Health is not simply the outcome of age, genetic make-up, and health behaviours; it is influenced by the physical and social environments. The physical environment includes biological, chemical and physical hazards that are found in air, water, soil and food. Exposure to these hazards may occur in specific geographic locations or in places such as the home, workplace, school and the larger community1. The social environment encompasses the social, cultural and economic aspects of our lives. It includes institutions and organizations and the ways they interact with individuals and the community2,3,4. Thus, everything from the political system (macro–level health determinants) to families and social groups (meso–level determinants) are part of the social environment1. These macro– and meso–level factors interact with individuals (micro–level) through behaviours and biological processes1.
The following indicators were chosen to represent aspects of the physical and social environments whose effects may be felt by individuals directly, such as through exposure to toxins, or indirectly, through access to resources, for example.
Shelter is a basic human need and issues surrounding housing are important to communities. In the Report on the State of Public Health in Canada 2008, Dr. Butler-Jones discusses the negative health consequences of inadequate home environments, from the direct effect of poor ventilation and exposure to toxins to the behavioral risk factors associated with homelessness5. The report states that 13.7% of Canadians lack access to acceptable housing. Affordability is a major component of acceptable housing. This report presents housing affordability defined as the proportion of people who spend an excessive amount of their household income on shelter costs, thereby leaving inadequate resources for food and other health–promoting necessities.
Employment is positively associated with health. As well as enhancing the ability to afford housing and other essentials, employment is associated with psychosocial benefits6,7. In addition, employment helps generate a tax base that, in turn, provides community services. As a result, individuals and the community as a whole benefit from an employed population. On the other hand, long–term unemployment is a threat to health. Thus, the percentage of the community who remain unemployed for a year or more indicates a group within the community who are likely under stress and is another measure of the health of the social environment.
Education, which is closely linked to employment, is also positively associated with health. An educated population is a community resource and another measure of the social environment. The percentage of young people who have, at minimum, completed secondary school is presented as an indicator of the health of the social environment.
A healthy environment may also be defined as one in which community members thrive physically, mentally and socially. A subjective measure commonly used to assess communities is sense of community belonging. Canadians who feel connected to their community have higher odds of reporting positive health, including mental health8,9.
Second–hand smoke is an environmental pollutant that directly impacts health through exposure in homes, public places, and vehicles. Second hand smoke has been associated with health problems such as lung cancer, asthma and bronchitis, and Sudden Infant Death Syndrome (SIDS)10,11. This report presents the percentage of non-smokers who are exposed daily, or almost daily, in the home, private vehicles, and public places. Monitoring the second hand smoke indicator over time provides insight into the effectiveness of public and private smoking bans12.
These attributes of the physical and social environments in Canada varied over time and across provinces and territories. Positive findings include the majority of Canadians reporting a strong sense of community belonging; an increase in the percentage of young people with secondary diplomas; and decreasing exposure to second-hand smoke. However, nearly one in four households spent more than 30% of their income on shelter costs in 2006, and it is evident that renters were much more likely than homeowners to face housing affordability problems. Long–term unemployment remained relatively stable although it was high in some areas, particularly the territories and the Atlantic Provinces. Yet these same areas are more likely to report strong community belonging. Relatively high percentages of Ontario and British Columbia residents experienced housing affordability problems, but the percentages of secondary graduates in their populations were also relatively high. These examples illustrate some of the variation across Canada; no single place could be labelled the "healthiest" place to live.
Despite provincial and territorial differences, males and females expressed similar feelings of community belonging, although younger and older Canadians were more likely to report strong feelings of community belonging than were people in their middle years. Males were more likely than females to be exposed to second-hand smoke, as were children and youth compared with adults.
Monitoring indicators of the physical and social environments in which Canadians live and work is important for understanding changes in population health. It also helps evaluate the health impact of policies aimed at improving social and economic conditions. Addressing housing, education and employment issues, exposure to toxins like second-hand smoke, and striving to enhance sense of community belonging is an "upstream" approach that helps prevent disease and promote health.
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1. Young TK. Population Health: Concepts and Methods. New York: Oxford University Press, 2005.
4. Patrick DL, Wickizer TM. Community and health. In: Amick III BC, Levine S, Tarlov AR, Chapman Walsh D, eds. Society and Health. New York: Oxford University Press, 1995: 46-92.
5. Butler-Jones D. The Chief Public Health Officer's Report on the State of Public Health in Canada, 2008.
6. Mathers CD, Shofield DJ. The health consequences of unemployment: the evidence. Medical Journal of Australia 1998; 168: 178-82.
7. Ross CE, Mirowsky J. Does employment affect health? Journal of Health and Social Behavior 1995; 36(3): 230-43.
10. Vozoris N, Lougheed MD. Second-hand smoke exposure in Canada: prevalence, risk factors, and association with respiratory and cardiovascular diseases. Canadian Respiratory Journal 2008; 15(5): 263-9.
11. Klonoff-Cohen HS, Edelstein SL, Lefkowitz ES, et al. The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome. Journal of the American Medical Association 1995; 273(10): 795-8.
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