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Key determinants of Health as per Upstream, midstream and downstream

Discuss about the Social Network Determinants of Depression.

Canada is situated in Northern part of North America. It is a second largest country in the world after Russia, it covers almost around an area of 9.98 million square kilometres. Total population of Canada is 35,151,728 out of which 1,673,785 are aboriginal Canadians.   With fifteenth highest nominal per capita income, Canada gets a status of a developed nation globally. It positions among the highest international measurements of life quality, government transparency, economic freedom and education (Globaledge, 2018). Beside that the country is facing many issues which are related to socio economic status determinates of health such as income status, Government policies, education, culture and many more (Blackstock, 2011). This report contains the Upstream, Midstream and Downstream socio economic determinates and their negative impact on the indigenous population of country. In continuation this report contains, the current initiative taken by the Canadian Government and their Health Department to control the effects of socio-economic determinates and afterwards the recommendations have been stated, which contains the innovative ideas to address the issues related to socio-economic determinates of health.

A Socio-economic condition is an amalgamation of sociological and economic measures of economic and social position in relation to others or personal work experience of an individual.  It is referred to an individual level of wealth, income, prestige and education. Social economic position is been connected to the well-being of young children and adults. The social economic conditions are typically divided into three levels high, low and middle, to explain the three variables, an individual, family and society. And when an individual or family or society once characterized into these three levels than the three variables can be assessed as per economic conditions (Business discovery, 2018).

Inequalities in Health refer to variance in statues of health. These variances can be due to, individual choice or chance or biological factors, but public health evidence that many of these variances contribute to the unsatisfactory distribution of the socio-economic features that affects the health condition of individuals. And it also provides exposure to social environments and conditions which are beyond the control of individuals (World Health Organisation, 2018).

The macro level determinants are related to upstream determinants of health, it includes government policies, international influences, and the fundamental determinants of health which includes social, physical, economic, and environment. The midstream determinant of socio economic condition includes behaviours related to health, psychosocial factors and the part played by the health care system. The micro level or downstream determinant includes variations in physiological system and biological functioning and these factors provide stimulus value to functioning of the upstream and midstream levels (Brownson, Seiler & Eyler, 2010).

Social status and Income: Health status of people enhance with the rise in the income status. High income determines that the living conditions of the individuals are really good and they are living a safe and healthy life and they are efficient to buy adequate amount of goods and food. The fittest population as per health conditions are those which are wealthy and have an equal distribution of income. If the income of an individual is low or he/she is living below poverty line that will definitely affect their health. As their living conditions are not good they are lacking in money and this will lead to bad health. Low income also affects people mentally and physically. In case the low income individuals fall ill if he/she does not have much money to pay their medical bills. And low income also affects the economy of country (Zitko, Jones, Lynch & Araya, 2013).

Social status and Income

There are 43% of indigenous Canadians were working for a monetary income in compared to 61 %Total Canadian in 2006. Later Aboriginal people of core working age 25 to 54 increased to 65.8%. Despite this increase in the employment rate of aboriginal people is still far less than general population. The low income of indigenous Canadian will effect there health and this will increase the chances of earlier death of indigenous Canadians and they suffer more illness than high income holder indigenous Canadians and general population, regardless of place of residence, sex, race, and age. At each increasing level of income indigenous Canadians suffers less illness, get improved health and live longer life expectation (Hadley, 2014).

Social Support Network: The support which is given by the friends, families and communities will help in providing better health condition. This type of social support network could be very helpful in problem solving of people and also help in transact with hardships, as well helps in retaining a sense of mastery and control over life conditions (Rosenquist, Fowler & Christakis, 2011). As per National Population Healthy survey report, out of five there are four indigenous Canadians need someone on whom they can rely on in the crisis, to advice, and someone who makes them feel cared and loved (Bryant, Raphael, Schrecker, & Labonte, 2016).

