Social Determinants of Racial Disparities in Cognitive Impairment in Later Life in Canada

Health inequalities have long been medicalized, obscuring the significant role that social factors play in causing these disparities. In recent years, however, increasing attention has been directed towards the importance of various ‘Social Determinants of Health’ (SDH). According to the World Health Organization (WHO), for example, the ‘social conditions in which people are born, live, and work are the single most important determinants of one's health status’ (CSDH, 2008), with the health disparities experienced by various groups in a society generally attributed to the unequal distribution of social and economic resources. Yet, despite growing recognition of the important role social factors play in influencing health, little remains known regarding whether and how social inequalities influence non-physical health outcomes such as cognitive impairment, particularly in the Canadian context. To address this gap, this study focused on the impact of racial disparities (white, non-white) on cognitive impairment among older adults in Canada and the extent to which these racial disparities operate through differences in socioeconomic and other resources. Data were drawn from the 2011 Canadian Community Health Survey. The study sample included 21,300 people aged 65 years or older. Multivariate regression analyses revealed that a racial gap in cognitive impairment does exist among older adults in Canada and that inequalities in education, income, food security and socially patterned behaviours (i.e., physical activity levels) represent major pathways through which these disparities operate. However, we were unable to show the effects of occupation and socially patterned behaviours like smoking and alcohol consumption on this gap. We conclude that the SDH approach helps us to see how health inequalities emanate from broader structural inequalities in society and therefore the need for policies directed at reducing social inequalities as a whole.