Social Determinants of Health
Health, whether of an individual, a family, a neighbourhood or an entire region, is the result of many factors. Health is the product of many interconnected influences, external and internal, that are part of our lives, communities, and environments. Within public health, we refer to these influences as the determinants of health.
The World Health Organization notes that “many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment… factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.”
The Public Health Agency of Canada has identified key determinants of health.
- Income and Social Status
- Social Support Networks
- Education and Literacy
- Employment/Working Conditions
- Social Environments
- Physical Environments
- Personal Health Practices and Coping Skills
- Healthy Child Development
- Biology and Genetic Endowment
- Health Services
- Gender
- Culture
In Niagara, variations within and across municipalities in the determinants of health (e.g. differences in household incomes, employment stresses, housing, local environmental conditions, etc.) result in differences in health needs, opportunities and outcomes. The determinants of health underpin our public health planning, strategies, and program delivery. Whether it is regarding the development of poverty reduction strategy, an interaction with a new mom and baby, or school-based programming, we need to be constantly aware of and mindful of the health impacts of the determinants of health.
The impact of the determinants of health is a common thread throughout the themes of the Health Story of Niagara. The truth is that an individual will have the capacity to lead a healthier, more engaged life when they are part of a community that strives to build and sustain the needed resources, supports, and partnerships encompassed in challenges of improving strengthening the determinants of health.
Population and Demographics
Niagara region consists of 12 municipalities with a total population of 427,421 residents.
It is located in southern Ontario, between Lake Ontario and Lake Erie and covers a land area of 1,854.2 km2.
| Population density per square kilometre | Population of 2001 | Population of 2006 | Population change | Total private dwellings | Private dwellings occupied by usual residents | Land area (square km) | |
|---|---|---|---|---|---|---|---|
| Fort Erie | 179.9 | 28,143 | 29,925 | 6.3% | 14,251 | 12,219 | 166.4 |
| Grimsby | 347.2 | 21,297 | 23,937 | 12.4% | 8,944 | 8,743 | 68.9 |
| Lincoln | 133.4 | 20,612 | 21,722 | 5.4% | 7,875 | 7,623 | 162.9 |
| Niagara Falls | 392.1 | 78,815 | 82,184 | 4.3% | 33,871 | 32,482 | 209.6 |
| Niagara-on-the-Lake | 109.8 | 13,839 | 14,587 | 5.4% | 6,025 | 5,447 | 132.8 |
| Pelham | 127.8 | 15,272 | 16,155 | 5.8% | 6,058 | 5,933 | 126.4 |
| Port Colborne | 152.5 | 18,450 | 18,599 | 0.8% | 8,519 | 7,791 | 122 |
| St. Catharines | 1,373.30 | 129,170 | 131,989 | 2.2% | 57,790 | 54,730 | 96.1 |
| Thorold | 219.6 | 18,048 | 18,224 | 1.0% | 7,678 | 7,054 | 83 |
| Wainfleet | 30.4 | 6,258 | 6,601 | 5.5% | 2,916 | 2,390 | 217.3 |
| Welland | 620.7 | 48,402 | 50,331 | 4.0% | 21,543 | 20,717 | 81.1 |
| West Lincoln | 34 | 12,268 | 13,167 | 7.3% | 4,433 | 4,296 | 387.7 |
| Niagara Region | 230.5 | 410,574 | 427,421 | 4.1% | 179,903 | 169,425 | 1,854.20 |
| Ontario | 13.4 | 11,410,046 | 12,160,282 | 6.6% | 4,972,869 | 4,554,251 | 907,573.80 |
Source: Statistics Canada, Census 2006.