Education and Literacy: Socio economic condition is closely related to education. A lifelong learning to adults and an effective education to children will contribute to the prosperity and health for country and individuals. Education equips the individuals with skills and knowledge, and also help in providing a sense of control over life situations. Education increases security through generating income and by providing satisfaction and opportunities in jobs. It also expands ability in people to understand and access statistics to keep the inhabitant healthy (Sorensen, et al. 2012). Aboriginal Canadians are having low literacy skills and among them many are unemployed and poor in comparison of non- indigenous Canadians this lead to the earlier death and poor health because they don’t have much money to pay their medical bills and individuals with higher qualification level have improved access to strong physical situation and they are capable to avail better education and health facilities for their children.

Working Conditions and Employment: Underemployment, unemployment, or insecure works are closely related to deprived health. The people who work in stress free working environment suffer less with health issues in comparison to those who work in a stressful work environment or who are jobless. Employment has important consequences on a physical, mental, and social health of people. Pay receives from work, not only provide cash but it also provides a great sense of purpose and identity, chances for individual growth and social contacts. When the individual misses these aids it will disturb them and their family member’s health. Conditions at work can have a reflective effect on individual emotional well-being and health (Reutter & Kushner, 2015). The condition of indigenous Canadians balanced in comparison of other residents of Canada in present but can be worse in future because the young indigenous Canadians are not interested in taking higher education. Due to that they will not get good jobs and high position in the organisation. The non-indigenous Canadians will overtake the jobs and only low profile jobs will left for the young indigenous This condition will increase the level of stress and due to that their health conditions will get affected and because they are not having good job they will get less salary they won’t be able to pay hospital bills and this will make them sicker.

Social Support Network

Social Environments: The significance of communal support is spread over the community. A strong social connection inside the country, community or region provides strength. The norms and value of society influence the well-being and health of the individuals and population. On other hand safety, good working relationship, social stability, and organised groups deliver a compassionate society that decreases or avoids numerous possible threats to good health.  A fit life style can be gain through a extensive explanation of public actions with three inter-related proportions these are individual, individuals within their social environment which include family, community and workplace,  and the relation between individual and their social environment (Pouliou, & Elliott, 2017).

Physical Health or Environment: The determinants of socio economic conditions which are related to health are considered to be very harmful for environment in which people lives. Polluting the natural resources like air, soil, water or food can cause a variety of contrary health effects which give invitation to the disease like birth defects, gastrointestinal ailments respiratory illness and cancer. Among indigenous Canadians the commonness of childhood asthma, a respirational sickness that is extremely sensitive to airborne impurities has augmented sharply over the last two decades, particularly among age group of 0 to 5 (Willox, et. al. 2015).

Coping Skills and Personal Health Practice: Personal Health practice and handling skills are those activities by which individuals can prevent them from stimulate solve problems, disease and self-care, cope with challenges, develop self-sufficiency and make choices that enhance health. In Canada depression is projected to be blameable for at least one-quarter of all deaths for grownups between the ages of 26 to 59. The depression increase chances of suicide if it is not well treated. The indigenous women suffer more desperation in comparison to other Canadian men and women. If the depression is not treated that will affect their health and because of that they may attempt suicide. (Sibley & Weiner, 2016).

Genetic and Biology Endowment: The simple organic and biology makeup of the human body are an important cause of issues related to health. Hereditary legacy provides an inborn inclination to an extensive variety of discrete responses that affect status of health. Even though environmental factors and socio-economic status are significant determining factor for complete health, in some situations hereditary legacy appears to predispose certain individuals to health problems or specific diseases (Krewski, et. al. 2014).

Health services: In this determinant the services of health mainly includes those planned factors which are helpful in continuing and promoting health service and to restore wellbeing and prevent diseases and functions contribution to health of population. The services of health, range of care includes secondary prevention and treatment. The additional report on Canadians Health evidence that injury and disease prevention actions in area such as immunization and the use of mammography are viewing optimistic results. These actions must remain if development is to be maintained (Krewski, et. al. 2014).

Gender: It refers to the group of behaviours, attitudes, personality traits, relative power, society-determined roles, values, and affect the society attributes to the two genders on a differential basis. As per report on health indigenous Canadian Men in comparison of women likely to die premature due to disease like cancer, hearth or by suicide.  On the other hand women who are living a longer life are stuffing from depression, stress overload and they spend their entire life on anti-depression pills (Willox, et. al. 2015).

