The Village Voice of the Niagara, Ontario Region
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Healthy Failure?
Social Determinants of Health
Edited by Dennis Raphael

This book is a massive, scholarly look at the
issue of what makes us healthy or unhealthy.
Chapters are written by experts in a variety of
fields with such well-known figures as
economist Andrew Jackson, early childhood
education researcher Martha Friendly, housing
advocate Michael Shapcott and physician
Michael Rachlis. Detailed references are
included, along with an index.

One of the key factors that consistently comes
to the fore in the book in determining health
status is income. Quite simply, poor people are
less healthy. Increase poverty and you will
increase poor health. And children who grow
up in poverty will have poorer health as adults.
Perhaps the saddest chapter—written by Lynn
McIntyre, a physician and epidemiologist—is
entitled “Food Insecurity.” The term is defined
as “the inability to acquire or consume an
adequate diet quality or sufficient quantity of
food in socially acceptable ways, or the
uncertainty that one will be able to do so.” She
reports that in 1998–99, a National Population
Health Survey found ten per cent of households
with 678,000 children in Canada were food
insecure.

While data on the subject tends to be sketchy,
a 1996 study of children and youth estimated
75,615 Canadians under the age of 13 were
reported to have experienced actual hunger at
least every few months, usually at the end of
the month. So how do families cope when the
threat of child hunger looms? “...the parent
skipped meals or ate less.” Sometimes the
children did as well.

In spite of the fact that usage of local food
banks is widespread, their use has had little
impact on the problem. As nutritionist Valerie
Tarasuk points out, “problems of food
insecurity do not appear to have diminished”
because of food banks and other stop–gap
measures. A key reason is that, as McIntyre
notes, “food needs give way to shelter needs.”
As well, food from the food bank often fails to
provide a well–balanced, nutritious diet.
A surprising finding is that even more
important than income is literacy. It makes
sense since if, for instance, you are a severe
diabetic and can’t read the food labels or the
nutritionist’s instructions, you could be in big
trouble.

The book points to the role of our present
Prime Minister Paul Martin in undermining the
health status of Canadians, not just in cutting
medicare payments but also in hacking
transfer payments for social services, welfare
and also drastically—almost fatally—slashing
support for housing.

Martin’s gross neglect of the housing portfolio
is all the more inexcusable because he is fully
aware of the problem and of its relationship to
poverty. In 1990, he and M.P. Joe Fontana
produced a report on the deficiencies of the
Tory government‚s policies in this area: “The
housing crisis is growing at an alarming rate
and the government sits there and does
nothing; it refuses to apply the urgent
measures that are required to reverse this
deteriorating situation.” And, as far as his other
malfeasance in relation to health status is
concerned, “...the major contributing factor to
the current (housing) crisis is poverty.”

This review barely scratches the surface of
what can be found between the covers of this
exhaustive look at what determines our health
status. It is an indispensable contribution to the
field, but reading it and thinking of how far in
the wrong direction our current leadership has
taken us might well make you feel sick.

[BY REUEL S. AMDUR]

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