Promoting Newcomer Health
The Social Determinants of Health
The social determinants of health (SDH) are the social and economic factors that influence people's health. These are apparent in the living and working conditions that people experience everyday. The SDH influence health in many positive and neagative ways. Extreme differences in income and wealth for example, have negative health consequences for those who are living in poverty...
Source: Canadian Public Health Association
Among the variety of models of the social determinants of health that exist, the one developed at a York University Conference held in Toronto in 2002 has proven especially useful for understanding why some Canadians are healthier than others.
The 14 social determinants of health in this model are:
Source: Dahlgren, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Futures Studies.
Aboriginal status
Gender
Disability
Housing
Early Life
Income and Income
Distribution
Education
Race
Employment and working conditions
Social exclusion
Food insecurity
Social safety nt
Health services
Unemployment & job security
Each of these social determinants of health has been shown to have strong effects upon the health of Canadians. Their effects are actually much stronger than the ones associated with behaviours such as diet, physical activity, and even tobacco and excessive alcohol use.
Source: Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives, 2nd edition. Toronto: Canadian Scholars’ Press.
“Poor and unequal living conditions are the consequence of poor social policies and programmes, unfair economic arrangements, and bad politics”.
Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
Governments make choices when making SDH-related public policies. Choosing to overlook the impact on the social determinants of health is not a prescription for a healthy Canada. Although the social determinants of health are complex and intertwined, good public policy created by informed governments can strengthen these social determinants and provide means of both promoting health in general and reducing health inequalities to a minimum.
Newcomers and Access to Health Care
have a family doctor
85% of newcomers have a regular doctor
compared to
91% of longer-term immigrants
and
87% Canadian-born residents
Newcomers are less likely to:
use some types of preventive healthcare
Fewer Pap tests
54% of newcomer women had a pap test in the past 3 years compared to 70% of longer-term immigrants and 80% of Canadian-born residents.
Fewer mamograms
38% of newcomer women had a mammogram in the past 2 years compared to 57% of longer-term immigrants and 54% of Canadian-born residents.
Fewer dental visists
79% of newcomers had visited a dentist in the past 3 years compared to 89% of longer-term immigrants and 92% of Canadian-born residents.
Newcomers are less likely to:
Source: Toronto Public Health and Access Alliance Multicultural Health and Community Services, The Global City: Newcomer Health in Toronto
Barriers to Accessing Health Care
Seven key barriers to health services
1. Awareness of services
Many newcomers are unaware of health services and have difficulty understanding the local health care system. This can be especially challenging for newcomers with limited English language proficiency.
2. Language
Professional language interpretation is not widely available for health services. One study found that only 55% of organizations in the Toronto Central Local Health Integraiton Network (LHIN) use professional interpreters and that interpreters were used in only 25% of the situation where they are needed.
3. Stigma
There may be stigma, shame or embarrassment associated with accessing services for certain health issues such as mental illness, sexual helath and HIV/AIDS.
4. Socio-cultural beliefs
Beliefs about health and illness can affect the kinds of health services that some newcomers access.
5. Cultural competency of service providers
Some newcomers report that health services are not sensitive to their cultural or religious beliefs. In some cases, newcomers report experiences of discrimination and racism when accessing health and other services. These experiences may lead to distrust and discourage newcomers from seeking or continuing care.
6. Cost
Cost is a key barrier to accessing dental services, vision care, prescription drugs, counselling and other services that are not covered by the Ontario Health Insurance Plan (OHIP).
7. OHIP Eligibility
Refugee claimants, undocumented residents and some temporary workers are not eligible for the Ontario Health Insurance Plan (OHIP). Permanent Residents to Ontario must also wait for three months to receive OHIP coverage. Recent changes tot he Interim Federal Health Program have reduced or eliminated temporary health care coverage for refugees and refugee claimants who do not qualify for provincial or territorial health insurance plans.
Source: Toronto Public Health and Access Alliance Multicultural Health and Community Services, The Global City: Newcomer Health in Toronto
Some Myths and Facts