Education and Literacy

Culture: Certain individuals or group of people may experience extra threats related to health due to socio economic environment, which mainly define by leading cultural ethics that contribute to the preservation of circumstances such as relegation, loss or deflation in culture and language and absence of admission to culturally appropriate services and care related to health (Greenwood & de Leeuw, 2016).

In 2012, Canada along with World Health Organisation and its Member states, endorsed the Rio Political Declaration on social Health Determinates, and pledge to take action to promote health and equity in the country. Strengthening the capacity to monitor and report on health inequalities was recognised as a critical foundation for achieving meaningful progress towards this goal (Canadian Public Health association, 2017).      

The Canada is doing impartially fine by standard health status indicators. The life expectancy ratio of birth currently is 80 years that it is highest in the world among which first nation males and females in Canada average expectancy birth ratio is 68.9 year and 76.6 and general population men is 76.3 years and women is 81.8 years.  The mortality rate has progressively fallen over the last four decades from 27 per 1000 births in 1990 to just 5 per 1000 in 2004. For First nation mortality rate is 7 out of 1000. The Canadian Government always support indigenous Canadian there policies which government design always include balancing the allocation of resources across every program and activities determining causality of disease and disability and identifying the most effective interventions for promoting heath or treating illness. Recent government decision support the creation of National Aboriginal Health Organisation as well as Institute of Aboriginal Peoples Health and Canadian Institute of Heath research which will address the issues of aboriginal resident of Canada. To address the inequality in Health condition of the aboriginal resident of Canada following steps are taken by the designed bodies:

Improve Daily leaving conditions: The Canadian government has keep their focus on making effective programs and policies that deliver access to equal opportunities for education for aboriginal girls and boys, safe shelter, decent jobs for all, early childhood support, clean water, education for females, and universal access to health care with a focus on primary health. Investing in initial childhood growth is best way to reduce inequities in health and education for females is a speculation that will pay itself numerous times over. Equity in health at the heart of urban governance and planning will address the requirements of over 1 billion aboriginal residents who live in urban slums.

Address the discriminatory in distribution of power, money and resources: The government has support and create the social and political structures that will address the problems of ethno-racial inequality and gender, and support for aboriginal society, creates good supremacy, and an accountable private and public sectors. The Government system has more reasonable and create fairer systems through which events such as income redistribution, benefits plans, pension and progressive taxation and gender equality will do much to diminish the health gaps between general resident and aboriginal residents of Canada.

Working Conditions and Employment

Understand and Measure the problems and evaluate the impact of action: There are many evidences exist right now which are showing that the government is acting on the determinate of health for improve aboriginal population health. It will lead to set up action on global health equity investigation and monitoring, training infrastructures and in the end it focus on evaluation and investment to measure the impact of set action.

Adoptive Collective will and leadership: It become the priority of aboriginal Canadian society to address the health gaps by spreading awareness and by acknowledgment of social economic health issues, collection of proper data to measure and monitor development and involving leaders across all subdivisions of society to take up the cause for dropping inequality in health.

Reduction in child Poverty: The Government of Canada is investing more to fulfil the needs that will give a kick start to health among aboriginal Canadian children, the child poverty is the big issue in front of the government and they have taken many initiative to reduce the child poverty as the children are future of country and if they not kept in good conditions then the future of country will be in danger. For removal aboriginal child poverty the government has started a redeployment programs, and the main aim of this program is to support the children who belongs to the low income families and they are also trying to provide housing and food supports, education opportunities to the poor children.

Strengthen Community: The individual is a part of community and if the community become strong the individual who is a part community will automatically become stronger. This thought leads the government to take initiative to make the aboriginal communities more strong in the country. With help of this initiative of the government, community will be honoured and support to advance their own responses to build on, experience, existing knowledge and energy and that will develop their ground level (Government of Canada, 2018). 

