In nursing school I learned about the social determinants of health. I read countless pages, wrote lengthy papers and sat in many lectures all dedicated to the topic. But despite this ‘knowledge’ I gained at university, the reality of how our health has social sources didn’t really hit me until I ventured out into the real world.
I’ve worked in urban communities as a Registered Nurse for the last five years, after starting out in acute care and then public health, specifically with populations considered high risk for communicable diseases and sexually transmitted infections. This includes patients who work in the sex trade, are homeless, and/or suffer from addictions. Every patient I see on these front lines is a prime example of why social and economic factors are central for determining our health.
I was twenty-four and had just transitioned from working in acute care to public health. I was running a walk-in clinic at an outreach center where core neighbourhood clients could get tested for blood-borne and sexually transmitted diseases. I was responsible for gathering the patient’s health history, doing the pre-test counselling and education, collecting the blood and urine, submitting the samples to the lab, receiving the results, delivering the results to the client, and following up with treatments. One day, a young woman entered my clinic room for testing, and changed the way I looked at the world.
She grew up on a nearby reserve. She never knew her father, and her mother was an alcoholic. A few years ago she moved to the city where she soon found herself in a lifestyle that to this day she’s been unable to escape. She told me her boyfriend was physically abusive and would force her to work the streets to support both of their drug addictions. She used injection drugs and had a history of serious infections as a result. She admitted to sometimes sharing needles and other drug equipment. She didn’t graduate from high school. She had never known any job other than sex trade work. She would often have sex with her clients without a condom if the men were willing to pay more. She couch-surfed from house to house and was in and out of shelters and detox centers. She was bruised, tired, and as I would find out in five days, HIV and Hepatitis C positive.
My patient and I were both young women of nearly the same age, but she looked at least ten years older than me. Despite similar biological factors, we couldn’t have been in a less comparable state. I asked myself, what was so different between us? Why was I on one side of the coin and she on the other? Why was I so healthy while she was so deeply unhealthy?
It didn’t take a lot of reflection to realize our respective social and economic backgrounds determined our current health status. I grew up with two loving parents who provided me with a stable and nurturing home. I have always had reliable access to proper health care. Having enough healthy and nutritious food to eat has never been a concern. I’ve always had a secure roof over my head and clean clothes on my back. I completed high school and furthered my education by earning a university degree. Support, access, money, and education — these are all things I had, and my patient lacked.
This story is not a unique one. Most of the patients I see in my current job have a very similar background to the young woman who turned on the light bulb of social determinants for me. Their health is often very poor, specifically in terms of sexually transmitted or blood borne infections, and often related to addiction. We as Canadians must urgently address the social and economic gaps that are the root cause of so many preventable diseases. There’s been lots of progress on this issue already, and a lot of great work is being done. But we can do better. Until the social and economic sources of poor and unequal healthcare are dealt with, we will continue to see alarmingly high rates of addiction as well as HIV, Hepatitis C, and other communicable and preventable diseases.
If there’s one thing I hope you’ll take away from my story, it’s to not judge another person until you have walked a mile in her shoes.