1.2 Substance use and the determinants of health

What makes you who you are? When you think about who you are, everything matters; for example, your physiology (body and brain), the environment around you, your biological makeup, your life experience, your gender, your abilities, your ethnicity, and your psychological well-being (mental health). These are just some of the factors that have gone into your development and where you find yourself at this moment in time. These are part of Canada’s Determinants of Health.

The determinants of health[1] are a broad range of factors that impact every person’s health, including

  1. Income and social status
  2. Employment and working conditions
  3. Education and literacy
  4. Childhood experiences
  5. Physical environments
  6. Social supports and coping skills
  7. Healthy behaviours
  8. Access to health services
  9. Biology and genetic endowment
  10. Gender
  11. Culture
  12. Race / Racism

These factors, along with other social factors like systemic racism and sexism impact your health.  For example, “studies have shown that people exposed to racism have poorer health outcomes (particularly for mental health), alongside both reduced access to health care and poorer patient experiences”[2] The social determinants of health therefore tell us our health is affected by more than just exercise and healthy eating. When we use the social determinants of health to explore our health we are  looking at the big picture. Sometimes we are not always aware of the various systems which play a role in our life. To help us understand ourselves a little more, let us start with reflecting on our own experiences.

1.2A Activities

  1. Review the Government of Canada’s determinants of health website.
  2. Create a picture of yourself.  Using the social determinants of health, identify our experiences with one example in each category.
  3. What is one intervention that could have impacted your health in a positive way?
  4. What is one intervention that could have impacted your health in a negative way?
  5. When you think about the social determinants of health, what areas do you think might put you at risk of a substance use disorder?  Why?

After participating in this activity, you may have a deeper understanding of yourself.  More exploration of the social determinants of health can help you gain a deeper understanding of substance use When people study substance use and the people who live with a substance use disorder, the social determinants of health can be used to look broadly at the many factors and systems that intersect in a person’s life. To understand and develop empathy for people living with a substance use disorder, we must examine not only the determinants of health, but how the intersection between those determinants of health impact an individual. For example, if a person has multiple social identities (for example a racial/ethnic minority and a woman) and there are structural inequalities linked to these identities (racism, sexism), these intersections may compound the negative impacts on their health[3], which may lead to substance use. In other words, there may not be one single factor that relates to a person’s substance use or substance use disorder.

The video Intersectionality and health explained[4]may help you understand intersectionality further.

Research suggests we must acknowledge intersectionality, systems, and theories to work effectively in the field of substance use and substance use disorders. As you further your understanding substance use, take time to reflect on each section, participate in the food-for-thought and activity sections, and reflect on your growing understanding.

Food For Thought

  • How did you become aware of substance use?
  • What do you think the difference is between substance use and substance use disorders?
  • Take a moment and reflect honestly on how you feel about substance use and substance use disorders.
  • Where do your beliefs about substance use come from?  Friends, media, family?

Now that we have established the complexity of substance use, the next section will examine the language we use and the role it plays in the lives of people with substance use disorders, their family, friends, and health care workers.

  1. Government of Canada. (2020). Social determinants of health and health inequities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
  2. Stanley, J., Harris, R., Cormack, D., Waa, A., & Edwards, R. (2019). The impact of racism on the future health of adults: Protocol for a prospective cohort study. BMC Public Health, 19(346), p.1. https://doi.org/10.1186/s12889-019-6664-x
  3. Kulesza, M., Matsuda, M., Ramirez, J. J., Werntz, A. J., Teachman, B. A., & Lindgren, K. P.  (2016). Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug and Alcohol Dependence, 169, 85-91. https://doi.org/10.1016/j.drugalcdep.2016.10.020
  4. Sociological Studies Sheffield. (2020, Oct. 8). Intersectionality and health explained. [Video]. https://www.youtube.com/watch?v=rwqnC1fy_zc


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