| People ages 25-64 who have not completed high school | Lone female parent | Lone male parent | Knowledge of neither English or French | Population who immigrated to Canada in the last 5 years | Aboriginal identity | Visible minority status | |
|---|---|---|---|---|---|---|---|
| Fort Erie | 15.1% | 25.1% | 5.2% | 0.3% | 12.7% | 3.2% | 5.5% |
| Grimsby | 9.3% | 13.5% | 4.2% | 0.1% | 5.2% | 0.8% | 3.2% |
| Lincoln | 12.1% | 12.6% | 4.2% | 0.5% | 5.3% | 0.6% | 3.2% |
| Niagara Falls | 15.0% | 25.5% | 6.4% | 1.1% | 12.4% | 1.7% | 7.8% |
| Niagara-on-the-Lake | 8.4% | 14.2% | 2.6% | 0.2% | 7.2% | 0.6% | 5.9% |
| Pelham | 6.8% | 13.4% | 3.1% | 0.1% | 3.4% | 0.5% | 2.2% |
| Port Colborne | 16.1% | 24.7% | 6.4% | 0.3% | 7.2% | 2.1% | 1.5% |
| St. Catharines | 13.9% | 24.4% | 5.6% | 0.7% | 12.9% | 1.5% | 10.0% |
| Thorold | 14.9% | 20.0% | 5.8% | 0.9% | 4.5% | 1.9% | 2.1% |
| Wainfleet | 15.7% | 7.8% | 5.0% | 0.0% | 1.8% | 2.9% | 1.8% |
| Welland | 15.7% | 24.3% | 5.5% | 0.5% | 9.1% | 2.4% | 3.7% |
| West Lincoln | 19.5% | 10.6% | 4.5% | 0.4% | 4.2% | 0.7% | 1.4% |
| Niagara Region | 14.0% | 21.9% | 5.4% | 0.6% | 10.4% | 1.6% | 6.3% |
| Ontario | 13.6% | 20.0% | 4.5% | 2.2% | 17.1% | 2.0% | 22.8% |
Source: Statistics Canada, Census 2006.
Population density
In Niagara, there are approximately 230.5 people in 1 square kilometre compared to 13.4 per square kilometre in all of Ontario. There are only four municipalities out of the 12 that make up the region which have a higher population density than Niagara as a whole; these are Grimsby (347.2), Niagara Falls (392.1), St. Catharines (1,373.3) and Welland (620.7). This means that overall the Niagara region has a relatively large rural area.
Population change
Between 2001 and 2006, the population of Niagara grew by 4.1%, which is less than the population growth of Ontario during the same period (6.6%). Within Niagara the population growth for each municipality varied from 0.8% to 12.4%. The municipalities of Port Colborne (0.8%), Thorold (1.0%), and St Catharines (2.2%) had the lowest growth in the region; meanwhile West Lincoln (7.3%) and Grimsby (12.4%) had the highest growth. The rest of the municipalities grew slightly faster than the Niagara average over the 5 year range 4.0-6.3 %.
Population who did not graduate from high school
In Niagara, 14.0% of the population between the ages of 25 and 64 have not completed their high school education; compared to 13.6% in Ontario. The most educated municipalities within Niagara are Pelham, Niagara-On-The-Lake, and Grimsby in which only 6.8%, 8.4% and 9.3% of residents aged 25-64 have not completed high school respectively. The municipalities with the highest percent of individuals that have not completed high school are West Lincoln (19.5%), Port Colborne (16.1%), Wainfleet (15.7%) and Welland (15.7%).
Lone parent families
In Niagara, 21.9% of families with children at home are single mother families compared to 20% in Ontario. The municipalities with the largest percent of single mother families among families with children in the home in Niagara are Niagara Falls (25.5%), Fort Erie (25.1%), and Port Colborne (24.7%); the lowest in the region are Wainfleet (7.8%), Grimsby (13.5%) and Niagara-On-The-Lake (14.2%).
In Niagara, 5.4% of families with children at home, are single father families compared to 4.5% in Ontario. The municipalities having the largest percent of single father families among families with children in the home in Niagara are Niagara Falls (6.4%), Port Colborne (6.4%), and Thorold (5.8%); the lowest in the region are Niagara-On-The-Lake (2.6%) and Pelham (3.1%).
Language, immigration and Aboriginals
Almost all of the residents of Niagara are able to speak either English or French, only 0.6% cannot. This is similar to Ontario where 2.2% cannot speak one of our official languages. Among the municipalities this proportion ranges from 0% in Wainfleet to 1.1% in Niagara Falls.
In Niagara 6.3% of residents are of a Visible minority, which is much lower than Ontario (22.8%). The municipalities with the smallest proportion of Visible minority residents are West Lincoln (1.4%), Wainfleet (1.8%), and Pelham (2.2%). The largest proportions are found in St. Catharines (10%), Niagara Falls (7.8%), and Niagara-On-The-Lake (5.9%).
