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Social Determinants of Health

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From:
Dennis Raphael <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Sat, 7 Jan 2006 08:41:21 -0500
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As you may be aware, Toronto is in the midst of a surge in gang-related gun
violence.  The big story is whether these are "Hariss' Children" referring
to the effects of a draconian reduction in services and increases in
poverty during the 8 year term of as US-style very conservative Premier of
Ontario.  The following was published almost 18 months ago. - dr
--------------------------------------------------------------------------

Author(s): Ryder, Ron
Section: The Province
Publication title: Guardian. Charlottetown, P.E.I.: Aug 24, 2004.  pg. A.2

Money may not buy happiness, they say, but the lack of money is a pretty
strong predictor of misery, delegates to a Charlottetown conference heard
Monday.

Dennis Raphael, associate professor at York University's School of Health
Policy and Management, told delegates to the Atlantic Summer Institute on
Healthy and Safe Communities, that a growing body of research is showing
that there is a common obstacle in the fights for health promotion, crime
prevention and social development.

"Poverty is a major cause of all these problems, poverty and exclusion,"
Raphael said in an interview.

"It's not a question of how thick your wallet is, but whether you can
participate in the activities that are expected as a member of an affluent
society."

He said people who live lives of exclusion, particularly children raised on
society's margins, are the people at greatest risk of becoming criminals,
of becoming victims of crime, of developing health problems later in life.

"If I'm raised in an environment where I can see a future for myself, I'm
not going to mug an old lady for her purse, I'm not going to rob a corner
store and I'm probably not going to start smoking," Raphael said.

The speaker said studies that look at developed countries have found that
the gap between rich and poor is the strongest predictor of crime rates,
regardless of the country's overall wealth.

He said poverty is similarly a huge factor in the prevalence of low birth
weights, addictions, cancers and chronic diseases.

Raphael said it is not the wealthiest nations that do the best job of
fighting diseases and of preventing crimes, but the ones that do the most
to make sure that people are able to continue to participate in and
contribute to society. He said social policy is one of the surest
mechanisms for both safer streets and healthier lives.

He said families led by single mothers tend to be among Canada's poorest,
but that isn't the case in Sweden, for example.

"They recognize that here is a person who is at risk so they put money into
supporting her, into child care, into training opportunities," he said.
"The result is that in Sweden female-led families are not poor families and
because the women are supported they are generally back out, able to get
well-paid work and able to support themselves.

"When I see health promotions now they're all about individual choices, get
your exercise, eat vegetables, don't smoke. That's where we were 20 years
ago in health policy. Are you really going to tell somebody eating from a
food bank to eat more vegetables?"

A panel discussion that followed Raphael's speech shared his views.

Jeannita Bernard, director of health promotion and rehabilitation for
Veterans Affairs Canada, said it is difficult to get the health system and
planners to come around to the multidisciplinary approach in which a
family's income is seen as making as much of a contribution to their health
as the family diet does.

"We all know the importance of income and social stability in our
development programs, on our children," she said.

"We need to learn how to embrace health promotion as a part of our health
agenda."

Jim Ellsworth, Atlantic regional director of the National Crime Prevention
Centre, said planners are coming to recognize that safe communities and
healthy populations come out of the same factors.

"We're saying yes, certainly crime prevention, but not only that; we have
to face the fact that crime prevention is part of something larger," he
said.

Raphael said crime prevention is like illness prevention. It can't replace
response to emergency situations, but it may do more to help communities in
the long run.

"When I hear gunshots in my laneway, I'll call 911 but I don't think that's
the end of the problem," he said. "We have to look at it at all levels."

The Atlantic Summer Institute on Healthy and Safe Communities continues
today and Wednesday at UPEI.

[Illustration]
Dennis Raphael, guest speaker, and Malcolm Shookner, regional development
co-ordinator for the Atlantic Health Promotion Research Centre, prepare
before a seminar for Atlantic Summer Institute on Healthy Communities held
at the University of Prince Edward Island.

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