Dennis, you might ruffle some people's feathers, but, man, are you dead on the mark....congratulations on continuing to fight the good fight...
Marie
______________________________
Marie Klaassen
Health Education Consultant
Planning and Policy
Toronto Public Health
e-mail: [log in to unmask]
fax: 416-338-0921
phone: 416-338-0954
>>> [log in to unmask] 01/23/03 12:24pm >>>
This was published today in the Canadian Centre for Policy Alternatives Monitor
http://www. policyalternatives.ca.
It originally appeared in the Toronto Star, October 11, 2002.
Poor choice or no choice?
Even more evidence links low income with disease, so why
keep blaming lifestyle choices like fries?
Dennis Raphael
Stop smoking. Get off the couch. Don't touch those fries.
Do this, we're told, and we can fight off obesity, heart disease
and diabetes.
But a new study published today in the British Medical Journal
provides further evidence that adverse life conditions- not
lifestyle choices- are the main contributors to obesity, heart
disease and diabetes.
Even more significant, this study relates the risk factors for these
diseases in adults to the socioeconomic position they
experienced as children.
Researchers at the University of Bristol assessed the degree of
insulin resistance, blood cholesterol levels, and obesity among
4,286 adult women.
Insulin resistance is the body's inability to utilize available insulin
to process blood sugars. It's a significant contributor to heart
disease and to Type II diabetes, the most common kind, which
appears in adulthood.
Most disturbing is the news that childhood socioeconomic
circumstances were even better predictors of insulin resistance
than adult situations.
Women from lower income conditions as children and as adults
were 58 per cent more likely to show high insulin resistance than
those who lived under higher income conditions as children and
adults. But women living in better social and economic
circumstances as adults still had a 29 per cent greater chance of
being insulin resistant if they grew up in low-income families.
Women who grew up poor were more likely to show increased
insulin resistance, have higher levels of bad cholesterol and
obesity than those who lived under better socioeconomic
circumstances as children. These relationships remained after
taking into account adult social and economic conditions.
This news comes one day after the release of the 2002 Report
Card on Children showing that childhood poverty is on the rise
in Toronto. The number of children in low-income families grew
9 per cent in the city from 1995 to 1999 and the city's poorest
neighbourhoods have experienced a 35 per cent increase in the
number of children since 1996.
Because they're growing up poor, these children are at greater
risk for obesity, heart disease and diabetes as adults.
Nevertheless, if disease awareness and prevention campaigns
continue on their current course, these kids may grow up to be
adults who are blamed for putting themselves at risk for these
diseases by smoking, not exercising and indulging in unhealthy
food.
And yet, research since the mid-1970s has found lifestyle and
biomedical factors account for only a small proportion of
whether someone develops heart disease or diabetes.
In fact, Health Canada and Canadian Public Health Association
policy statements of the past 25 years outline what really
matters for disease prevention: adequate income, shelter, food,
employment and working conditions, and a social safety net.
The British Medical Journal study is consistent with the results
of many published studies indicating that socioeconomic
circumstances are the best predictors of both the risk conditions
and actual incidence of heart disease and diabetes.
Indeed, many researchers have noted that trying to prevent
lifestyle illnesses by changing adult lifestyle behaviours is unlikely
to profoundly alter the incidence of heart disease and diabetes if
no change is made in the improvement of people's economic
conditions. Poverty influences health by determining the level of
material resources available such as income, shelter, food, etc.,
stress that threatens bodily functioning and the adoption of
unhealthy coping behaviours such as poor diet, smoking and
alcohol use.
These factors- the social determinants of health- are clearly not
under individual personal control. They're not choices people
make. Is it a lifestyle choice to have poor parents or be
homeless or hungry because of low social assistance or
minimum wage levels?
These social determinants of health are sensitive to social and
economic policies that result from government decisions.
Knowing all this, knowing that children living in poverty grow up
at greater risk of diabetes, heart disease and obesity- all of this
costly to a government health care system, by the way- would
we not expect that governments at all levels would promote the
health of Canadians by assuring the quality of these social
determinants of health?
Wouldn't we also expect that public health, health care, and
heart and diabetes associations would consider how social and
economic conditions affect health?
And yet, we hear little from these sources except to be
preached to about the importance of making "healthy lifestyle
choices," even though these behaviours are relatively
unimportant to the health of Canadians.
Why is this the case?
One question to ask is: Who benefits from such neglect?
Governments that weaken the social safety net, transfer wealth
from the poor to the wealthy through income tax reduction and
privatize public services create the risk conditions that lead to
heart disease and diabetes.
Yet these governments can point to their lifestyle-oriented heart,
health and diabetes programs as evidence of their commitment
to health. Public health units can appear to be working to
improve health without raising sensitive economic and social
issues that will certainly draw the ire of their political
paymasters.
Better safe than sorry.
Why disease associations neglect the social determinants of
health is less clear. Perhaps research findings- and especially
today's report about the impact of childhood poverty on adult
risk of heart disease and diabetes- will guide the Heart and
Stroke Foundation and the Canadian Diabetes Association to
communicate the following tips for better health in their
pamphlets:
Reduce poverty.
Improve economic and social conditions to reduce stress and
insecurity.
Restore the social safety net to assist Canadians in navigating
their life course.
Such tips - consistent with the latest research- would serve to
focus public attention on the real risk factors for heart disease
and diabetes, and in the process improve the health of all of us.
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, published by the CSJ Foundation for
Research and Education.
Send one line: unsubscribe click4hp to: [log in to unmask] to unsubscribe
See: http://listserv.yorku.ca/archives/click4hp.html to alter your subscription
BEGIN:VCARD
VERSION:2.1
X-GWTYPE:USER
FN:Klaassen, Marie
EMAIL;WORK;PREF;NGW:[log in to unmask]
TEL;PREF;FAX:416-397-4778
X-GWUSERID:mklaasse
ADR;DOM;WORK;PARCEL;POSTAL:;850 Coxwell Avenue
LABEL;DOM;WORK;PARCEL;POSTAL;ENCODING=QUOTED-PRINTABLE:Klaassen, Marie=0A=
850 Coxwell Avenue
ORG:;Community & Neighbourhood Services
N:Klaassen;Marie
TEL;WORK:469-8555
TITLE:COMMUNICABLE DISEASE NURSE
END:VCARD
|