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Social factors affect public health

The Northwestern Health Unit released a report this month about the social determinants of health, including income, education, employment, inclusion, and housing, and how they affect the health of residents of the Kenora and Rainy River Districts.

Using statistics from numerous sources, the report makes several key points, such as:

•the average income of catchment area households is less than the provincial average;

•the employment rate for the catchment area is below the provincial average; and

•although the majority of households reported being “food secure,” the cost of feeding a family of four for a month keeps going up, increasing 11 percent in 2010.

Medical Officer of Health Dr. James Arthurs said the purpose of the report is to raise awareness of the complex factors affecting public health.

“It’s about everybody and how their behaviours differ depending how they grew up and what their income is and what their parents were like, the house they grew up in, the school they went to, and on and on,” he explained.

Dr. Arthurs said information from the report will help the health unit in getting its public health messages out, especially through social media.

“We may well have the right message for you but you may already have that message,” he noted. “The people who are most vulnerable, who live on the lower edge of the economic scale, and in poorer housing or in some places, no housing at all, they just don’t have the same advantages.

“Some people may say, ‘Well, that’s how it goes. We made some good choices and we’re better off. They made some bad choices and they’re not so well off,’” Dr. Arthurs conceded.

“But ultimately, that costs all of us some amount of time and money,” he stressed. “We pay a lot of taxes and we don’t know always what we get back from them.”

Dr. Arthurs said the Northwestern Health Unit will be taking a close look at this information and figure out how they can use it to improve public health.

For example, the health unit can’t control the cost of food but it can educate people on healthy eating and food preparation, and partner to offer a “Healthy Living” food box program.

It also will identify what the health unit has no control over but district municipalities and individuals might, which is important to delineate when dealing with community partners.

For example, the health unit can promote exercise but it’s up to municipalities to build parks and bike lanes and maintain them, and it’s ultimately up to individuals to get on their feet and move.

The report identified “promising practices” are being done by the Northwestern Health Unit to “reduce social inequities in health.”

These include reporting on health equities, conducting equity-focused assessments, making health equity a priority in the organization, engaging the community, and working with partners.

The Northwestern Health Unit will take action by:

•incorporating a “health equity lens” into program planning;

•disseminating this report as an advocacy tool, a reference document, and a discussion starter;

•introducing a position on the social determinants of health that shows its organizational commitment to addressing health inequities;

•increasing outreach to priority populations with community nursing positions; and

•sharing information about determinants of health and health inequities with the public and community partners.


“Income can determine our living conditions, the kind of food we buy, and our social activities,” the report noted.

“Research tells us that people with higher incomes are more likely to report that they have excellent or very good health, live longer and have fewer illnesses,” it added.

Average household income is reported by the median income–the mark at which 50 percent of census families report earning more income and 50 percent report earning less income.

In 2005, the average after-tax household income for both the Kenora ($52,896) and Rainy River ($57,362) districts was lower than that found for census families in Ontario ($59,337).

Inequality in health is growing as the gap between the rich and the poor gets larger, the report indicated.

In Rainy River District, female-led lone-parent families continue to be the most economically disadvantaged, reporting a 53 percent lower median after-tax income than male-led lone-parent families ($26,248 versus $49,501 after-tax income).

In the health unit’s region in 2010, almost 1,000 residents, couples, and families received social assistance income support.

Employment and

working conditions

Employment, job security, and working conditions affect both physical and mental health, according to the report.

“Income from work provides a practical means to contribute and be part of society,” it noted. “More control over our work translates to more control over our health.

“The social organization of work, management styles, and social relationships in the workplace all affect how healthy we are.”

The employment rate represents the number of people employed in the week prior to census day.

The employment rate for 2006 in the Northwestern Health Unit’s catchment area was 59.6 percent—below the provincial rate of 62.8 percent.

In the area, residents reported a higher percentage of workers in apprenticeship and trades compared to Ontario (19.1 percent versus 14.1 percent), which is a reflection of the division of labour across the province.

Primary industries reflect the type of employment available to residents. Natural resources comprise nine percent of primary industry versus 2.9 percent for Ontario.

Health care and social services make for 14.3 percent versus 9.4 percent for Ontario while education comprises 8.2 percent versus 6.7 percent for Ontario.

Between 2003-08, 4,855 residents left the Kenora and Rainy River Districts. More than half of these residents were of working age (between 18-44).


“Education influences our sense of control over our lives,” the report stated. “Higher education increases opportunities for employment, income, and job security.

“Persons with higher education are more likely to be physically active, have access to healthier foods, prepare their children for school, and are less likely to smoke,” it added.

The Northwestern Health Unit area has more high school graduates aged 25-34 than Ontario (28.9 percent compared to 23.8 percent) but less university graduates with diplomas or degrees than Ontario (13.3 percent versus 32.7 percent).

Social inclusion

and support

Inclusion and social connection increases one’s ability to deal with adversity, defined the report.

“It provides us with a sense of community, feelings of belonging, and means we get to participate in the things we want to join,” it noted.

“Those who are strongly connected to the community are less likely to be involved in risky health behaviours.”

In 2010, residents aged 12 and older in the Northwestern Health Unit area reported a higher sense of community belonging than the rest of Ontario (73.3 percent versus 67.7 percent).

Since 2003, however, this has been declining in the area (down from 77.4 percent) and increasing in Ontario (up from 64.4 percent).

Food security

“Adequate food and food supply are central to good health,” the report found. “Everyone has the right to enough safe, nutritious, and culturally-acceptable food.

“Families or households that experience food insecurity are more likely to report poor or fair self-rated health and chronic health conditions,” it continued.

In 2007-08 in the Northwestern Health Unit area, 94.4 percent of households reported being food secure compared to 92.3 percent for the province.

But the cost of eating keeps rising in this area at a rate much faster than income or social assistance.

In 2010, for instance, the cost of feeding a family of four for a month increased 11 percent to $916.53, compared to $732.51 for that of Ontario (up only slightly from $729.61 in 2009).


Housing is a necessity in life. Lack of affordable, acceptable housing impacts health in many ways, noted the report.

“High-cost housing affects the resources that we have left over for living, which can lead to stress and increased sickness,” it warned.

“Homeless people experience poor health status and have limited access to care.

“Poor housing conditions from lead, asbestos, cold, heat, radon, dust mites, and bed bugs are linked to negative health outcomes,” it added.

In the Northwestern Health Unit area, the Kenora and Rainy River district services boards have social housing units (public non-profit, municipal or federal non-profit, and rent supplement) available for people in need.

However, there are fewer than 1,600 housing units available—and waiting lists are common.

Information from the two district service boards suggests that in 2011, around 170 seniors and 315 families are waiting for social housing units.

There are six women’s shelters in the Northwestern Health Unit area. In 2010, for those shelters that provided information, there are at least 36 shelter beds and at least 19 units (which may have one-three bedrooms).

It is reported that shelter staff provided assistance to almost 800 women and children, and dealt with almost 5,000 crisis calls.

The full report is available online at

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