Should Public Health Workers be Able to Address the Public's
Health?

  I recently had the opportunity to give a "How Does Poverty
and Low Income Affect Health" presentation to close to 100
health workers at the Canadian Public Health Association
Annual meeting in Ottawa.1 This presentation had previously
been given to Health Canada staff, members of the social
development sector, and a number of community forums in
Toronto. This was the first time however, that the audience
had been mainly public health workers. The reaction of these
health workers to this presentation forms the basis of this
commentary.
   After outlining the indisputable evidence concerning the
adverse effects of poverty and low income, I usually consider
the ideological, political, institutional, personal and
attitudinal barriers to health workers raising issues of
poverty and income. I recognize that it is difficult for
health workers to raise issues within an institution that
contradict the "party line" that may be emanating from
government officials and institutional mandarins.
    Public health workers were in complete agreement with my
thesis that poverty and low income pose direct threats to the
health of Canadians. Indeed, no one suggested that pursuit of
neo-liberal policies of increasing economic inequality,
weakening social infrastructure and weakening social cohesion
was good for population health! I was not prepared however to
hear the stories in the question and answer period following
my presentation of how health workers feel they are unable --
in addition to raising the issue within their organizations --
to raise these issues in their role as private citizens.
   I was repeatedly told that public health workers cannot
speak out on how poverty and low income affects health in
letters to editors, to local elected representatives, or even
to fellow citizens.  To do so would risk advancement in their
careers and even the future of their careers in public health.
        I was stunned to hear this.  As I stated at the next
day's Annual General Meeting in support of the CPHA resolution
concerning the effects of poverty on health, "It is
frightening that those who know the most about the health
effects of poverty -- public health workers -- feel unable to
raise these issues in their role of citizens." I see no such
reticence among teachers, social workers, and others in
publicly raising issues they see as affecting the well-being
of the public.
   Considering the growing literature on the health effects of
poverty and low income on health, and the increasing incidence
of poverty in Canada, thes issue of the ability of public
health workers to participate in societal debate as citizens
demands attention.  Perhaps the passing by CPHA of its strong
motion concerning the effects of poverty upon health will help
stimulate this discussion.2

References
1. Raphael, D. Addressing Health Inequalities in Canada.
Presentation given at the Annual Meeting of the Canadian
Public Health Association, October 24, 2000. On line at
http://www.utoronto.ca/qol/cpha2000.pdf
2.   Reducing Poverty and Its Negative Effects on Health.
Resolution Adopted by the Canadian Public Health Association
at the CPHA Annual Meeting in Ottawa, October 25, 2000

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Dennis Raphael, Ph.D.
Associate Professor
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 308
Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
fax: (416) 978-2087
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