CanMEDS Health Advocate
What are the determinants of health?

What are the determinants of health?

DPI/UN Photos


Health Canada has identified 12 determinants of health [3]:

  1. income and social status 

  2. employment 

  3. education 

  4. social environments 

  5. physical environments 

  6. healthy child development 

  7. personal health practices and coping skills 

  8. health services 

  9. social support networks 

  10. biology and genetic endowment

  11. gender

  12. culture










The recent WHO report Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health (link to report) unequivocally identifies social determinants of health as major factors in illness. 

  • A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away.

  • A girl in Lesotho is likely to live 42 years less than another in Japan.

  • In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17,400; in Afghanistan, the odds are 1 in 8.

Biology does not explain any of this. Instead, the differences between countries and within countries result from the social environment where people are born, live, grow, work and age.[2]


This Closing the Gap document gives a fascinating look at various diseases nationally and internationally in various countries.  One can see that high priced Western style health care is not necessarily the answer to many health problems.  For example, Cuba’;s infant mortality rate is similar to Canada's at far lower costs [4].  Senator Keon writes about  Cuba’;s polyclinics which focus on primary care and collaborative programs.  These polyclinics have been effective in various prevention and screening initiatives.  Cuba’;s example of "good health at low cost" is something we can all learn from.






2. WHO Closing the Gap: Commission on Social Determinants of Health-final report

3. Health Canada. Women's Health Strategy, Women's Health Bureau, Health Canada, 1999. http://hc-sc.gc/english/women/womenstrat.htm

4. Keon WJ. Cuba's system of maternal health and early childhood development: lessons for Canada.CMAJ. 2009 Feb 3;180(3):314-6.

All references for this section