Very glad to see this point raised. "Environment" is much more than outdoor "air quality and civic infrastructure" per the CMA graphic and associated percentage. It is as cross-cutting an issue as the social determinants of health and health inequities. For example, research is increasingly pointing to indoor environmental health as being of particular concern and a lot of environmental factors are contained within the determinant of "housing." Children are especially vulnerable. Such issues include but are not limited to mould, lead, pesticides, pests, radon, and a myriad of chemical exposures that arise indoors. There is also strong evidence demonstrating greater exposure under low income circumstances. Evidence also indicates greater exposure to pesticides and other toxic substances from food arising from low income circumstances (processed and canned foods, etc.), including but not limited to the extraordinary exposures that can occur among First Nations communities. Likewise there can be greater exposure to toxic substances as a result of employment and not necessarily only in jobs where toxic exposures are typically recognized such as chemical manufacturing but in jobs such as retail sales, where low wages predominate and high exposure to bisphenol A from thermal paper is increasingly recognized. Assigning percentages seems an overly simplistic exercise that does not recognize such complexity.
Kathleen Cooper, Senior Researcher and Paralegal, Canadian Environmental Law Association
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-----Original Message-----
From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of Gagné Thierry
Sent: Wednesday, January 25, 2017 2:07 PM
To: [log in to unmask]
Subject: Re: [SDOH] Social Determinants of Health Impact on Health/Health Outcomes
Hi all,
My two cents:
1. It can be counterproductive to give a specific percentage to each dimension as they are interconnected. For example, the influence of the health care or the environment on your health is conditional on your socioeconomic means to access and use it.
2. I attach a paper (Ng & Muntaner, 2015) that examined the association between public expenditures and all-cause mortality in Canada. The authors found that spendings on "medical care, preventive care, other social services and postsecondary education” were associated with lower all-cause mortality.
Cheers,
Thierry
Thierry Gagné
PhD Candidate (Health Promotion)
School of Public Health // École de santé publique de l’Université de Montréal (ESPUM)
7101 av du Parc, office 3139, Montréal, QC, H3N 1X9
514-343-6111 ext. 4565
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On Jan 25, 2017, at 1:08 PM, Diana Daghofer <[log in to unmask]<mailto:[log in to unmask]>>wrote:
I would agree, Dennis.
I did a bit of investigating into the source of the CMA figures and was told, by the Senate research department (whose report the CMA references), that they drew the numbers from CIFAR (Canadian Institute for Advanced Research). CIFAR told me that figures are attributed to them, but were never published by CIFAR. They referred me to the CDC website: http://www.cdc.gov/nchhstp/socialdeterminants/faq.html.
That page shows a pie chart with similar figures to the CMA chart, with the proviso that: “ Figure 1 represents rough estimates of how much each of the five determinants contributes to the health of a population. Scientists do not know the precise contributions of each determinant at this time.” (emphasis mine)
If you do use the figures, Tina, I would use a similar proviso. I have been unable to find any research that substantiates the CMA figures.
Diana
From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of Dennis Raphael
Sent: January-25-17 7:22 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: [SDOH] Social Determinants of Health Impact on Health/Health Outcomes
That number is somewhat drawn out of a hat but probably accurate. I would focus on the strong evidence that once socioeconomic situation of an individual/family/community are taken into account only 10-15% of variance in health outcomes can be attributed to behaviour, suggesting living and working conditions account for most of the remaining 85-90% variance in health outcomes.
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