As a midwife from Manitoba I am all too familiar with the social determinants of health and the disparities and barriers Canadians from different walks of life face in achieving and maintaining good health and gaining access to quality health care. Manitoba is one of Canada’s “have not” provinces with a significant amount of the population living below the poverty line and/or living on reserve with abysmal and unaffordable access to clean water, fruits, vegetables and other healthy food. I have worked on reserves where a bag of chips and a 2 litre of pop were cheaper to purchase than anything fresh and healthy. I once purchased a red pepper for $8 in Norway House, MB! It was an astronomically high price and I complained (loudly) but at the end of the day, caucasian and gainfully employed, I was still able to procure a healthy meal for myself. This is so often not the case for many Canadians and the impacts on health over one’s lifetime lead to a major disparity in quality of life and burden of disease.
As Bryant T, et al. discuss, there is direct correlation between income and health in Canada which has “increasingly led to a “privatization of security” whereby security is (financially) guaranteed for the wealthy and rather less so for the poor and disadvantaged [135]”. The research is clear, the more socioeconomically disadvantaged one is, the more likely an individual is to suffer from poorer health over their lifetime. I would argue that Canada’s First Nation’s population is the hardest hit by this truth. Living on reserve, racism, poverty, lack of cultural competency by the primarily white health care system have all contributed to the Aboriginal population carrying a disproportionate percentage of the disease burden in Canada. And as health care workers we have to do better. Reading and Wein do excellent job of reviewing the multifaceted and complex inequities that have led to the disparities that Aboriginal people face that lead to a less healthier life with higher rates of everything from asthma to diabetes to obesity.
Working in health care means trying improve health and health outcomes for ALL. To me this means treating each patient I meet with compassion and respect while helping them figure out how to overcome the unique obstacles in their path while recognizing that the reasons for an individual’s poor health are systemic and complex.
References
Bryant T, et al. Canada: A land of missed opportunity for addressing the social deter-minants of health. Health Policy (2010), doi:10.1016/j.healthpol.2010.08.022
Reading, C.L. & Wien, F. (2009). Health Inequalities and Social Determinants of Aboriginal Peoples’ Health. Prince George, BC: National Collaborating Centre for Aboriginal Health.La
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