Toronto Star
News, Saturday, March 19, 2005, p. A17
Lewis's health message will be a hard sell

Jim Coyle

If Canadian statesman Stephen Lewis isn't the king of uphill battles, he
certainly seems to be within spitting distance of the throne.

Back in the 1970s, as the fabled Big Blue Machine of Ontario Conservatism
chugged along into its fourth consecutive decade in power, Lewis was the
upstart leader of the provincial NDP.

In the fall of 1984, he was appointed Canada's ambassador to the United
Nations, forced to take his socialist sensibilities to capitalism's
epicentre in New York - or as his journalist wife Michele Landsberg put it,
to live face to face with "the 1980s glut of heartless wealth."

More recently, as a U.N. special envoy, Lewis has assumed the monumental
challenge of confronting the HIV/AIDS crisis in Africa.

Now, along with former federal health minister Monique Begin, he's been
appointed to a three-year term on a panel set up by the World Health
Organization to study the social determinants of health.

In an age that celebrates self and so-called individual responsibility, an
era of purported meritocracy in which people allegedly get what they
deserve, the notion that something as personal as health might have a
social aspect is not always the easiest of sells.

As Carol Goar noted in the Toronto Star yesterday, one of the more
pernicious myths retailed by the comfortable is that the solution to
poverty is for the poor to simply get a job (a remedy that David K. Shipler
showed last year in his splendid book, The Working Poor, is usually not
nearly enough).

Equally, one of the delusions widely extant is that poor health, especially
among the underprivileged, could be remedied simply by their chucking the
cigarettes and eschewing the continent's ubiquitous fast-food pits.

What research has shown, however, is that the most important determinants
of health, the things that shape our well-being and lifespan, are
societally oriented and beyond the control of most individuals.

One of the challenges Lewis et al. will face in this new enterprise will be
steering governments to think and act in ways - the long term and the big
picture - to which the electoral cycle does not normally leave them
inclined.

As he gets down to work, one of the volumes he's likely to be reading (if
he hasn't already) is Social Determinants of Health, Canadian Perspectives,
a book published last year and edited by Dennis Raphael, an associate
professor at York University.

The health-care emphasis is usually placed on matters of individual medical
profile and personal behavioural risk factors, Raphael says. Things like
cholesterol, weight, diet, exercise, tobacco use.

It hasn't been the practice, he says, to consider things like
early-childhood education, literacy, employment and working conditions,
housing, income distribution, social relationships and job insecurity as
health issues. But they are.

Numerous studies have shown that low-income and low-employment groups show
a greater likelihood of suffering from a wide range of diseases and
premature death from illness or injury at every stage of the life cycle, he
says.

In addition to advising citizens not to smoke, to exercise, to eat a
balanced diet, to drink in moderation, to use sunscreen, to practise safe
sex, to drive carefully and learn first aid, there are other rules of thumb
for optimizing health, Raphael notes.

Don't be poor. Don't have poor parents. Don't work in low-paid, manual
jobs. Don't live in damp, low-quality housing. Don't become unemployed.
Don't live near major highways or environmentally dubious factories.

In fact, the 11 social determinants of health in Canada identified by the
organizers of a York University conference on the issue were not things you
would typically expect to find in medical texts.

They were: aboriginal status, early life, education, employment and working
conditions, food security, health-care services, housing, income and its
distribution, social safety net, social exclusion, and unemployment and job
security.

"Health differences among Canadians result primarily from experiences of
qualitatively different environments," Raphael wrote. "Income is a prime
determinant of Canadians' premature years of life lost and premature
mortality from a range of diseases.

"Premature death by injuries, cancers, infectious disease, and others are
all strongly related to income differences among Canadians.

"Canadian children living in low-income families are more likely to
experience greater incidence of a variety of illnesses, hospital stays,
accidental injuries, mental-health problems, lower school achievement and
early drop-out, family violence and child abuse," he wrote.

As Shipler wrote in his book, "Breaking away and moving a comfortable
distance from poverty seems to require a perfect lineup of favourable
conditions.

"A set of skills, a good starting wage, and a job with the likelihood of
promotion are prerequisites. But so are clarity of purpose, courageous
self-esteem, a lack of substantial debt, the freedom from illness or
addiction, a functional family, a network of upstanding friends, and the
right help from private or governmental agencies.

"Any gap in that array is an entry point for trouble."

As usual, Stephen Lewis will be sinking his teeth into a big, big
challenge.

Then again, he seems to like it that way.

Jim Coyle usually appears Tuesday, Thursday and Saturday.

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