Congratulations on the piece -- and on helping make SDOH the kind of public
priority issue that Stephen Lewis and Monique Begin will take on publicly.
Susan
At 01:08 PM 19/03/2005, you wrote:
>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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Susan McMurray
34 Condor Avenue
Toronto, ON M4J 3M8
416-406-1684 H
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