The heart of poverty: The health risks of low-income life run deeper than
mere lifestyle 'choices'; [Final Edition]
Dennis Raphael. The Ottawa Citizen. Ottawa, Ont.: Nov 6, 2001. pg. A.15
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Most Canadians believe that medical and health research is an ideologically
neutral activity based on the "facts." And the "facts" that get reported to
us through the media are that diseases in general, and heart disease in
particular, are caused by biological imbalances in our bodies that result
from faulty lifestyle choices. This message is repeated by organizations
such as the Heart and Stroke Foundation and our public health departments.
A typical message is given by British medical officer Dr. Liam Donaldson in
his Ten Tips for Better Health:

1. Don't smoke. If you can, stop. If you can't, cut down.

2. Follow a balanced diet with plenty of fruit and vegetables.

3. Keep physically active.

4. Manage stress by, for example, talking things through and taking time to
relax.

5. If you drink alcohol, do so in moderation.

6. Cover up in the sun, and protect children from sunburn.

7. Practise safer sex.

8. Take up cancer screening opportunities.

9. Be safe on the roads: Follow the highway code.

10. Learn the first-aid ABC: airways, breathing, circulation.

The problem with this message is that a wealth of research indicates the
factors that have the greatest impact on whether we develop heart disease
are usually beyond our personal control. More specifically, many
large-scale studies find that income levels, rather than medical and
lifestyle factors, are better predictors of whether we develop illnesses
such as heart disease and stroke. It is estimated that 23 per cent of all
years of life lost prematurely prior to age 75 in Canada can be attributed
to income differences.

Of these premature deaths related to income differences, the greatest
proportion of these years lost -- 22 per cent -- is caused by heart disease
and stroke. Income differences in incidence of heart disease account for a
24-per-cent excess in premature deaths from heart disease among Canadians.
Were the rates of death from heart disease among all Canadians equal to the
wealthiest one- fifth, there would be at least 6,000 fewer deaths each year
from heart disease.

But if low-income people could be weaned from their poor lifestyle choices,
wouldn't their health improve? The answer is no.

First, even if their habits were as healthy as we might like, the material
effects of living on low income would still lead to higher rates of illness
and death. Numerous studies indicate that the living conditions of
low-income and poor children lead to their having a much greater likelihood
of developing cardiovascular disease, regardless of their lifestyle choices
or income status in adulthood.

Second, the psychological stresses of not having enough income to meet
basic needs is a potent predictor of heart disease. The National Population
Health Survey found that among Canadians in the lower third of the income
distribution, almost half reported seeing the world as not being
meaningful, events as being incomprehensible and life's challenges as being
unmanageable -- almost twice the figure of the highest-third income group.

Third, decades of research have indicated that low-income people lack the
same opportunities as others to make healthy lifestyle choices because of a
lack of material resources and psychological stress. Try exercising and
eating fruits and vegetables when your main concern is how you are going to
feed your children or pay your rent.

Perhaps the message we should be getting is that provided by David Gordon
of Bristol University in Britain with his Alternative Ten Tips for Better
Health:

1. Don't be poor. If you can, stop. If you can't, try not to be poor for
long.

2. Don't have poor parents.

3. Own a car.

4. Don't work in a stressful, low-paid manual job.

5. Don't live in damp, low- quality housing.

6. Be able to afford to go on a foreign holiday and sunbathe.

7. Practise not losing your job and don't become unemployed.

8. Take up all benefits you are entitled to, if you are unemployed, retired
or sick or disabled.

9. Don't live next to a busy major road or near a polluting factory.

10. Learn how to fill in the complex housing benefit application forms
before you become homeless and destitute.

Since societal features such as the number of people living on low income
and lack of services are the greatest influences upon the heart health of
the population, three questions must be asked. Why is it that the Canadian
media and health institutions are so neglectful of these influences? What
will it take to shift attention to the societal factors that either support
heart health or lead to heart disease? Are we prepared to live with the
consequences of subjecting so many Canadians to heart-threatening living
conditions?

Dennis Raphael is an associate professor at the School of Health Policy and
Management, Atkinson faculty of liberal and professional studies, York
University.

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