This issue of the influence of economy on health has been addressed in a
plenary  session at the XVIth World Conference on Health Promotion and
Health Education, in San Juan Puerto Rico, in June 1998, together with other
critical themes such as equity in health, empowerment for health, and
environment for health. 

The integral presentations on these themes have been published in a triple
issue of the quarterly Journal of the International Union for Health
Promotion and Education "Promotion & Education", available through the IUHPE
Headquarters at the address below.(Price per issue : 15 US$ mailing included.)

Bonne journee

Marie-Claude Lamarre 







At 16:06 26/01/1999 -0500, you wrote:
>>From Poverty to Societal Disintegration:
>How Economic Inequality Affects the Health of All Canadians
>
>        For most Canadians real income decreased during the 1990's, and by 1996
>the level of child poverty had begun to set ever-increasing records. At the
>same time the rich were getting richer, the cause of which is obvious to
>Peter Montague, the editor of Rachel's Environmental Newsletter:  "The
>growing gap between rich and poor has not been ordained by extraterrestrial
>beings.  It has been created by the policies of governments."  While the
>extent of increasing economic inequality in Canada has been documented in
>reports such as The Growing Gap by the Centre for Social Justice, there has
>been little public discussion of the health effects of economic inequality.
>This is surprising since prestigious publications such as the British
>Medical Journal have stated: "What matters in determining mortality and
>health in a society is less the overall wealth of that society and more how
>evenly wealth is distributed.  The more equally wealth is distributed the
>better the health of that society." Economic inequality may be the major
>public health issue facing Canada and other Western nations. Why is this so?
>
>Increasing Poverty
>        Poverty is not good for children and other living things. The Canadian
>Institute of Child Health's report The Health of Canada's Children
>documented the profound variation between poor and non-poor children in
>incidence of death and illness, accidents and injuries, mental health and
>well-being, school achievement and drop-out, and family violence and child
>abuse.
>        Explanations for these effects include material deprivation associated
>with poverty such as malnutrition, poor housing, and lack of clothing.
>More important may be poverty's grinding effects that produce feelings of
>hopelessness, lack of control, and depression, all processes that manifest
>effects through biological pathways and lead to disease.  Health workers
>tend to focus on the health impacts of poverty through programs to teach
>skills and provide information and support to change individual lifestyles.
>These programs say little about the economic conditions  that create health
>problems. Sadly, recent poverty figures suggest that Canadian governments
>seem to be working hard to increase, rather than decrease, poverty levels.
>
>Inequality Affects Everybody, Not Just the Poor
>        It now appears that economic inequality affects the health of the
well-off
>as well as the poor. For example, after 20 years of rapidly increasing
>economic inequality, the most well-off in Britain now have higher heart
>attack and child mortality rates than the least well-off in Sweden. Other
>data indicate that societies with less inequality have lower death rates --
>even controlling for absolute level of economic resources. This is also so
>in USA communities: more economic inequality is associated with greater
>death rates – among the well off as well as the poor.
>        In Unhealthy Societies: the Afflictions of Inequality,  Richard
Wilkinson
>shows that societies with greater economic inequality begin to
>"disintegrate" --  that is, they show evidence of decreased social cohesion
>and increased individual malaise. These are all precursors of  increased
>illness and death. To illustrate, the well-off increasingly opt out of the
>public discourse. They send their children to private schools, lobby for
>two-tiered medical systems, hire security guards for their property; all of
>which heightens societal disintegration. In Canada, the well-off grow
>wealthier, but become subject to the same threats that the less-well off
>experience -- deteriorating health and educational systems, increased crime
>and violence, and greater danger on the roads -- among others. All of which
>is associated with a lack of personal control; an important predictor of
>illness and death.
>        Another means by which economic inequality affects Canadian society is
>through the tax base.  Societies with greater economic inequality and
>poverty have lower tax rates that favour the rich.  In Ontario for example,
>income tax breaks to the well-off lead to reduced services to the most
>vulnerable.  The result is less social cohesion, greater differences in
>health and well-being, and increased evidence of societal disintegration
>such as poverty and homelessness.
>
>Societal and Public Health Responses
>        Canadians need to become more aware of the effects of increasing
economic
>inequality. Currently, there is no one societal institution that monitors
>the health effects of government policies such as the ones creating
>economic inequality.  Possible candidates for such a role are municipal,
>provincial and federal public health units.  Acting as a kind of health
>ombudsperson, these units could advise governments and institutions on
>policies and actions that will enhance the health of the citizenry.  They
>could assure that government and institutional actions are assessed for
>their impacts on the health of the citizenry. That Canadians tolerate
>poverty is shameful.  That Canadians tolerate increasing economic
>inequality is hazardous to their health. Ask not for whom the economic
>inequality bell tolls, it tolls for thee.
>
>Dennis Raphael is an associate professor of Public Health Sciences at the
>University of Toronto, e-mail: [log in to unmask] This column is
>adapted from "Public Health Responses to Health Inequalities" published in
>the Canadian Journal of Public Health, Nov/Dec, 1998. Much of the
>literature on inequality and health can be accessed at
>http://weber.u.washington.edu/~eqhlth/
>
>
>
>
>Visit our Web Site for Free Copies of Our Community Quality of Life Reports!
>
>http://www.utoronto.ca/qol
>
>  ****************************************************
>   Canalising a river
>   Grafting a fruit tree
>   Educating a person
>   Transforming a state
>   These are instances of fruitful criticism
>   And at the same time instances of art.
>       -Bertolt Brecht
>  ****************************************************
>
>Dennis Raphael, Ph.D.
>Associate Professor and Associate Director,
>Masters of Health Science Program in Health Promotion
>Department of Public Health Sciences
>Graduate Department of Community Health
>University of Toronto
>McMurrich Building, Room 101
>Toronto, Ontario, CANADA M5S 1A8
>voice:    (416) 978-7567
>fax: (416) 978-2087
>e-mail:   [log in to unmask]
>
>
Marie-Claude Lamarre
Executive Director
International Union for Health Promotion and Education
2 rue Auguste Comte
92170 Vanves
France
Tel : 33 1 46 45 00 59
Fax : 33 1 46 45 00 45