York University will be putting out a press release detailing how the
Toronto Charter has been applied or potentially applied to influence public
policy.  Toronto Board of Health and City Council have endorsed it and I
understood other municipalities would be considering it. Any use or
distribution at places of employment would be helpful as well.

Please forward any snippets of news to me at [log in to unmask]

Thank you.  The following is a draft of a piece that will appear in Health
Promotion International.

----------------
Toronto Charter Outlines Future Health Policy Directions for Canada and
Elsewhere

Dennis Raphael, PhD, Associate Professor
School of Health Policy and Management
York University
Toronto, Canada M3J 1P3
416-736-2100, ext. 22134
[log in to unmask]

Toba Bryant, PhD, Post-Doctoral Fellow
York Centre for Health Studies
York University
Toronto, Canada, M3J 1P3
[log in to unmask]

Ann Curry-Stevens, MSW, Ph.D. Candidate
Department of Adult Education
Ontario Institute for Studies in Education
University of Toronto
Toronto, Canada M5S 1V6
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From November 29 to December 1, 2002 a conference of over 400 Canadian
social and health policy experts, community representatives, and health
researchers met at York University in Toronto, Canada to consider the state
of ten key social or societal determinants of health across Canada; explore
the implications of these conditions for the health of Canadians; and
outline policy directions to improve the health of Canadians by influencing
the quality of these determinants of health. The conference took place at a
time when Canadian social and health policies were undergoing profound
changes related to shifting political, economic, and social conditions
(Bryant, 2002).
The conference was funded by the Policy Research Program of Health Canada -
with support from the Canadian Institutes for Health Research -- in the
tradition of Canadian government action on the determinants of health.  It
brought together representatives from a wide range of sectors: labour,
childcare, food security, social development, anti-poverty, housing,
education, and many others. Ten social determinants of health - early life,
education, employment and working conditions, food security, health
services, housing, income and income distribution, social exclusion, the
social safety net, and unemployment and job insecurity were examined.
These were chosen on the basis of their prominence in Health Canada and
World Health Organization policy statements and documents (Health Canada,
1998; Wilkinson and Marmot, 1999; World Health Organization, 1986) and
because social and economic restructuring has profoundly affected the
quality of these determinants of health in Canada (Raphael, 2003).
The conference was also a response to accumulating evidence that growing
social and economic inequalities among Canadians are contributing to higher
health care costs and other social burdens.  Indeed, the recent Canadian
Senate Report on the Federal Role in Health Care points out that 75% of
Canadians' health is determined by physical, social, and economic
environments (Kirby, 2002).  Evidence was also accumulating that a high
level of poverty - an outcome of the growing gap between rich and poor -
has profound societal effects as poor children are at higher risk for
health and learning problems in childhood, adolescence, and later life, and
are less likely to achieve their full potential as contributors to Canadian
society (Raphael, 2003).
As a result of the conference, the Toronto Charter on the Social
Determinants of Health was developed.  It drew upon initial feedback by
conference participants and was then ratified by conference participants.
The Toronto Board of Health and Toronto City Council have since endorsed
the Charter and it is going before additional municipal councils across
Canada for endorsement. Conference presentations (Centre for Social
Justice, 2003) and electronic versions of the Charter are available in
English, French, and Spanish (Raphael and Curry-Stevens, 2003). Health
Canada has prepared summaries and policy implications of the presentations,
four articles based on the Conference appeared in the prestigious Canadian
journal Policy Options (Institute for Research in Public Policy, 2003), and
a volume of conference papers is in preparation (Raphael and Langille,
forthcoming). The conference served to reintroduce the concept of the
social determinants of health to Canadians at a time of increasing
influence of neo-liber
al ideology in Canada and the weakening of the welfare state (Coburn,
2001).
Additional efforts are being made to bring this issue to public attention
and to influence the policy community. A public relations campaign on the
social determinants of health is being offered (Centre for Social Justice,
2003). There is also a concerted policy effort on the part of Health Canada
and various civil society actors to raise and address a variety of
important social determinants of health. The cooperation of the labour
movement and other progressive societal sectors with university researchers
is an especially promising development.
This Charter itself has and will continue to be a tool for promoting health
and social justice, both within and outside of Canada. It can provide a
powerful impetus for social change, notably by municipal council
endorsement followed by political action. The contents of the Charter
should be especially relevant for health promoters in jurisdictions where
the social determinants of health are being weakened by short-sighted
governmental policymaking.

References
Bryant, T. (2002). The role of knowledge in public health and health
promotion policy change. Health Promotion International 17(1), 89-98.
Centre for Social Justice (2003).  Social Determinants of Health Across the
Life-Span.  Toronto: Author. On line at http://www.socialjustice.org.
Coburn, D. (2001). Health, health care, and neo-liberalism. In H.
Armstrong, P. Armstrong & D. Coburn (eds.), Unhealthy Times: The Political
Economy of Health and Care in Canada Toronto: Oxford University Press, pp.
45-65.
Health Canada (1998). Taking Action on Population Health: A Position Paper
for Health Promotion and Programs Branch Staff, Health Canada: Ottawa,
Canada. On-line at: http://www.hc-sc.gc.ca/hppb/phdd/pdf/tad_e.pdf.
Kirby, M. J. (2002). The Health of Canadians: The Federal Role.  Ottawa:
Standing Senate Committee on Social Affairs, Science and Technology. On
line at
http://www.parl.gc.ca/37/2/parlbus/commbus/senate/Com-e/SOCI-E/rep-e/repoct02vol6-e.htm.
Institute for Research in Public Policy (2003). Policy Options, Dossier,
March 2003. On line at http://www.irpp.org/po/index.htm.
Raphael, D. (2003). When social policy is health policy: Why increasing
poverty and low income threatens Canadians' health and health care system.
Canadian Review of Social Policy, 51, 9-28.
Raphael, D. & Curry-Stevens, A. (2003).  The Toronto Charter for a Healthy
Canada.  Toronto: York University School of Health Policy and Management
and the Centre for Social Justice. On line at
http://quartz.atkinson.yorku.ca/draphael.
Raphael, D. and Langille, D. (eds.) (forthcoming). Social Determinants of
Health: Canadian Perspectives.  Toronto: Canadian Scholars Press.
Wilkinson, R. and Marmot, M. (1999). Social Determinants of Health: The
Solid Facts.  Copenhagen: World Health Organization European Office.
On-line at: http://www.who.dk/document/E59555.pdf.
World Health Organization (1986). Ottawa Charter for Health Promotion.
Geneva: Author.

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