Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.[i]
Wellness as a multidimensional state of being, describing the existence of positive health in an individual as exemplified by quality of life and a sense of wellbeing. Several important characteristics included in this definition are: wellness is multidimensional; wellness is a state of being described as positive health; wellness is part of health; wellness is possessed by the individual; quality of life and wellbeing are the descriptors of wellness; and health and its positive component (wellness) are integrated[ii]. Determinants of wellness for Indigenous peoples have also been described; these arise from an Indigenous world view, the Medicine Wheel, and traditional knowledge, and reflect the diversity of Indigenous peoples and traditions across Canada.[iii]
Social Determinants of Health (SDOH)
According to the World Health Organization, the social determinants of health are defined as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries”[iv].
The York University Conference Model (2002) has proven especially useful for understanding the SDOH and why some Canadians are healthier than others. Each of these social determinants of health has been shown to have strong effects upon the health of Canadians. Their effects are much stronger than the ones associated with behaviours such as diet, physical activity, and even tobacco and excessive alcohol use[v]. The 14 social determinants of health in this model are:
- Aboriginal status
- early life
- income and income distribution
- employment and working conditions
- social exclusion
- food insecurity
- social safety net
- health services
- unemployment and job security
Health equity means that all people can reach their full health potential and should not be disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status or other socially determined circumstance.[vi]
Structural violence includes colonial violence and any systemic conditions that perpetuate discrimination, oppression, stigma or powerlessness. It is a “major determinant of the distribution and outcomes of social and health inequities”. Structural violence is increasingly seen in public and population health as a major determinant of the distribution and outcomes of health inequities.[vii]
Structural inequities refer to how policies and practices embedded in systems such as social welfare, economic, justice and health care operate to produce inequitable distribution of the determinants of health.
The terms ‘marginalized,’ ‘vulnerable’ or ‘disadvantaged’ refer to the conditions and processes by which particular populations are affected by structural inequities and structural violence in ways that result in a disproportionate burden of ill health and social suffering. An emphasis should be placed on marginalizing conditions to suggest that particular populations are not inherently marginalized, rather, it is the marginalizing conditions that create and sustain inequities.