Reflection on the Social Determinants of Health
For many years of my childhood I had lived on the native reserve of Sliammon in my hometown. My family tended to move frequently, on and off the reserve until I was around the age of 11, searching for inexpensive housing. Which was the reason why we repeatedly returned to the reserve. Growing up, I loved living in Sliammon. I was constantly by the ocean, and many children my age lived nearby. My best friend lived next door, and it was not unusual for a group of 10 of us to be playing in each other’s yards. At the age of 4, 6, 7, 10 you are blind to socioeconomic disparities. And I will admit, it wasn’t until reaching university that I would become fully aware of the Social Determinants of Health (SDH) and how they have the ability to affect your life.
As I grew older I grew more distant from most of my friends I had in Sliammon. A few years ago I would have denied that living conditions could pre-determine your life. And of course, it does not have to. But I can also say I have witnessed first hand the living conditions, education levels, and lack of employment that existed on the reserve, and how such condition could predisposed a person to perpetuate the same social situations that are already in place. It is well documented that those living on a native reserve experience higher unemployment rates, lower levels of education, and insufficient social housing when compared to those who do not. (1) It has also been observed that family violence and suicide rates are higher. Income, education, work environment, and living conditions are all determinants of health. (2)
The social determinants of health are responsible for health inequities, including oral health inequities. According to research by Newman and Gift (3), regular preventative dental care was accessed by people who had dental insurance, were high school graduated, and had no cost barriers. This is unfortunate considering that income and education are linked to oral health status with the burden of disease being heaviest on those with lower socioeconomic status, (4) such as with the native population in BC.
I am grateful for my background and childhood experiences because it has made me a passionate advocate. Although I believe in the power of a person to overcome their situation in life, such as my best friend from childhood had done, I am also not so adamant as to say that growing up in an environment does not pre-dispose you to experience the conditions that already exist. When providing care, it is important to not judge a person based on their social or cultural background. It has been shown that variations in service provision for dental care were found to be associated with factors unrelated to oral health, such as socioeconomic status (SES). (5) Their findings suggested that better service is given to those with higher SES. This cannot exist if one is to fulfill his/her role of promoting health and acting as an advocate. To overcome the avoidable health inequities experienced by those negatively affected by the social determinants of health, it is important that the dental hygienist act as a change agent and advocate in the clinic and community so that the needs of people from all backgrounds can be met.
References
- Frohlich KL, Ross N, Richmond C. Health disparities in Canada today: Some evidence and a theoretical framework. J Health Pol 2006; 79(3):132-143.
- Mikkonen J. Social determinants of health: The Canadian facts. Toronto: York University School of Health Policy and Management; 2010.
- Newman JF. Gift HC. Regular pattern of preventive dental services—A measure of access. Soc Sci Med 1992; 35(8):997-1001.
- Timis T, Dănila I. Socioeconomic status and oral health. J Prev Med 2005; 13(1):116-121.
- Brennan DS, Spencer AJ. Influence of patient, visit, and oral health factors on dental service provision. J Pub Health Dent 2007; 62(3):148-157.
View of the ocean from Sliammon
My pre-school on the reserve