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What Determines Health?

What is the impact of poverty on health? Which drug would better treat a patient? What is the impact of contaminants on cancer? What is the best length of hospital stay for certain surgeries? What is the usefulness of some medical screening practices? Why are teenagers so attracted to smoking? What intervention strategies are best to address particular health issues?

All of these questions require the best information possible to help us address these very difficult health issues. The federal government recognizes that the national health research infrastructure needs to be reorganized in order to be able to answer these questions. The infrastructure should support collaborative research ventures involving researchers working in different fields and in different parts of the country.

see Population Health Evidence Program

The federal government also recognizes that spending more on health research is only part of the solution. We can also address health issues by broadening our approach to health interventions. We've learned a lot in the past several decades about what determines health and where we should be concentrating our efforts. Much of the research is telling us that we need to look at the big picture of health to examine factors both inside and outside the health care system that affect our health. At every stage of life, health is determined by complex interactions between social and economic factors, the physical environment and individual behavior. These factors are referred to as 'determinants of health'. They do not exist in isolation from each other. It is the combined influence of the determinants of health that determines health status.

see Determinants of Health

The challenge we face is how to use what we know about the determinants of health to:

  • focus our research agenda so we can increase our understanding of how the basic determinants of health influence collective and personal well-being
  • adopt strategies that improve health for Canadians

That's where a population health approach comes in. In a population health approach, taking action on the complex interactions between factors that contribute to health requires:

  • a focus on the root causes of a problem, with evidence to support the strategy to address the problem
  • efforts to prevent the problem
  • improving aggregate health status of the whole society, while considering the special needs and vulnerabilities of sub-populations
  • a focus on partnerships and intersectoral cooperation
  • finding flexible and multidimensional solutions for complex problems
  • public involvement and community participation

for more information, see Key Elements of a Population Health Approach

Determinants of Health
What Makes Canadians Healthy or Unhealthy?

This deceptively simple story speaks to the complex set of factors or conditions that determine the level of health of every Canadian.

"Why is Jason in the hospital?
Because he has a bad infection in his leg.
But why does he have an infection?
Because he has a cut on his leg and it got infected.
But why does he have a cut on his leg?
Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on.
But why was he playing in a junk yard?
Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them.
But why does he live in that neighbourhood?
Because his parents can't afford a nicer place to live.
But why can't his parents afford a nicer place to live?
Because his Dad is unemployed and his Mom is sick.
But why is his Dad unemployed?
Because he doesn't have much education and he can't find a job.
But why ...?"

– from Toward a Healthy Future: Second Report on the Health of Canadians

More detailed information on the determinants of health and What Makes Canadians Healthy or Unhealthy is available.

Key Determinants

  1. Income and Social Status
  2. Social Support Networks
  3. Education and Literacy
  4. Employment/Working Conditions
  5. Social Environments
  6. Physical Environments
  7. Personal Health Practices and Coping Skills
  8. Healthy Child Development
  9. Biology and Genetic Endowment
  10. Health Services
  11. Gender
  12. Culture

Research & Evidence Base
Defining Evidence-Based Decision Making

The aim of evidence-based decision making (EBDM) is to ensure that decisions about health and health care are based on the best available knowledge. To use EBDM one must first assess what constitutes evidence, both in relation to health-enhancing interventions and to organizational or policy level decision making. One also needs to explore the availability and accessibility of reliable information and knowledge that identifies how interventions, practices and programs affect health outcomes.

More detailed information on the determinants of health and What Makes Canadians Healthy or Unhealthy is available.

Population Health Evidence Program

Over the last five years, the need for better evidence has become manifest in the health sector. Forward-looking discussions on population health research needs have taken place at the National Forum on Health and the Federal, Provincial and Territorial Advisory Committee on Population Health. These discussions have lead to the creation of various projects and infrastructures to support the development of population health evidence.

The National Forum on Health

Among the multiple benefits gained through the National Forum on Health in 1997, a national consensus emerged to support the need for evidence-based policy development and decision making. The Forum dedicated one of its reports to describing how health professionals and administrators can use the most solid information available to make their decisions, and to ensure that these decisions reflect the values and principles of Canadians regarding health and health care.

Just released in September 1999, the Second Report on the Health of Canadians contains a wealth of information and is a good starting point for a reflection on evidence.

More detailed information on the determinants of health and What Makes Canadians Healthy or Unhealthy is available.

Health Status Indicators

A population health approach recognizes that any analysis of the health of the population must extend beyond an assessment of traditional health status indicators like death, disease and disability. A population health approach establishes indicators related to mental and social well-being, quality of life, life satisfaction, income, employment and working conditions, education and other factors known to influence health.

More detailed information on the determinants of health and What Makes Canadians Healthy or Unhealthy is available.