The Kitchener-Waterloo Record, Final ed.
 Insight, Friday, August 31, 2001, p. A11

 Low income predicts health

 Dennis Raphael
 Special To The Record

 Based on what we see, hear and read in the media, the causes of
 heart disease are biomedical imbalances in our body caused by
 faulty lifestyle choices. This message is reinforced by the pamphlets
 we receive from health-related organizations and the research
 funding announcements made by government agencies.

 The "it's your own fault" message about the causes of heart disease
 is still being given despite the rapidly growing body of research that
 finds that the economic and social conditions under which people
 live their lives are the major factors determining whether they fall
 prey to heart disease.

 And it is these precursors of heart disease such as living on low
 income, lack of shelter and food, and shortage of health and social
 services that are showing ominous increases among Canadians.

 More specifically, numerous large-scale studies find medical and
 lifestyle factors account for rather small amounts of variation in the
 incidence of heart disease among populations as compared to
 income level. Heart disease is the disease most associated with low
 income among Canadians and several extensive followup studies
 show that heart disease is reliably predicted from adverse
 childhood circumstances regardless of one's life status in
 adulthood.

 When these findings are combined with the studies that show the
 minimal success of lifestyle changes in reducing the risk of heart
 disease among those most at risk, one must seriously question the
 entire approach towards reducing heart disease by those
 concerned about its incidence.

 The most recent estimates are that 23 per cent of all premature
 years of life lost prior to age 75 in Canada can be attributed to
 income differences and the greatest proportion of these years lost
 are caused by heart disease.

 In addition, it can be estimated that income differences in incidence
 of heart disease can account for a 24 per cent excess in premature
 deaths (prior to 75 years) from heart disease among Canadians.
 Were all Canadians' rates of death from cardiovascular disease
 equal to those living in the wealthiest quintile of neighbourhoods,
 there would be 6,000 fewer deaths each year from heart disease.

 At the same time that the media and health organizations continue
 to focus on biomedical and lifestyle risk factors for heart disease,
 there is documentation of the increasing numbers of Canadians
 being moved into low-income status and the weakening of the
 social safety net.

 As of 1991, Canadians enjoyed remarkably lower heart disease
 and total death rates than our neighbours to the south. Our poverty
 rates were also much lower than our American neighbours and
 Canada was in the mid-level of nations in the percentage of tax
 revenues allocated to spending on the social safety net, an
 important determinant of heart health for all individuals, but
 especially those living on low incomes.

 But since 1991, income inequality has increased in Canada and a
 move towards reduced spending on services and supports has
 occurred simultaneously with an increase in the numbers of
 Canadians living on low incomes.

 Since the research literature indicates that these societal features
 are the greatest influences upon the heart health of the population,
 three questions must be asked.

 Why is it that the Canadian media and health institutions are so
 neglectful of these influences?

 What will it take to shift their and our attention to the societal
 factors that support heart health or lead to heart disease?

 Are we prepared to live with the health consequences of subjecting
 so many of our neighbours to heart health-threatening living
 conditions?

 Dennis Raphael is an associate professor at the School of Health
 Policy and Management at York University. He is the author of
 Inequality Is Bad for Our Hearts: Why Low Income And Social
 Exclusion Are Major Causes of Heart Disease in Canada, which
 will be released in September.

 Note(s):

 Photo saved by Library

 Illustration(s):

 Photo: TORSTAR NEWS SERVICE

 A couple and a friend, along with a dog appropriately named
 Chaos, try to keep dry in a leaking tent in a tent city in Toronto last
 winter. Without adequate food, shelter and support, their health
 problems will be greater than Canadians with higher incomes.
 torstar news service

 Story type(s): Opinion
 Length: Medium, 549 words





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