Toronto Star, April 11, 2000

Jim Coyle


One subject that won't cross Tom Long's lips

OH, DEAR. It appears Tom Long is
joining the Canadian Alliance
leadership race. Doubtless, much will
be heard in coming days about how
bright he is, a good deal said about his
tactical brilliance.All that's true. (And
we shall trouble no one today by
repeating Einstein's warning ``not to
make the intellect our god; it has, of
course, powerful muscles but no
personality. It cannot lead; it can only
serve.'')

In fact, we're likely to be informed the next little while about
Tom Long's every burp and hiccup, modern media much given
(think O.J., Diana, Monica) to all-or-nothing coverage under
which one story is given more play than anyone could consume
while worthy others are ignored.

So today - before the Long deluge begins about the need for
more tax cuts and increased productivity, harsher sentences
and zero tolerance for transgressions of every sort, the dangers
of immigration, the repugnance of welfare moms, the sins of
Jean Chrétien, (not to mention the evils of a society in which
deserving citizens are denied peerages) - let us ponder
something about which Tom Long will likely not be talking.

Let us consider economic inequality and health.

Dennis Raphael, a University of Toronto professor I have yet to
meet but from whom I hear frequently, has a passion he tries (in
vain, it usually turns out) to share with reporters.

It's his view, and he's in the habit of passing along mounting
bodies of research to support it, that economic inequality is bad
for public health.

Over and over, he says, research suggests that health is very
much linked to how societies are organized and structured and
that one of the most important societal factors appears to be the
degree of economic equality within a given jurisdiction.

Those in the lowest income groups generally show greater
likelihood of a wide range of diseases and greater likelihood of
death from illness or injury at every stage of life.

Of course, this should hardly seem surprising. You're poor,
your health is more likely to suffer. Ditto if you work in low-paid
manual jobs, live in damp, low-quality housing, reside next to
busy roads or polluting factories.

In fact, it's striking how often these themes appear.

In 1986, the Ottawa Charter for Health Promotion identified as
prerequisites to health peace, shelter, education, food, income,
a stable ecosystem, sustainable resources, social justice and
equity.

Last year, a British working group identified social class, stress,
early life, social exclusion, work, unemployment, social support,
addiction, food and transport as key determinants of health.

Maybe it was best put in a recent article from the Boston
Review, in which the authors said that by the time a 60-year-old
heart attack patient arrives in an emergency room, bodily insults
have been accumulating over a lifetime.

For such a person, medical care is, figuratively speaking, ``the
ambulance waiting at the bottom of the cliff.''

Yet in the wonderful deadpan one occasionally finds in the
groves of academe, Raphael observes that consideration of
health's social determinants ``has been - with some notable
exceptions - uncommon in North America.''

Raphael says he doesn't find a great deal of interest in the
research he undertakes and gathers.

But the good news is he's as unlikely to stop talking about the
health consequences of poverty and economic inequity as Tom
Long is to make it a centrepiece of his campaign.

And perhaps Raphael can even take comfort in the fact that 20
years ago, Long - upon whose every utterance reporters will for
a time hang - was also a much-mocked inhabitant of the outer
fringes of political discourse.

As Bob Nixon (the greatest premier Ontario never had) used to
say, it's a long road without a turning.

Jim Coyle's column usually appears Tuesday, Thursday and
Saturday.




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  Long have I looked for the truth about the life of people together.
  That life is crisscrossed, tangled, and difficult to understand.
  I have worked hard to understand it and when I had done so
  I told the truth as I found it.

  - Bertolt Brecht
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Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
voice:    (416) 978-7567
fax: (416) 978-2087
e-mail:   [log in to unmask]