The following abstract was submitted to a Canadian call for stories for a
population health casebook.  It was NOT accepted but thought you might be
interested in its content. -- dr

BUILDING A BROAD NATIONAL COALITION TO ADDRESS THE SOCIAL DETERMINANTS OF
HEALTH IN CANADA Dennis Raphael and Toba Bryant,
York University, Toronto Canada

In December 2002, 400 Canadian social and health policy experts, community
representatives, and health researchers met at York University in Toronto
to consider the state of ten key social or societal determinants of health
across Canada; explore the implications of these conditions for the health
of Canadians; and outline policy directions to improve the health of
Canadians by influencing the quality of these determinants of health.

The conference was funded by the Policy Research Program of Health Canada -
with support from  the Canadian Institutes for Health Research -- and
brought together representatives from labour, childcare, food security,
social development, anti-poverty, housing, education, and many others. Ten
social determinants of health - early life, education, employment and
working conditions, food security, health services, housing, income and
income distribution, social exclusion, the social safety net, and
unemployment and job insecurity were examined.

As a result of the conference, the Toronto Charter on the Social
Determinants of Health was developed.  Health Canada has prepared summaries
and policy implications of the presentations, four articles based on the
Conference
appeared in the prestigious Canadian journal Policy Options and the book
"Social Determinants of Health: Canadian Perspectives" has appeared. To
date the volume has sold over 2800 copies. A SDOH listserv based at York
University has been established to disseminate new developments. It now has
1100 members. A few progressive public healthy units across the nation are
taking up the challenge posed by SDOH concepts.

Lessons Learned

Despite all these developments, the health care and public health sectors
remain strangely resistant to adopting and applying  these concepts in
their activities. If anything, there is continuing active denial  of these
broader concepts of population health among health workers. Witness the
focus of the "Healthy Living Strategy" and the Chronic Disease Prevention
Alliance of Canada. This is not the case among non-health NGOs and other
social welfare organizations which have enthusiastically picked up the
importance of social determinants of health and are actively educating
their constituencies.

The primary lessons learned are:
1. Do not leave population health to the health sector.
2. Do not count on more research evidence to effect a change in public
policy approaches to promote population health.
3. Involve political scientists and public policy experts in population
health research: They have the answers as
to why Canada has become a laggard in population health.
4. Evidence follows policy; not the opposite.

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