The Social Determinants of
Health and Social Justice
Elizabeth McGibbon, PhD, RN, Associate Professor
St. Francis Xavier University
Presentation for StFX Nursing 115, Jan , 2014
Today’s Presentation
• What are the social determinants of health
(SDH)?
• How do the SDH
come together or intersect
to deepen disadvantage?
• What is social justice?
• How are the SDH always
connected to social justice?
What are the social determinants of
health?
The conditions in which
people are born, grow,
live, work and age
(World Health
Organization, 2008,
2013).
What are the social determinants of
health?
The conditions in which
people are born, grow,
live, work and age
(World Health
Organization, 2008,
2013).
These conditions include
social, economic,
financial, geographic,
environmental…
The Social Determinants
of Health
• early childhood
development
• education
• employment and
working conditions
• income and its equitable
distribution
The Social Determinants
of Health
• health care services and
access
• food security
• housing security
• social exclusion/
inclusion
• social safety nets
The Social Determinants
of Health
•
•
•
•
race
age
Aboriginal status
gender
Let’s take a closer look at the SDH…
early childhood
development
Let’s take a closer look at the SDH…
early childhood
development
education
employment
and working
conditions
employment
and working
conditions
income and its
equitable
distribution
health care
services and
access
food security
food security
housing
security
social exclusion
and inclusion
social exclusion
and inclusion
social safety
nets
race
age
race
age
Aboriginal
status
gender
• A closer look at gender; Ellen Degeneres and
Bic Pens for Women ©
http://www.youtube.com/watch?v=eCyw3
prIWhc
So…How do the SDH come
together or intersect to deepen
disadvantage?
An example:
family income….
education…..gender….employment
How do the SDH come together
or intersect to deepen
disadvantage?
More examples:
race (racism)…. access to health services…
What else?......
Why is social justice so closely linked
to the SDH?
“Economic and racial inequality are not abstract
concepts, [they] hospitalize and kill even more
people than cigarettes.
The wages and benefits we're paid, the
neighborhoods we live in, the schools we attend,
our access to resources and even our tax policies
are health issues every bit as critical as diet,
smoking and exercise…”
(Larry Adelman, Executive Producer, UNNATURAL CAUSES, March
2008)
…The unequal distribution of these social
conditions - and their health consequences - are
not natural or inevitable.
They are the result of choices that we as a
community, as states, and as a nation have made,
and can make differently. Other nations already
have, and they live longer, healthier lives as a
result.”
(Larry Adelman, Executive Producer, UNNATURAL CAUSES,
March 2008)
Equality and Equity
First, what is the difference
between equality and
equity?
Equality is when everyone is
treated equally,
regardless of their
SDH…so wheelchair
ramps, no adaptations for
people with disabilities,
no scholarships or
supports for students
who cannot afford
tuition; no supports for
rural families who must
navigate the health care
system…
EQUITY is…
Equity happens when we address avoidable or
remediable differences among groups of
people… (WHO, 2013)
Some examples are public policy supports for
students in need, such as low interest student
loans; social assistance for parents who wish
to return to university; affirmative action
policies that support more women in
leadership roles…
What is Social Justice?
Social justice refers to
fair and equitable distribution
of society’s benefits and
responsibilities and their
consequences (CNA, 2006)
What is Social Justice?
Social justice refers to
fair and equitable distribution
of society’s benefits and
responsibilities and their
consequences (CNA, 2006)
When we work for social justice,
we address the social,
economic and political origins
of health inequities- the ROOT
CAUSES (Anderson et al., 2009; World
Health Organization, 2011).
© McGibbon, 2014
Evidence about the “root causes”:
What’s missing here?
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
Lack of education
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
No money for
education
Lack of education
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
No money for
education
Lack of education
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
Parents unemployed or
underemployed
No money for
education
Lack of education
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
Parents lack education
Parents unemployed or
underemployed
No money for
education
Lack of education
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
Parents lack money for
education
Parents lack education
Parents unemployed or
underemployed
No money for
education
Lack of education
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
Parents lack money for
education
Parents lack education
Parents unemployed or
underemployed
No money for
education
Lack of education
Unemployed or
underemployed
Evidence about the “root causes”:
What’s missing here?
Parents lack money for
education
Some root causes:
Public policies, Systemic
discrimination that create
structural barriers for
families and communities
Parents lack education
Parents unemployed or
underemployed
No money for
education
Lack of education
Unemployed or
underemployed
“All diseases have two
causes:
One pathological,
the other political”
Rudolf Virchow
(1821-1902)
© McGibbon, 2014
A modern
example….
Globe and Mail,
2010:
Front Page
but…
the causes of infant mortality in
‘rich’ countries, such as Canada,
have been found to be related to:
• Racism-related stress and socioeconomic hardship
(Giscombe & Lobel, 2005)
• High prevalence of low income among women who
experience serious hardships during pregnancy
(Braveman et al., 2010)
• High poverty rates and lack of access to a socialized
health care system, as is the case in the United States
(Tillet, 2010)
• Strong relationship between high poverty rates and
infant mortality among minority and white mothers in
the US (Simms, Simms, & Bruce, 2007)
• Strong relationships among poverty, racial composition
of geographic areas, and infant mortality rates (Eudy,
2009)
So what for nurses?
Social Justice is a moral and ethical
responsibility for nurses and for the entire
nursing profession, rather than a desired but
not always achievable goal
Neutrality is not an option for ethical practice…
Want to know more about social
justice and the SDH?
Nursing electives for learning about
justice 
Social Justice and Health (N364/
WMGS 364)
Policy for Health: Interdisciplinary
Strategies (N495)
….more about social justice and the
SDH