Three things that can make you sick

You are likely aware of how personal choices around diet, exercise, smoking and other behaviours affect health. But, there are other powerful contributing factors, ones you may not have considered,that may be out of your control.

These social determinants of health are the conditions in which you are born, live and work. They can include:

• income and income distribution
• education
• unemployment and job security
• employment and working conditions
• early childhood development
• food insecurity
• housing
• social exclusion
• social safety network
• health services
• aboriginal status
• gender and sexism
• race/racism
• disability

Roman Pabayo is an assistant professor and health researcher in the School of Public Health. Here he explains some of the key social determinants of health he has examined through his research and how they unfairly affect the health of some people and populations.

Income and income distribution

"The more money you make and the higher your social status, the more likely you are to be healthy," states Pabayo. "Money provides the means to take more personal control over your health."

He explains that the wealthiest in society also tend to be the most powerful. They are the decision and policy-makers, and may not be fully aware of, or care for, the disadvantaged.

"When the income gap between the richest and poorest widens, a society is less likely to fund the services and programs that the most disadvantaged need and would benefit from."

Social cohesion and exclusion

That income gap, and other inequalities, are tied to social cohesion.

"Social cohesion is essentially a feeling of community. It means people feel connected and like they can trust one another. They feel like they belong."

Pabayo explains that income inequality can cause people to compare themselves to others, increasing their stress level. The comparisons may trigger feelings of resentment, inadequacy and exclusion. "The lack of cohesion contributes to poor mental health and depression, which are further risk factors for chronic diseases such as diabetes, for example."

Evidence of the adverse mental health effects of social exclusion emerged from a study Pabayo conducted. The study looked at the relationship between income inequality in urban Boston neighbourhoods and depressive symptoms among adolescents. "Those who were living in neighbourhoods with higher income inequality and where there was a lesser degree of social cohesion reported more feelings of sadness, irritability and hopelessness. This was especially true for girls. "

Childhood development

The environment in which children are born and raised, and their early experiences, have both immediate and lasting impacts.

Currently, Pabayo is conducting research to discover how the social environment of schools is associated with the health of children and youth-something few studies have done.

"Children and youth spend most of their day at school," he says. "The setting provides ideal opportunities to look at how determinants including income inequality affect them. Schools also provide a unique opportunity to introduce interventions that can promote better lifelong health."