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Reduce Differences in Health Status Build Healthy Public Policy Strengthen Community and Personal Action
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What Makes Us Healthy, What Makes Us Sick?
One way to investigate what makes us healthy and what makes us sick is to use the determinants of health approach, integral to the research that is being done at the Centres of Excellence for Women’s Health. This approach offers a means to examine health in the context of everyday life by recognizing the complex interplay of social, political, environmental and economic conditions in producing health. This issue of the Research Bulletin highlights some recent work from the Centres on the links between women’s health and their social and economic circumstances. With the release of A New Perspective on the Health of Canadians¹—the now famous Lalonde Report—in 1974, Canada became the first national government to articulate the importance of factors beyond the health care system that promote or diminish health. While the Lalonde Report named four factors as determinants of health (human biology, environment, lifestyle and health care organization), today Health Canada recognizes 12 determinants: income and social status, employment, education, social environments, physical environments, healthy child development, personal health practices and coping skills, health services, social support networks, biology and genetic endowment, gender, and culture. Significantly, both sex (biology) and gender are recognized in this list as determinants of health and the emphasis on lifestyle has been reduced.² The power of such a list is that it reminds us to recognize the limitations of considering health services or biophysical endowment in isolation from the rest of life. Yet any list runs the risk of omitting some aspect of women’s lives. For example, the migration experience has not yet been identified as a determinant of health, though there is growing evidence of its importance to health and illness.³ This issue of the Research Bulletin highlights two studies that consider this as a determinant. Some of the research presented in this issue may also indicate the need to constantly consider the interaction of multiple factors. Indeed, the complexity of women’s health in its everyday context makes it difficult to study a single determinant. A project that examined the midlife health needs of women with disabilities, for example, suggests that a middleaged woman with a disability may have difficulty, financially, accessing exercise programs; exercise equipment adapted to her physical needs is scarce; social contact and support is hard to find; and accurate information about the interaction of disability with menopause does not exist. All of these factors interact and may affect a woman’s health at midlife. Other articles in this issue illustrate how social isolation, economic restructuring, homophobia, geography, poverty, public health policy, and weak language skills can undermine women’s well-being. In contrast, several articles suggest that collective action, personal empowerment, social relationships, strong public health policy and a healthenhancing physical environment can help maintain and foster good health. Thus the message from this issue is that even as we need to understand more about what makes women sick, we also need to ask ourselves what makes women healthy. A strength of the determinants of health approach is that it shows that many of these factors are changeable—with sufficient individual and collective action. A risk that could arise from this important understanding, however, is that by demanding individual responsibility we overdo it and further burden the affected individual by blaming them for their illnesses. The health promotion strategies outlined in the Ottawa Charter offer some safeguards against this by suggesting how we can support both individual and collective action by building healthy public policy, creating supportive environments, strengthening community action and reorienting health services toward prevention. 4 As we face the continuing reality of health reform—most recently apparent in the Romanow Commission on the Future of Health Care in Canada—finding answers to what makes us healthy and what makes us sick is more important than ever. 5 New evidence continues to be needed to ensure that we are making the maximum difference where it is needed. This means understanding not only acute medical conditions and how to optimally organize health services, but also what enhances and threatens health outside the hospital doors. Ann Pederson NOTES |
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