Chapter 2 - Social Determinants of Health & Health Equity

Key Messages:

• Algoma’s community is quickly diversifying as the proportion of the visible minority population is growing.
  
  
• The majority of Algoma residents have completed high school and are employed.
  
  
• 1 in 5 Algoma households is experiencing food insecurity.
  
  
• The average cost to feed a family of four in Algoma increased by nearly 7% in one year from 2022 to 2023

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About

 

Health is influenced by various factors, including our genetics, individual behavior, and the physical, social, and economic environments in which we live, work, and play. Factors beyond an individual's biology and behaviour are the social determinants of health (SDOH). The SDOH contributes to individual and community health outcomes.

Differences in health outcomes between individuals or groups are known as health inequalities. When health inequalities can be changed or decreased through social action, they are called health inequities. Health inequities are health differences that are:

 

• Systematic, which means that health generally improves as socioeconomic status improves;
• Socially produced, and these can be avoided by making sure that the social and economic conditions needed for good health are accessible to all people; and
• Unfair and/or unjust

 

"Health equity is the absence of unfair systems and policies that cause health inequalities” so that all
people can reach their full health potential without being disadvantaged based on their race, ethnicity,
religion, gender, age, social class, socioeconomic status, or other socially determined circumstances."

 

The Social Determinants of Health in Ontario (SDOH)

 

Within Ontario, health equity is linked to the following key SDOH:

 

• Access to health services
• Culture, race, and ethnicity
• Disability
• Early childhood development
• Education, literacy, and skills
• Employment, job security, and working conditions
• Gender identity and expression
• Food insecurity
• Housing
• Income and income distribution
• Indigenous status
• Personal health practices and resiliency
• Physical environments
• Sexual orientation and attraction
• Sexual inclusion/exclusion
• Social support network

Key Social Determinants of Health Across Algoma

 

Visible Minority

Algoma's proportion of visible minority population has increased from 2.6% to 3.4% in 2021, due to an influx of immigration over the past several years.

• 31% increase since 2016
• 3.4% visible minority
• 96.6 % not a visible minority

Ethnicity/Language

Most commonly visible minorities: South Asian, Chinese, Black

 

Knowledge of Official Languages

• • English only: 88%
  • English & French: 11.4%
  • Neither English nor French: 0.4%

 

Indigenous Identity

• • Algoma: 14.3% (First Nations: 8.8%, Metis: 5.0%, Inuit: 0.05%)
  • Ontario: 2.9%

 

Indigenous Language

• • Algoma: 0.3%

 

Registered or Treaty Status

• • Algoma: 7.3%

 

Housing

Owned private households: 70.9% (29.1 renters)

Households with core housing needs:

• • Algoma: 8.8%
  • Ontario: 12.1%

Spending 30% or more on shelter costs

• • Algoma: 1 in 6 households
  • Ontario: 1 in 4 households

 

Education

 

25 to 64-year-olds who have completed high school or equivalent

• • Algoma: 89.4%
  • Ontario: 88.5%

 

25 to 64-year-olds who have completed a post-secondary certificate, diploma, or degree

• • Algoma: 60.3%
  • Ontario: 67.8%
    
    

Employment

 

People aged 15+ years old in the labour force who are employed

• • Algoma: 87.1%
  • Ontario: 87.7%
  • NE PHUs: 89.2%

People aged 15+ years old in the labour force who are unemployed

• • Algoma: 12.9%
  • Ontario: 12.2%
  • NE PHUs: 10.8%

Food Insecurity

 

Households experiencing food insecurity

• • Algoma: 19.4%
  • Ontario: 17.3%
  • NE PHUs: 17.6%

 

Employed households experiencing food insecurity

• • Algoma: 11.0%
  • Ontario: 8.9%

 

Children and youth (1-17 years old) experiencing food insecurity

• • Algoma: 11.3%
  • Ontario: 15.3%

 

Income

 

Adults (18 to 64 years old) in low income

• • Algoma: 12.5%
  • Ontario: 9.1%
  • NE PHUs: 11.2%

 

Children (<18 years old) in low income

• • Algoma: 15.6%
  • Ontario: 11.5%
  • NE PHUs: 14.1%

 

Children (<5 years old) in low income

• • Algoma: 17.7%
  • Ontario: 12.4%
  • NE PHU: 16.4%

 

Median Income After Taxes - Households

• • Algoma: $62,200 
  • Ontario: $79,500

 

Median Income After Taxes - Individual

• • Algoma: $35,600 
  • Ontario: $37,200

 

Health Care

 

Have a regular healthcare provider

• • Algoma: 85.0% 
  • Ontario: 90.5%

 

Talked to a general practitioner or family doctor in the past 12 months about their emotional or mental health

• • Algoma: 60.2%
  • Ontario: 55.7%

 

Increasing Health Equity: A Health Promotion Approach

 

Health promotion action means building healthy public policy, creating supportive environments for health, strengthening community action, developing personal skills, and re-orienting health services to help people reach a complete state of physical, mental, and social well-being.

