The most important influences on our health may not be the first things we think of.

People often believe their health is influenced largely by smoking, diet and exercise. While these behaviours play a role, they often stem from broader conditions such as inadequate income, lack of education, inadequate or precarious employment and lack of social connections. Having a secure predictable job, affordable housing, food on the table, and a neigbourhood where one feels safe and a sense of belonging all have powerful positive impacts on health -from childhood on!

The broad factors that impact health are called the social determinants of health.

The following video illustrates the connection between the social determinants and health.

Social Determinants of Health

There are 3 basic levels to target when looking to improve peoples’ health and wellness: individual, community and policy. The most commonly targeted is the individual by encouraging us to eat a healthy diet, get active and eliminate tobacco. The second way is by creating environments that support making the healthy choice the easier choice. The third is through healthy public policy.

The diagram below shows the interconnection of factors that influence health. The AHC Approach is designed to assist community teams to focus on the community and policy levels to address local priorities.

Adapted from Dahlgren, G., & Whitehead, M. (1991)9

At the centre are factors that are beyond personal control.  Moving outward, health behaviours, often called lifestyle factors, that can be modified and, in turn, affect individual’s health are presented. Examples include healthy eating habits and getting regular exercise. 

Encircling individual factors are social and community factors, such as accessible (both in proximity and affordability) grocery stores and opportunities for physical activities and meaningful social engagement. The overarching layer is that of policy and environment, where communities and governments provide support for healthy living. Examples at this level include local policies to promote healthy food and beverage choices in public facilities and city planning that promotes public transportation.

The choices people make do not occur in a vacuum. How a person’s overall health and wellness are affected by the broader determinants of health is illustrated in Nadia’s story.

Nadia's story

Nadia has asthma and once again she’s in the emergency room. Lately she’s been stressed. She would really like to move because her apartment is old and musty. But she can’t because her rent is all she can afford right now… plus it’s close to where she works shifts at a low-skill manufacturing job.

Now the factory is cutting back benefits, and her inhalers will not be fully covered by her health plan. While living close to work shortens her commute, her neighbourhood is known for its poor air quality - much worse than neighbourhoods further from the industrial sector. And because the streets are poorly lit, she doesn't feel safe getting out for some recreation in her neighbourhood at night. Her apartment is surrounded by fast food outlets, convenience and liquor stores. She needs to bus to the nearest grocery store. Nadia would like to better herself through further education, but the community college is across town and doesn't offer on-line courses, so her study plans have been put on hold.

Nadia's story illustrates how her options, in effect - her opportunities to be healthy- are enabled or constrained by the environments where she lives, works, learns and plays. It's hard to eat right, get or stay active, afford prescriptions' or simply 'get ahead' under certain circumstances.

Consider how different Nadia's story would be if there was a grocery store or a farmer's market nearby. If the community college had distance learning options. If her municipality offered appropriate affordable housing. If her neighborhood was safe, well-lit and pollution free.

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Recognizing how the social determinants of health influence our opportunities to be healthy changes how we look at improving health and wellbeing. The question, “how do we promote healthy behaviours?” becomes, “how can we create the community environments that make the healthier choice the easier choice"

The Healthy Communities Approach empowers communities to prevent chronic disease, including cancer, by taking action on the social determinants of health.

For more information visit:

Public Health Agency of Canada, What determines health?

World Health Organization (WHO) Conceptual Framework on the social determinants of health

Wellesley Institute SDOH -The Canadian Facts

  1. Canadian Council on Social Determinants of Health, 2013, p. 2
  2. Sudbury & District Health Unit
  3. Social Determinants of Health THE CANADIAN FACTS http://www.thecanadianfacts.org/The_Canadian_Facts.pdf
  4. The Social Determinants of Health…understanding how health is shaped, Apple Summer 2015, Issue 18, p. 37 http://www.applemag-digital.com/applemag/summer_2015?pg=45#pg45 
  5. Stanford Encyclopedia of Philosophy https://plato.stanford.edu/entries/race/
  6. Fried, L.P., Ferrucci, L., Darer, J., Williamson, J.D. and G. Anderson. Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care The Journals of Gerontology: Series A, Volume 59, Issue 3, 1 March 2004, Pages M255–M263, https://doi.org/10.1093/gerona/59.3.M255
  7. Wellesley Institute: Making the Connections: Our City, Our Society, Our Health
  8. Public Health Agency of Canada http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php#determinants

  9. Adapted from Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health: Background document to WHO - Strategy paper for Europe. Institute for Futures Stories, 1–69. Retrieved from https://core.ac.uk/download/pdf/6472456.pdf