One way to think about this is to consider the idea of the welfare state and the political ideologies that shape its form in Canada and elsewhere. The concept of the welfare state is about the extent to which governments – or the state – use their power to provide citizens with the means to live secure and satisfying lives. Every developed nation has some form of the welfare state.
Two literature's inform this analysis. The first concerns the three forms of the modern welfare state. Esping-Andersen identifies three distinct clusters of welfare regimes among wealthy developed nations: Social Democratic (e.g., Sweden, Norway, Denmark, and Finland), Liberal (USA, UK, Canada, Ireland), and Conservative (France, Germany, Netherlands, and Belgium, among others).[114][115] There is high government intervention and strong welfare systems in the social democratic countries and rather less in the liberal. Conservative nations fall midway between these others in service provision and citizen supports.
Social democratic nations have very well developed welfare states that provide a wide range of universal and generous benefits. They expend more of national wealth to supports and services. They are proactive in developing labour, family-friendly, and gender equity supporting policies. Liberal nations spend rather less on supports and services. They offer modest universal transfers and modest social-insurance plans. Benefits are provided primarily through means-tested assistance whereby these benefits are only provided to the least well-off.
Navarro and colleagues provide empirical support for the hypotheses that the social determinants of health and health status outcomes are of higher quality in the social democratic rather than the liberal nations.[116][117] Some of these indicators are spending on supports and services,equitable distribution of income, and wealth and availability of services in support of families and individuals. Health indicators include life expectancy and infant mortality.
Could this general approach to welfare provision shape Canadian receptivity to the concepts developed in this volume? And if so, what can be done to improve receptivity to and implementation of these concepts? The final chapter of this volume revisits these issues.
A particularly important issue that is emerging is whether any particular analysis of social determinants of health is de-politicized or not. A de-politicized approach is one that fails to take account of the fact that the quality of the social determinants of health to which citizens in a jurisdiction are exposed to is shaped by public policy created by governments. And governments of course are controlled by political parties who come to power with a set of ideological beliefs concerning the nature of society and the role of governments.
Such analyses that recognize the role played by politics outline the particular importance of having social democratic political parties in power. Nations that have had longer periods of social democratic influence such as Norway, Finland, Sweden, and Denmark have government policymaking that is remarkably consistent with social determinants of health concepts. Nations such as the USA and Canada,dominated by liberal and neo-liberal governing parties, much less so.
A wealth of evidence from Canada and other countries supports the notion that the socioeconomic circumstances of individuals and groups are equally or more important to health status than medical care and personal health behaviours, such as smoking and eating patterns.
An example of SDOH, applicable to the United States, is shown in the graph, below. It shows self-reported health as it relates to income level and political party identification (Democrat vs. Republican).[120]
The weight of the evidence suggests that the SDOH have a direct impact on the health of individuals and populations, are the best predictors of individual and population health, structure lifestyle choices, and interact with each other to produce health (Raphael, 2003). In terms of the health of populations, it is well known that disparities-the size of the gap or inequality in social and economic status between groups within a given population-greatly affect the health status of the whole. The larger the gap, the lower the health status of the overall population.[121][122]
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