This report will be released in September... and should be posted on a number of
web sites at that time.  Currently it is anticipated that it will be 50+ pages
with 110 references.

Inequality is Bad for Our Hearts:
Why Low Income and Social Exclusion are Major Causes of Heart Disease in Canada

"Poor conditions lead to poorer health.  An unhealthy material environment and
unhealthy behaviours have direct harmful effects, but the worries and
insecurities of daily life and the lack of supportive environments also have an
influence."

     Heart disease and stroke are the leading killers of Canadians and the
leading causes of hospitalization. The Heart and Stroke Foundation of Canada
estimated the total cost to Canada of cardiovascular disease in 1993 as $19.7
billion.
     An extensive body of research now indicates that the economic and social
conditions under which people live their lives, rather than medical treatments
and lifestyle choices, are the major factors determining whether they fall prey
to cardiovascular disease. One of the most important life conditions that
determine whether individuals stay healthy or become ill is their income. In
addition, the overall health of a society appears to be more determined by the
distribution of income among its members rather than the overall wealth of the
society.
     Cardiovascular diseases are the diseases which are most associated with low
income among Canadians. Yet to date, there has been virtually no public
consideration in Canada of the role that societal factors such as income play in
the incidence of cardiovascular disease and how recent changes in income
distribution may be affecting heart health. This is surprising as numerous
studies find that socioeconomic circumstances are the main contributors to heart
disease and stroke, and that circumstances during early life are especially
important.
     The report outlines the role that income and its distribution play in the
incidence of heart disease and stroke. There is particular focus on how living
on low income -- combined with government policies that limit access to basic
needs and resources required for health -- contributes to the process of social
exclusion by which individuals are denied full participation in Canadian life.
This exploration of the role of income on heart health is particularly timely as
the distribution of income is becoming less equitable in Canada.
     Societal changes that increase the numbers of Canadians living on low
income and foster social exclusion are considered in relation to what is know
about the societal determinants of health disease. The hypothesis that increases
in income inequality are associated with deteriorating health of those who are
not living on low incomes is also examined.  Finally, means of addressing the
growing inequalities in incomes among Canadians are outlined with an eye towards
reducing the incidence of heart disease and stroke in Canada.

Key Messages Contained in this Report
1.  Focussing on medicine and lifestyle to prevent cardiovascular disease is not
enough.
2.  Low income is a major contributor to heart disease and stroke in Canada.
3.  Social exclusion -- involving material deprivation, lack of participation in
common societal activities, and exclusion from decision-making and civic
participation -- is the process that explains how low income leads to heart
disease and stroke.
4.  Canadians should be aware that directions in which Canadian society is
heading are inconsistent with what is known about reducing the incidence of
cardiovascular disease.
5.  These directions -- including greater inequality of distribution of income
-- undermine the heart health of Canadians at all income levels.
6. Solutions are available to reduce the number of Canadians living on low
incomes and distribute income more fairly, thereby helping to improve the heart
health of Canadians.

This report is being prepared by the North York Heart Health Network and will be
released in September, 2001.