The Toronto Star, Ontario ed.
 LIFE, Friday, November 9, 2001, p. F02

 Having healthy heart is often a question of income

 The message at the recent release of the North York Heart
 Health's report, Inequality Is Bad For Our Hearts, was clear: If
 you don't want to die prematurely of heart disease, don't be
 poor.

 Canadians living below the poverty line are at increased risk for
 illness and death, including death from coronary artery disease.
 We should all be concerned about growing poverty in our city,
 in our province and country, as concerned as we are about
 preserving medicare, or making sure politicians follow through
 on promises of national pharmacare and homecare programs.

 According to the author, Dr. Dennis Raphael at York
 University's School of Health Policy and Management, if all
 Canadians were as heart-healthy as the richest Canadians, we
 could avoid 6,366 deaths each year from heart disease.

 Besides saving lives, addressing poverty could also save us
 money. The cost of taking care of Canadians suffering from
 poverty-related heart disease adds up to almost $4 billion
 annually.

 The gap between the rich and poor is growing but much of the
 poverty is hidden, and most of those who struggle to make ends
 meet don't broadcast their plight, even to their doctors.

 In a 1998 study released by Toronto's Centre for Social Justice,
 the ratio of pre-tax income between the richest and poorest
 Canadian had grown from 21: 1 in1973 to 314: 1 in 1996. In
 Toronto, an estimated 38 per cent of children are living in
 low-income homes.

 We should all be alarmed. Given what the evidence shows, we
 can expect more heart disease and death. Rather than sending
 a cheque of $100 for every child on welfare, what our provincial
 government should do is increase the minimum wage and
 strengthen the social safety net.

 The second message from last week's report is that prevention
 programs aimed at reducing smoking rates, increasing exercise
 and eating healthier diets don't work if people are poor.

 In a study conducted in St. Henri, a neighbourhood in Montreal,
 where 45 per cent of the families live below the poverty line-
 despite $1.5 million and five years of a comprehensive lifestyle
 approach intervention- participation rates never exceeded 2 per
 cent. The only significant difference, when compared to a
 control group, was that more people had their cholesterol blood
 levels measured.

 People who are marginalized do not attend smoking cessation
 classes or do aerobics. They often don't vote ("Why bother?")
 and don't join their children's parent teacher associations.

 People who are poor feel powerless. It is unlikely that someone
 who feels powerless will change unhealthy behaviour.

 Inequality Is Bad For Our Hearts (available at www.york
 u.ca/wellness/heart.pdf) warns that there are three groups within
 society who are at high risk for increased poverty and increased
 heart disease: women, new immigrants and members of visible
 minorities.

 Forty-one per cent of women over 65 years live in poverty.
 Families headed by a single mother are poor 56 per cent of the
 time. New Canadians are more likely to be living in poverty than
 other Canadians, particularly if they are Asian, Polish, Arab,
 Jewish, Chinese or Ukrainian in origin.

 The report references a study entitled Canada's Creeping
 Economic Apartheid, published this year, to warn that
 Canadians of colour "experience a persistent income gap, above
 average levels of living on low income, higher levels of
 unemployment and underemployment, and under-representation
 in higher paid jobs."

 The prescription for improving heart health must include policies
 that address income and prevent the material deprivation that
 dooms its survivors. Increasing the minimum wage, ensuring pay
 equity, providing a guaranteed minimum income and increasing
 welfare payments are all effective solutions.

 Equally important are strategies that address social exclusion
 and powerlessness: legislation that protects the rights of minority
 groups, improving access to education and training, building
 more housing co-operatives. And then there's funding a national
 daycare programs and building supportive neighbourhoods and
 communities, especially for the vulnerable.

 These are reasonable solutions that are within our grasp as a
 society concerned about creating a healthier future for all its
 citizens.

 Preventing heart disease is possible, if we resist doing the
 familiar and insist on doing the political.

 Note(s):

 The views expressed are those of the author, a family physician
 at a Toronto community health centre. The views expressed are
 those of the author, a family physician at a Toronto community
 health centre.

 Category: Science and Technology
 Uniform subject(s): Children; Diseases, therapy and
 prevention; Laws and regulations; Public health and physical
 fitness
 Length: Medium, 569 words

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