound and socially acceptable. Everyone in the community should have access to it, and everyone should be involved in it. Beside an appropriate treatment of common diseases and injuries, provision of essential drugs, material and child provision of essential drugs, maternal and child health, and prevention and control of locally endemic diseases and immunization, it should also include at least education of the community on prevalent health problems and methods of preventing them, promotion of proper nutrition, safe water and sanitation.”

Socio-economic status (SES): a term that describes the position of an individual group in a population or society, reflecting the overall hierarchy. The most frequently used indicators of SES are income, education and occupational categories. Its conceptual cousin is class, which originated in social theories that explain rather than simply describe the structure and functioning of society. To be consistent with previous national documents on health status and their determinants, SES is used and is intended to be interpreted in the broader sense of the term.

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¹ Commission on SDH discussion paper, “Towards a Conceptual Framework for Analysis and Action on SDH.”

² Raphael Dennis (Ed) 2004. Social Determinants of Health: Canadian Perspective

³ Kawachi I, Subramanian SV, Almeida-Filho N. A glossary for health inequalities. Journal of Epidemiology and Community Health 2002;56:647-52, at 647.

⁴ Kawachi, op. cit., at 647-8.

⁵ Federal/provincial/territorial Advisory Committee on Population Health. Strategies for Population Health: Investing in the Health of Canadians. Ottawa: Health Canada, 1994 http://www.phac-aspc.gc.ca/ph-sp/pdf/strateg-eng.pdf.

⁶ Last JM. A Dictionary of Epidemiology. New York: Oxford University Press, 1995.