Janice MacKinnon (Health's more than health care, July 13) underestimates
the importance of living conditions as compared to health care as a
determinant of health.  Most relevant scholarship places living conditions
as being four times to five times as important  as health care in
predicting health outcomes. She also confuses the issue of individual
choice in health outcomes by calling for individuals to make "better
choices." Professor David Gordon of Bristol University in the UK has
outlined -- based on available research evidence -- what some of these
important choices might be:
1. Don't be poor. If you can, stop. If you can't, try not to be poor for
long.
2. Don't have poor parents.
3. Own a car.
4. Don't work in a stressful, low paid manual job.
5. Don't live in damp, low quality housing.
6. Be able to afford to go on a foreign holiday and sunbathe.
7. Practice not losing your job and don't become unemployed.
8. Take up all benefits you are entitled to, if you are unemployed, retired
or sick or disabled.
9. Don't live next to a busy major road or near a polluting factory.
10. Learn how to fill in the complex housing benefit/ asylum application
forms before you become homeless and destitute.

The problem is that in most cases, individuals do not have a choice
concerning these options.  They result from government policymaking and
much of recent Canadian policy making has been a prescription for poor
health.  Having those who become ill from such  government actions pay more
for their treatment is indeed a classic case of "Blaming the victim."


Dennis Raphael, PhD  (416-465-7455)
Associate Professor and Undergraduate Program Director
School of Health Policy and Management
Atkinson Faculty of Liberal and Professional Studies
York University
4700 Keele Street
Toronto, Ontario M3J 1P3
tel: 416-736-2100, ext. 22134
fax: 416-736-5227
email: [log in to unmask]
website: http://atkinson.yorku.ca/draphael/

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