Three Day National Conference Identifies Poor State of Social Determinants of
Health in Canada

               Why a Conference on Social Determinants of Health?
     Increasing evidence is accumulating that while medical and lifestyle
choices affect the state of Canadians



' health, by far the greatest influences
upon health concern how communities and societies are organized to support
health (Evans, R. G., Barer, M. & Marmor, T. R., 1994, Why Are Some People
Healthy and Others Not?: the Determinants of Health of Populations. New York:
Aldine de Gruyter).  These aspects of societies and communities ? how income is
distributed, availability of education, housing, food security, degree of
support for early childhood development, the availability and type of
employment, and the extent to which citizens are socially excluded from
participation in society ? are termed social determinants of health (Marmot,
M.G. & Wilkinson, R.G. (eds.), 1999, Social Determinants of Health, Oxford:
Oxford University Press.  These issues are the focus of many policy initiatives
in Canada but to date there had been little systematic attempt to bring together
-- within a social determinants of health perspective -- those working in the
diverse fields associated with these issues (Raphael, D. 2000, Health
inequalities in Canada: Current discourses and implications for public health
action. Critical Public Health, 10, 193-216.)

               Identifying the Key Social Determinants of Health
     In 1986 the Ottawa Charter for Health Promotion outlined the prerequisites
for health as being  peace, shelter, education, food, income, a stable
ecosystem, sustainable resources, social justice and equity (World Health
Organization, 1986, Ottawa Charter on Health Promotion. Geneva: WHO). More
recently, the Canadian Institute for Advanced Research identified  determinants
of income and social status, social support networks, education, employment and
working conditions, physical environments, social environments, biology and
genetic endowment, personal health practices and coping skills, healthy child
development, and health services, Health Canada, 1998,  Taking Action on
Population Health:  A Position Paper for Health Promotion and Programs Branch
Staff.  Ottawa: Health Canada. On-line at
http://www.hc-sc.gc.ca/main/hppb/phdd/resource.htm).  Finally, a 1998 WHO Task
Force explicitly identified key social determinants of health of social status
and income, stress, early life, social exclusion, work, unemployment, social
support, addiction, food, and transport, Wilkinson, R. G., & Marmot, M., 1998,
Social Determinants of Health: The Solid Facts. Copenhagen: World Health
Organization.  On-line at http://www.who.dk/healthy-cities/.) Based on this and
other work, the following social determinants of health were the  focus of the
proposed conference: early life, education, employment, food security health
services, housing, income and social status, social exclusion, the social safety
net, and unemployment.

                              Conference Findings
     Speaker after speaker identified how the social determinants of health have
been decaying over the past decade in Canada. This has occurred as a result of
government decisions that have systematically weakened social infrastructure and
investment in populalation health.  Such actions threaten the sustainability of
the health care system.  The complete presentations and proceedings of the
conference are being posted at http://www.socialjustice.org.  Information about
the new School of Health Policy and Management at York University is available
at http://www.atkinson.yorku.ca/SHPM


Dennis Raphael
School of Health Policy and Management