Rearranging Deckchairs on the Titanic:
Premiers Promote Lifestyles as their Policies Create Disease and Misery

Dennis Raphael, Ph.D.

Our Premiers all assure us that they are concerned with maintaining the
health of Canadians and assuring the sustainability of the health care
system. Health Canada and Canadian Public Health Association statements and
documents argue that the means of accomplishing these worthy goals is to
promote population health by focusing on the determinants of health such as
income, working conditions, housing, food availability, education, and
heakthy child development. Yet, the Premiers shower us with exhortations to
improve our lifestyles and make healthy choices.  They do so at the same
time that their policies maintain very high levels of child poverty and
they reduce the social and other services that keep us healthy.  It is
difficult to believe that these developments are unrelated. The Premiers
weaken the determinants of Canadians' health,  and they then divert
attention from these activities by blaming Canadians for their own healthy
problems by promoting lifestyle explanations for disease.

It is increasingly clear that how a society produces and distributes
societal resources among its population are the prime determinants of
population health.  These links become clearer as evidence accumulates of
how societal factors such as income distribution, employment conditions,
and availability of social and health services are the primary determinants
of population health. Health is an important priority for Canadians, but
policymakers rarely consider these health determinants and the political
and economic forces that shape their quality.

For 30 years Health Canada and Canadian Public Health documents have
highlighted the role of healthy public policy in supporting health and
preventing disease. And data is now available that indicates that the forms
that public policies take are an important determinant itself of any number
of health determinants. However, Canada is increasingly looking like the US
and UK in its approach to public policy. These nations have the lowest
expenditures on health care and the lowest coverage of health costs by
public medical care. Wages are low, and income inequalities and poverty
rates are the greatest.  Similar patterns are seen when the US, Canada, and
Sweden are compared on a number of health determinants (income
distribution, wages, support for families and children) and health
indicators such as infant mortality and childhood death from injuries.
Sweden fares the best, US the worse, and Canada comes up the middle. And it
is clear that Canadian public policy is moving more and more towards the US
model. These issues -- not healthy lifestyles --are the primary threats to
health and the sustainability of the health care system and should be the
concern of policymakers.  Why is this not the case?

Our governments -- and our Premiers -- are implementing neo-liberal
policies that emphasize the "market" as the arbiter of societal values and
resource allocations. Unfortunately, these political and economic policies
foster income and wealth inequalities, weaken social infrastructure,
threaten employment security and working conditions and make life difficult
for families and children. The neo-liberal emphasis on reducing income and
corporate taxes benefits the wealthy and creates increasing social and
economic inequality.  Changing all the lifestyles in the world will
accomplish little in light of the health efffects of such policies.

The best means of promoting health therefore involves Canadians being
informed as to the primary determinants of health in a society.  They can
then consider -- and attempt to influence -- the political and economic
forces that influence these determinants. Rather than being told to improve
their lifestyles, Canadians need to reflect upon the kind of society in
which they wish to live and work. Who will help bell this cat?

Dennis Raphael is associate professor of health policy and management at
York University in Toronto and the editor of "Social Determinants of
Health: Canadian Perspectives" published by Canadian Scholars Press.

Dennis Raphael, 416-465-7455

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