Comparing social determinants of self-rated health across the United States and Canada
Highlights
► Study compares social determinants of health across Canada and the U.S. ► Size of effects of social determinants on health differs across the countries. ► Gender, race, nativity, education, BMI, life satisfaction have larger effects in U.S. ► Age, marital status, income, unmet health care needs have larger effects in Canada. ► Results reflect differences in social context, welfare policies of the countries.
Introduction
As wealthy developed nations, Canada and the United States share many similarities in history, culture, and living standards and styles. The two countries also differ in other important ways, namely in the funding, organization, and delivery of health care and other social welfare programs, distribution of income, and social inequities, which likely have implication for health determinants within and between the two countries (Evans and Roos, 1999, Navarro et al., 2006, Siddiqi and Hertzman, 2007, Siddiqi and Nguyen, 2010). It is within this context that this study examines the effects of social determinants of health across Canada and the United States.
Section snippets
Background
Social, demographic, economic, and behavioural risk factors play an integral part in shaping the health of Canadians and Americans alike. Collectively these factors are known as ‘social determinants of health.’ Social determinants do not exist in isolation from each other, but combine to determine the health of individuals, communities, and populations (Berkman and Kawachi, 2000, Kawachi and Kennedy, 2002, Link and Phelan, 1995, Link and Phelan, 1996, Marmot and Wilkinson, 2005, Phelan and
Data
U.S.-Canada comparative research on health outcomes has often encountered problems because of the lack of comparable data and/or sample design. The Joint Canada/United States Survey of Health (JCUSH) was conducted by Statistics Canada and the National Center for Health Statistics between November 2002 and June 2003 to overcome these problems. Given the use of a single survey and a standard methodology across countries, the JCUSH provides a unique opportunity to directly compare social
Bivariate results
Table 2 reports rates of self-rated health by each variable within each country. The columns labelled “CND” and “US” show associations between each variable and self-rated health within Canada and the United States respectively. The results in both countries are generally consistent with the social determinants of health model, where the associations between sociodemographic, socioeconomic, and risk and health care access factors and self-rated health are significant and in the predicted
Discussion
Cross-country comparisons provide a unique opportunity to examine how differences in the social context of countries shape social determinants of health. No research to date has explicitly assessed and compared a social determinants of health model across Canada and the U.S. To fill this gap in the research literature, the current study examined the effects of social determinant variables, as illustrated in Fig. 1, within and between the two populations using data from the Joint Canada/United
Acknowledgement
The author wishes to thank the anonymous reviewers for their constructive and helpful comments on earlier drafts of this paper. Financial support from the SEDAP (Social and Economic Dimensions of an Ageing Population) Research Program, which is funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) through Grant No. 412-98-0008, is gratefully acknowledged.
References (73)
- et al.
Heterogeneity in the determinants of health and illness: the example of socioeconomic status and smoking
Social Science & Medicine
(2000) - et al.
Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health
Social Science & Medicine
(2004) - et al.
Gender differences in structural and behavioral determinants of health: an analysis of the social production of health
Social Science & Medicine
(1999) - et al.
Does inequality in self assessed health predict inequality in survival by income? Evidence from Swedish data
Social Science & Medicine
(2003) - et al.
Socio-economic status and the utilisation of physicians’ services: results from the Canadian National Population Health Survey
Social Science & Medicine
(2000) - et al.
Sociodemographics, self rated health, and mortality in the US
Social Science & Medicine
(2003) - et al.
Socioeconomic status and health-related quality of life among elderly people: results from the Joint Canada/United States Survey of Health
Social Science & Medicine
(2008) - et al.
Self-reported hypertension prevalence and income among older adults in Canada and the United States
Social Science & Medicine
(2010) - et al.
Tracing the social gradient in the health of Canadians: primary and secondary determinants
Social Science & Medicine
(2003) - et al.
Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors
Social Science & Medicine
(2001)
A prospective cohort study investigating the explanation of socio-economic inequalities in The Netherlands
Social Science & Medicine
Politics and health outcomes
Lancet
Towards an epidemiological understanding of the effects of long-term institutional changes on population health: a case study of Canada versus the USA
Social Science & Medicine
The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: comparing the United States to Canada
Social Science & Medicine
Self-rated health: biological continuum or social discontinuity?
Social Science & Medicine
Geography and service supply do not explain socioeconomic gradients in angiography use after acute myocardial infarction
CMAJ
The gender composition and wages: Why is Canada different from the United States?
Disease and disadvantage in the United States and in England
Journal of the American Medical Association
Social epidemiology
Social organization, stress and health
Nativity, duration of residence, and the health of Hispanic adults in the United States
International Migration Review
A global measure of perceived stress
Journal of Health and Social Behavior
Determinants of self-rated health for Canadians with chronic disease and disability
Journal of Epidemiology and Community Health
Education and occupational social class: which is the more important indicator of mortality risk?
Journal of Epidemiology and Community Health
Socioeconomic status and the utilization of diagnostic imaging in an urban setting
CMAJ
The satisfaction with life scale
Journal of Personality Assessment
Inequalities in access to medical care by income in developed countries
CMAJ
Optimal indicators of socioeconomic status for health research
American Journal of Public Health
Comparing the health of low income and less well educated groups in the United States and Canada
Population Health Metrics
What’s right about the Canadian health care system
Milbank Quarterly
Comparing population health in the United States and Canada
Population Health Metrics
Immigration and the health of Asian and Pacific Islander adults in the United States
American Journal of Epidemiology
Understanding social factors and inequalities in health: 20th century progress and 21st century prospects
Journal of Health and Social Behavior
Age, socioeconomic status, and health
Milbank Quarterly
The social stratification of aging and health
Journal of Health and Social Behavior
Self-rated health and mortality: a review of twenty-seven community studies
Journal of Health and Social Behavior
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