These are few steps taken by the Canadian government to bridge the gap of social economic determinant of health in the country. Besides these steps the condition of aboriginal Canadian are not getting much better,  5 out of 10 aboriginal Canadian presently die due to cancer or cardiac disease, among which few cases are preventable. While the early death rates have dropped progressively over previous 50 years in 2005 42% of all Canadians over the age of 11 were recorded and for aboriginal Canadian it was only 33%. The lingering disease such as asthma or other breathing problems, arthritis, diabetes, mental health disorder, heart disease, high blood pressure, and cancer are the main reason behind the increase number of in death of aboriginal residents. Currently obesity is present as an important health challenge in front of Canadian government, there are 24% of all adult are overweight in 2002 which was increased to 35% overweight in 2005 among those 35% the aboriginal resident are more obese it is around 67%. Canada is having the highest rate of obesity among men in the world (Gore, 2016).

Social Environments

As discussed in the report that determinates of socio economic conditions are affecting the health of the aboriginal of Canada on large scale and to protect the population and to bridge the gap of health the Canadian government and their health care department are taking lots of measures. But these measures are not enough for addressing the determinants. To make a really effective plan and enhance health policies the Canadian government or Health Department should create or design an action plan to resolve the social economic causes of health. And the responsibilities and duties need to divide according to the plans and policies design by the government, this process will really help in improving the health inequality there are few steps which a government or health department can follow:

  1. Adopt proper governance for health and development: First the government need to build a coordination and alignment between diverse segments and diverse types of organisation those are in the chase of health and development as a shared goal. Then they need to develop the governance, by which all divisions take responsibilities for dropping inequities in health. It is important for every country to achieve health and development goals. The governance will help in developing understanding on promote health in their all policies, working with other sectors, developing operative strategies with measurable and clear outcomes that shape responsibility for communal determinants of inequities in health and health.
  2. Encourage participation in policy making and its implementation: To apply governance it is essential to develop a culture of participation that will ensure the equity and accountability. Participation will really help in safeguarding the fairness of principle and safeguard its inclusion in public policies. With the help of governance the partaking, includes other aspects such as individual partaking in services or partaking of societies and civil culture groups in the design of public policies, in monitoring the implementation and assessment of crucial actions on social economic determinants.
  3. Change the focus of Health sector toward reducing inequities in health and promoting health: The poor performing health sector is a major obstacle of health care and is a serious determinant social of health. According to socio economic status there is high level of disparities in the circulation of services related to health is been occurred and to address these issues of health it is required that focus of health care sector should be shift to promotion of health activates. By promotion of the health activates a well performing health system can be introduced by the government which will improve health outcomes and improve health equity. It will require a support and concerted efforts from different sectors which includes Government, civil society organisation and academia.
  4. Strengthen Governance and collaboration: The contribution to local and national action on social economic determinants requires enhancements in governance. It is very important for the government that when the governance or policies are developed they have to maintain it. Proper financing and incorporation of effective technologies are required to strengthen the governance and collaboration. The asses of financial resources and technical cooperation and coordination will promote health equity.
  5. Monitor progress and increase accountability: Monitoring of social economic determinants requires the data collection and the distribution and submission of these data to design the policy process. The measurement involve in the inequities of health are comparatively more developed then social production of disease and health. The collection of less information data regularly or on daily bases, which include the circulation of environmental and social threats for ill health, is scarcities of information barrier to monitor the effects of policies which are develop by the government and also to evaluate the evidences based on interference on social determinants to lessen inequities.


To conclude, as the economy of Canada is really strong and it is among a few developed nation and due to that, the health conditions of the Canada are quite well but the conditions of the aboriginal or indigenous are not good and this is due to the socio economic determinants which are affecting their conditions on large scale. The government of Canada has taken few initiatives to reduce down the effect of these determinants and up to some level they got succeed but the effects are not reduced as much as planned and designed, and for that the government need to redesign their policies and governance. The new policies and governance will element the risk of unequal distribution of income, poverty, health inequalities and lead the economic growth of the country as a whole which includes both aboriginal population and general population.


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