 

Upstream interventions try to change the conditions (social determinants of health) that cause health inequities. Upstream interventions based on evidence are necessary to reduce health inequities.

 

Levels of Interventions

 

Downstream Interventions

 

Seek to increase equitable access, at an individual level, to health and social services. These changes generally occur at the service or access to services level.

They are about changing the effects of the causes.

 

Midstream Interventions

 

Seek to reduce exposure to hazards by improving material working and living conditions, or to reduce risk by promoting
healthy behaviours.

 

These changes generally occur at the micro-policy level: regional, local, community, or organizational.

They are about changing the causes.

 

Upstream Interventions

 

Seek to reform the fundamental social and economic structures that distribute wealth, power, opportunities, and
decision-making.

These changes generally occur at the macro policy level: national or transnational.

They are about diminishing the causes of the causes.

 

Focus on Food Insecurity and Food Affordability in Algoma

 

Food insecurity is uncertain or inadequate access to sufficient quantity and/or quality of food, because of financial limits. Food insecurity most often affects households with lower income, including households where there are earned wages, salary, or self-employment.

 

Did You Know?

• The other of food-insecure Canadian households 39.8% receive their income through government transfers, private retirement, and other sources.
• 58.6% of food-insecure households in Ontario in 2021 were those who earned wages, and salaries or were self-employed.
• 60.2% of food-insecure households in Canada in 2021 were those who earned wages, and salaries or were self-employed.

Food insecurity is associated with higher risk of chronic illness, mental illnesses, infectious diseases, substance use, and adverse health outcomes across the lifespan including premature death. Because of systems of oppression, racial disparities are also observed in food insecurity, with Indigenous and Black households experiencing rates 2-3 times higher than white households.

Government Assistance Income Scenarios for Algoma, 2023

 

• The average cost to feed a family of four in Algoma in 2023 was $1,180.92, representing a 6.86% increase since 2022 ($1,099.86)
• Social assistance rates do not pay enough to cover rent, food, and other household necessities. Further, the amount leftover is likely an overestimate, as the rental market data underestimates the current rental prices by as much as 35-50%. Everyone in Algoma deserves dignified access to safe, nutritious, and culturally appropriate foods.
  
  

	Family of Four on Ontario Works	Single Parent with two Children, on Ontario Works	Single Person on Ontario Works	Single Person on ODSP	Single Pregnant Person on ODSP	Single Person on Old Age Security/Guaranteed Income Supplement
Monthly Income	$2,821	$2,587	$887	$1,386	$1,426	$2,010
Average Monthly Rent	$1,220	$1,091	$718	$718	$916	$916
Monthly Cost of Food	$1,181	$870	$423	$423	$423	$306
% of Income Required to Purchase Healthy Food	42%	34%	48%	31%	28%	15%
Amount leftover for other expenses	$420	$627	-$260	$46	$108	$787

 

Focus on Gender Identity & Sexual Orientation

 

Gender identity and sexual orientation also play a role in health outcomes. Gender-based discrimination intersects with other discrimination, such as ethnicity, socioeconomic status, disability, age, and geographic location, among others.

Data suggests that sexual minority individuals are at a greater risk for mental health conditions and other chronic diseases.

 

• 1.3 million Canadian residents identify as part of the 2SLGBTQI+ communities. We do not currently have Algoma-level gender and sexual identity data
  
  

Focus on Indigenous Social Determinants of Health

 

Indigenous Peoples aligned with APH include First Nations, Métis, and Inuit who live in First Nations communities, urban, and rural areas of Algoma. While Indigenous identity is recognized as an SDOH in Ontario, specific social determinants of Indigenous Peoples’ health have also been identified.

 

Indigenous Peoples experiencing health inequities are more susceptible to poor health and have limited access to beneficial resources. These inequities were identified in the Mamow-Ahyamowen report on the mortality experiences of First Nations in northern Ontario. Compared to Ontario, Mamow-Ahyamowen community members are much more likely to die before retirement age (65 years) and many could live longer with better public health and/or medical care.

 

Indigenous Health Statistics

 

• 61% of all deaths among band members occurred before retirement age (65 years old) compared to 22% for Ontario overall
• 3 out of every 10 deaths in communities could potentially have been avoided with effective and timely health care or public health intervention. This means there are ways we can help Indigenous community members live longer. 

 

Common Causes of Death

 

• Diabetes: 392
• Respiratory: 368
• Intentional and Unintentional Injuries: 1,369
• Cancers: 883
• Infections: 134
• Circulatory (i.e. heart attacks, strokes, etc.): 1,102
• Other: 963