Planning for a healthier community: The determinants of health

Community COVID-19 Featured

By Dr. T. Jock Murray

and Janet Murray

For The Advocate

In a previous column I talked about the opportunities to reform the health care system in the post Covid-19 pandemic. We have to focus on the determinants of health. The medical care model concentrates on better health outcomes for the individual, but the determinants of health look at health outcomes for the population. Each of the determinants is highlighted in the following paragraphs.

The two factors that are perhaps the most important are income and social status. If you have a good income, you are probably used to making good decisions and good choices and that will include ones related to your health and that of your family. You are in control and can afford to make good choices. Your income and status probably reflect a better education, another strong determinant to a healthy life and longer life expectancy. There is great concern in the increasing income disparity in populations, which leads to poorer outcomes for those in the lower third, which gave rise to the Occupy movement, and the campaigns for higher minimum wage, and a universal basic income. There has also been a focus on the obscene incomes of billionaires while many live below the poverty line.

Another important determinant of health is the support system we have. Our families, friends, and communities can provide emotional support, assist in making healthy decisions, and provide assistance in a time of need. This was evident during the Covid-19 pandemic, when the elderly in particular needed support, and loneliness and depression were a problem for those who were isolated.

The social environment that provides safety, encouragement, support and resources, permits a person to cope with challenges. If the values expressed by society are supportive, the people feel confident about their future and control over their destiny. Within a supportive and loving environment childhood development can prosper especially if education is valued and preventive medical and dental practices are encouraged. The Healthy Communities Movement was begun to address better health outcomes by focus on the determinants of health but has broadened to the economic factors that affect the population.

As mentioned, education equips people with skills and information to make better health decisions and improves their income, social standing, and their confidence and sense of control. About 60 per cent of Canadians are said to have low health literacy rates, and this impairs the ability to make good health decisions. Education also improves understanding of how society and organizations work and how they can negotiate and access their needs in a complex world.

Employment is very important to a healthy life. The employment environment also has to be safe and supportive. Having work with some sense of control and satisfaction leads not only to a happier life but a healthier life with greater longevity. The Covid-19 pandemic has been a financial and emotional crisis that hurt so many families. Unemployment and underemployment are very corrosive to families, and limit their choices in life. It also hurts a person’s self-image and confidence. There was concern during the Covid-19 isolation that stress, depression, suicide and domestic violence would likely increase.

We hear a lot about the environmental risks in our communities. Families require housing, clean air, potable water, good transportation, and a safe and adequate food supply. Our communities must be free from violence. Although our concerns were usually local, increasingly we recognize the dangers of natural disasters like floods and hurricanes, man-made risks from pollution of rivers, erosion from clear-cutting, and dumping of toxic wastes. A greater long-range tragedy is looming from global warming with resultant drought, famine, massive migration, and adverse effects on all living things on the planet.

There is a tendency to think that we can’t do anything about our biology and genetics makeup, but even here we can have an impact, such as treating the disorders we are genetically prone to, such as diabetes, hypertension, cystic fibrosis, some cancers and heart disease, arthritis and obesity. We are getting better at treating many of these illnesses, and in the future there will be breakthroughs in genetic engineering to alter the fundamental genetic defects. We also need to address gender differences that affect health, such as the provision of services, disparity of incomes and opportunities, and societal attitudes that adversely affect both men and women.

Our cultural background, beliefs, and traditions can affect our health. Some cultures have attitudes and beliefs about illness, gender equality, sexuality, relationships, and body image that can affect health and the use of the health care system.

Most of the determinants of health are amenable to some degree of intervention. I wrote in an earlier column about the personal lifestyle choices we can make to enhance our health and live a longer and healthier life. But everything connects — it is more likely we can make the lifestyle choices, if we are educated, with a good income, in a safe and satisfying job, in a supportive and safe community, with supportive family and friends. It is within our capacity to have a regular exercise program, a strong support group of family and friends, a well-balanced diet, low body weight, an active mind, few alcoholic drinks, no smoking and management of other health issues such as blood pressure.

The role of health services and health professionals is also a determinant of health, but it has received the major share of the attention and funding. We don’t wish to deny the importance of taking care of people in need, but emphasize that we must place more resources and research on preventing them getting sick.

In the future we will build bigger hospitals that will provide better therapies and more efficient services. Research will give us the vaccines to protect us from catastrophes like Covid-19. But we will only succeed in developing a healthier population if we keep our eye, and our commitment, focused on the determinants of health. An important document you should access, and I hope might be a text in the Pictou schools is Social Determinants of Health: the Canadian Facts, by J. Mikkonen and D. Raphael (2010). It is available online at:

Some of us can do these things ourselves, but our success also depends on the communities in which we live, and how much those communities — municipal, provincial, and federal — are able and willing to provide us with the things we need… clean water, clean air, good schools, safe work and play environments and opportunities to grow up and grow old healthier, wealthier and wiser.

Dr. T. Jock Murray is a graduate of Pictou Academy and former Dean of Medicine at Dalhousie University. Janet Murray is a graduate of Mount Saint Vincent, majoring in philosophy and a diploma in journalism. She is former Chair of the Board of Governors of Mount Saint Vincent University.

Families walking the Jitney Trail in Pictou. Families provide support, foster education and healthy lifestyle choices. The community of Pictou provides many other elements of the determinants of health, and encourages a healthy community outlook. (Submitted photo)