Registered Nurses' Association of Ontario

Social Determinants of Health Factors

Highlights of some of these issues are described briefly below:

Income and Social Status

  • Economic inequality is a significant determinant of health: as the gap widens the health status declines.

Social Support Networks

  • Within the youth population, the social safety net encompasses not only those issues that affect the total population – i.e. access to welfare and medical care – but also those unique to adolescence, especially those youth who are homeless due to abuse or neglect, youth with mental health disorders and those who are sexually exploited, lesbian, gay, bisexual, transgendered and questioning (LGBTQ) and parenting youth.
  • Youth services agencies should provide youth with a range of specifically developed services that are integrated, accessible, readily available and multi-sectoral.

 Education and Literacy

  • School plays a unique role in the lives of adolescents, as it provides not only an opportunity to learn and demonstrate academic achievement but also serves as a social setting. Evidence demonstrates that supportive schools with student-friendly environments can positively affect academic outcomes.
  • Adolescents who do poorly in school or feel marginalized are at risk of dropping out and becoming unemployed, pregnant, or participating in a range of unhealthy behaviours (e.g. drinking, smoking, drug abuse).

Personal Health Practices and Coping skills

  • Personal health practices established during adolescence often continue into adulthood. Enhancing social and problem-solving skills and self-confidence can help prevent mental health problems (e.g. conduct disorders, anxiety, depression, eating disorders), as well as other risk behaviours, including those that relate to sexual behaviour, substance abuse, and violence.


  • Sexual development and emerging sexual identity is a significant developmental task of adolescence. In today’s society, the discussion of gender and sexuality reaches beyond male and female to include lesbian, gay, bisexual, transgendered and questioning youth. These youth are at higher risk for adverse health outcomes such as human immunodeficiency virus (HIV) and STIs, substance abuse and depression.

Social Environment

  • The neighbourhood or community in which an adolescent lives may determine the resources available for spending time constructively after school (e.g. recreational facilities, skill development programs in the arts, interest clubs).
  • Social exclusion can result from racism, discrimination, stigmatization, hostility and unemployment (Wilkinson & Marmot, 2003). Youth who have been incarcerated, been in psychiatric hospitals, or are homeless are particularly vulnerable to addiction and social isolation.
  • Aboriginal youth are exposed to a barrage of risk conditions that have a profound effect on their health. These factors are associated with their circumstances and environments as well as the structures, systems and institutions that influence the physical, emotional, mental and spiritual dimensions of health.

Biology and Genetic Endowment – Adolescent Brain Development

  • During childhood and adolescence, there is a prepubertal increase in grey matter (neuron cell bodies, dendrites, glial cells), followed by post-pubertal decline.
  • Evidence indicates that adolescence is a time of considerable brain plasticity; there is also speculation that individual differences in brain structure and function could be linked to differences in experience (Steinberg, 2010). One implication is that this an ideal time for interventions directed at prevention and positive youth development.
  • Given that impulse control, planning and decision-making are largely prefrontal cortex functions that are still maturing during adolescence, researchers have hypothesized that the temporal gap between the development of the socio-emotional and cognitive control systems of the brain underlies some aspects of adolescent reckless behaviour and risk-taking.
Women and Children
Enhancing Healthy Adolescent Development
Background Information