10.4% of the population of Niagara has immigrated in the last five years, which is lower than the 17.1% who have immigrated to Ontario. Among the municipalities of Niagara this percent ranges from 1.8-12.9% where the lowest proportions are found in Wainfleet (1.8%), Pelham (3.4%) and West Lincoln (4.2%); and the largest are found in Niagara Falls (12.4%), Fort Erie (12.7%), and St. Catharines (12.9%).
The percentage of Aboriginals within Niagara is 1.6% compared to 2.0% across Ontario. The municipalities with the smallest proportion of Aboriginals are Pelham (0.5%), Lincoln (0.6%), and Niagara-On-The-Lake (0.6%); among the highest are Welland (2.4%), Wainfleet (2.9%) and Fort Erie (3.2%). However, only aboriginals who live off reserve were surveyed by the census.
| Low income before tax (among all persons in private households) | Low income after tax (among all persons in private households) | Low income before tax (with persons less than 18 years old living in them) | Low income after tax (with persons less than 18 years old living in them) | |
|---|---|---|---|---|
| Fort Erie | 11.40% | 7.50% | 16.30% | 11.00% |
| Grimsby | 8.20% | 5.60% | 8.10% | 6.00% |
| Lincoln | 5.30% | 3.80% | 4.90% | 3.90% |
| Niagara Falls | 13.60% | 9.60% | 17.80% | 12.60% |
| Niagara-on-the-Lake | 5.70% | 4.10% | 7.90% | 6.30% |
| Pelham | 4.60% | 3.20% | 5.80% | 3.90% |
| Port Colborne | 12.70% | 8.80% | 14.60% | 9.70% |
| St. Catharines | 14.80% | 10.50% | 19.10% | 13.00% |
| Thorold | 9.80% | 7.00% | 13.20% | 10.40% |
| Wainfleet | 7.00% | 4.30% | 8.50% | 6.10% |
| Welland | 14.40% | 10.20% | 17.60% | 12.40% |
| West Lincoln | 4.10% | 3.00% | 4.10% | 3.30% |
| Niagara Region | 12.00% | 8.40% | 15.00% | 10.50% |
| Ontario | 14.70% | 11.10% | 18.00% | 13.70% |
Source: Statistics Canada, Census 2006.
Population with Low income
The percentage of people considered as living in Low income (before tax) in Niagara is 12.0% compared to 14.7% in Ontario. Among municipalities this percentage ranges from 4.1–14.8%. West Lincoln, Pelham and Niagara-On-The-Lake sit at the lower end of this range with 4.1%, 4.6%, and 5.3% respectively; while Niagara Falls, Welland, and St. Catharines sit at the upper end having 13.6%, 14.4%, and 14.8% respectively.
Among all areas there are smaller proportions of families considered as living in Low income (after tax). Throughout Niagara this percentage is 8.4% as compared to 11.1% for Ontario. Among municipalities this percentage ranges from 3 – 10.5%. Similar to the before tax category the municipalities at the lower end of the range are West Lincoln (3.0%), Pelham (3.2%) and Lincoln (3.8%); and at the upper end of the range sit Niagara Falls (9.6%), Welland (10.2%), and St Catharines (10.5%).
Low income families
In Niagara, about 15% of families who are considered as living in Low income (before tax) have a child/youth under the age of 18 living with them in comparison to 18.0% in Ontario. After tax this decreases to 10.5%, compared to 13.7% in Ontario. There is a range of 3.3-13.0% after tax within the municipalities of the Niagara Region. Among these the lowest percentages are found in West Lincoln (3.3%), Pelham (3.9%), and Lincoln (3.9%); the largest percentages are in Welland (12.4%), Niagara Falls (12.6%), and St. Catharines (13.0%).
Priority Populations
To examine geographical patterns of socio-economic indicators (e.g. income, low education), a priority index was developed to explore characteristics of the Niagara region. A Priority Population is defined as those populations that are at risk and for whom public health interventions (e.g. the Health Bus program) may be reasonably considered to have a substantial impact at the population level. The map below shows an image of Niagara with areas of high versus low priority, based on six indicators included from the 2006 census:
- Median family income
- Proportion of people who have not graduated with a certificate, diploma or degree
- Unemployment rate
- Proportion of single parent families
- Proportion of people living alone
- Proportion of persons who are separated, divorced or widowed
