Guelph Mercury
The Editorial Page, Friday, September 7, 2001, p. A8
Local Views
Staying healthy in Canada: what's missing
Raphael, Dennis
Most Canadians believe that medical and health research is an ideologically
neutral
activity getting at the "facts" that exist in the world. And they also believe
that the "facts"
that get reported to us by the media are presented to us free of any
ideological filter.
The problem with this view is that illness prevention and health promotion is
a
particularly ideological enterprise. A number of different approaches to
understanding
and promoting health exists and the dominance of each view (biomedical,
lifestyle, and
societal) ebbs and flows according to which political and societal values
currently
predominate.
Currently, the health research that is reported to us about the causes of
diseases in
general - and particularly heart disease and cancer - is that these result
from biological
imbalances in our bodies that reflect faulty lifestyle choices. This message
is repeated
by organizations such as the Canadian Cancer Society, the Heart and Stroke
Foundation and Canadian public health departments. A typical message is given
by
British Medical Officer Liam Donaldson:
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 making time to
relax.
5. If you drink alcohol, do so in moderation.
6. Cover up in the sun, and protect children from sunburn.
7. Practice 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 - virtually none of
it
reported in the Canadian and USA media - indicates that the factors that have
the
greatest impact on whether we develop life-threatening diseases are usually
out of our
personal control. More specifically, many large-scale studies find that
poverty and
income levels rather than medical and lifestyle factors such as the Ten Tips
are better
predictors of whether we develop diseases such as heart disease and cancer.
The magnitude of these income effects are staggering. It is estimated that 23
per cent of
all premature years of life lost 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.
Seventeen per
cent are a result from injuries, and 14 per cent from cancers. And numerous
studies
indicate that the material conditions under which we live - especially during
childhood -
are far greater determinants of whether we die from illness than our adult
"lifestyle
choices".
Why are we not reading about these studies which appear with ongoing
regularity in
journals such as the British Medical Journal, the New England Journal of
Medicine,
Social Science and Medicine, and the International Journal of Epidemiology,
among
others? This is where ideology enters into the equation.
The current political climate is one of individualism and associated with
neo-liberal
ideology. The public health counterpart - healthy lifestyle choices - fits
nicely into this
ideology which is associated with a retreat from the welfare state, a
diminishing concern
with the common good, and a move away from equity and equal opportunity for
all.
As we become more familiar with the effects of such government directions -
and the
studies that usually go unreported - we will probably begin to think about
health and
how to maintain it in the ways suggested by David Gordon of Bristol University
in the
UK:
An 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. Practice 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/asylum application forms
before
you become homeless and destitute.
So your health depends more on the distribution of wealth and public services
- not on
your personal lifestyle. If that's the case, Canadians should ask themselves
three
questions. Why does political ideology influence the reporting of health
research? How
can we learn about research that shows the importance of non-lifestyle factors
in
Canadians' health? When will Canadians begin to see that economic policy is
health
policy?
Dennis Raphael PhD is an associate professor with the School of Health
Policy and Management, Atkinson Faculty of Liberal and Professional
Studies, York University. He is the author of "Inequality is Bad for Our
Hearts: Why Low Income and Social Exclusion Are Major Causes of Heart
Disease in Canada."
Length: Medium, 659 words
© 2001 Guelph Mercury. All rights reserved.
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