Is Health a Choice? What are The Social Determinants of Health?
Unfortunately too many people believe that one's health is determined solely by personal choice. Research supports that this is not the case, but rather, that the social conditions into which one is born into and lives are inextricably connected to how they experience health. This is not common knowledge but it should be.
Health Is Not Just About Choice
The idea that health is solely determined by willpower or lifestyle is comforting because it suggests that everyone starts from the same place and has the same opportunities. But that simply is not true. Canadians do not enter life on a level playing field, and they do not move through it with equal access to income, housing, safety, or opportunity.
When someone is working two precarious jobs, struggling to pay rent, or living in overcrowded or unsafe housing, “choosing” to eat well, rest, or exercise is not just hard, it is often impossible. The stress of these conditions does not just feel bad; it literally gets under the skin, increasing the risk of chronic illness, mental health concerns, and earlier death.
What Are the Social Determinants of Health?
In Canada, the social determinants of health refer to the social and economic conditions that shape people’s daily lives and, in turn, their health outcomes. These include things like income, education, employment and working conditions, food security, housing, social exclusion, access to health services, Indigenous status, race, gender, disability, and the strength of the social safety net.
Research shows that these factors powerfully influence who gets sick, who stays well, and who dies early. For example, people with lower incomes in Canada experience higher rates of chronic disease and shorter life expectancy than those with higher incomes, even when they live in the same country with the same healthcare system.
Knowledge and integration of the social determinants of health is well integrated into undergraduate nursing curriculum.
Why This Isn’t Common Knowledge
Despite decades of research, the idea that “health is mostly about how you live” still dominates public conversations and media narratives in Canada. The story that emerges from the evidence, that health is primarily shaped by income distribution, working conditions, housing, education, and social policy, remains unfamiliar to many Canadians.
This gap in understanding matters. When people believe health is mainly about personal responsibility, it becomes easier to blame individuals for being sick, poorer, or struggling. It also lets governments and systems off the hook for policies that create or sustain inequities in housing, employment, food security, and social supports.
Why the Social Determinants Matter for Justice
Recognizing the social determinants of health is not just an academic exercise; it is fundamentally about justice. Communities that face racism, colonialism, discrimination, and chronic economic insecurity (including many Indigenous, Black, racialized, and low-income communities) also face higher burdens of illness and shorter lives. This is not a coincidence; it is the predictable result of unequal living conditions.
If health is shaped by policies on housing, wages, childcare, education, and social assistance, then improving health means changing those policies. It means shifting from asking “Why don’t people make better choices?” to “Why are some people denied real choices in the first place?”
Learn More and Go Deeper
If this perspective feels new or different from how you were taught to think about health, you are not alone. Many Canadians are only now encountering this research in more accessible ways. A great starting point is Social Determinants of Health: The Canadian Facts, an accessible, evidence-based resource that explains how factors like income, housing, education, and work shape the health of people living in Canada.
Taking the time to learn about the social determinants of health is more than an intellectual exercise. It is an invitation to rethink how we talk about health, how we understand our communities, and what we demand from our policies and systems. If health is shaped by the social world, then changing that world is part of caring for one another.
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