get real!
----- Original Message -----
From: Dennis Raphael <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, April 05, 2002 4:31 PM
Subject: To appear in St. John's Telegram, NFLD


> Lifestyle Approaches to Heart Health Threaten the Health of Canadians
>
> Health care and public health workers tell Canadians that illness and
disease
> results for the most part from their lifestyle choices. Such exhortations
> neglects the strong impacts upon health of factors such as low income,
poverty,
> lack of food, poor or insecure housing, discrimination and isolation, and
other
> societal determinants of health. To illustrate, low income is one of the
> strongest predictors of the incidence of heart disease and cancers, having
a
> much stronger effect than any lifestyle factors such as diet, exercise,
weight,
> or tobacco use.
>
> This emphasis is even more surprising given that there is little evidence
of the
> long-term effectiveness of lifestyle efforts towards improving health and
these
> approaches have side-effects that can work against health. One side-effect
of
> the lifestyle emphasis has been to completely remove any public awareness
that
> societal factors such as those listed above play important roles in the
> development of disease. The pervasiveness of this public blind spot
concerning
> the societal determinants of heart disease was seen in a recent survey of
> Hamilton, Ontario residents that was published in the Canadian Journal of
Public
> Health. When asked an open-ended question about the causes of heart
disease and
> provided with the opportunity to give up to seven responses, only one
respondent
> of 601 identified poverty as a cause of heart disease -- a fact that has
been
> repeatedly demonstrated in careful studies of the incidence of heart
disease in
> Canada and elsewhere.
>
> What are low income residents of Hamilton, Ontario -- and elsewhere -- to
make
> of the greater incidence of heart and others diseases among their low
income
> neighbours, friends, and relatives than that seen among their more
well-off
> neighbours? Research evidence indicates that the greater incidence of
disease
> should be attributed to their lower income status which in most cases
results
> from factors outside their personal control.  But the ideology of
lifestyle
> choices being responsible for heart disease promulgated by health care and
> public health workers -- and clearly  internalized by most Canadians --
lead
> them to blame themselves for their higher incidence of disease and
illness,
> subsequently relieving government policy makers from taking responsibility
for
> their health threatening policies.
>
> In Ontario, for example, government policies that have reduced social
assistance
> benefits, eliminated new social housing, and transferred wealth from the
poor to
> the wealthy through income tax reduction for the well-off are likely to
increase
> the incidence of heart and other diseases.  Yet the government can point
to its
> lifestyle-oriented heart health program as evidence of its commitment to
health.
>
> This process is especially insidious in light of the limited evidence that
> lifestyle choices -- especially physical inactivity, weight, and diet --
are
> major causes of heart and other diseases.  Essentially, individuals and
> communities encountering heart and other health difficulties as a result
of
> governmental policies are doubly damaged.  First, they experience health
> threatening life situations, and second, they fall under the accusatory
and
> blaming gazes of health care, public health and other governmental
authorities.
> Sadly, health workers espousing lifestyle messages can become complicit in
the
> process of


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"poor bashing," a process of Ignoring facts and repeating stereotypes
about people who are poor.

In the end, lifestyle approaches remove the societal determinants of disease
right off the public debate agenda. The lack of pressure for governments to
address these fundamental determinants of health allows these health
threatening
conditions to remain or even worsen. Second, low income people are made to
feel
that they are responsible for their own poor health.  The impact of this
perception -- also known as "victim-blaming" -- adds to the psycho-social
difficulties these people are experiencing. By masking the true source of
people's health problems, these approaches do nothing to enable people to
gain
control over the determinants of their health -- the key component of health
promotion contained in Health Canada and provincial health documents. Health
care and public health workers must begin to seriously address the societal
determinants of Canadians' health.  The alternative is to continue to invest
in
activities that may not only be ineffective in promoting the health of
citizens
but may actually be serving to harm it.

Dennis Raphael is an associate professor in the School of Health Policy and
Management at York University, and the author of Social Justice is Good for
Our
Hearts:  Why Societal Factors -- Not Lifestyles -- are Major Causes of Heart
Disease in Canada and Elsewhere which is being published by the CSJ
Foundation
for Research and Education.

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