This is the concluding section of the paper "Health Inequalities in Canada:
Current Discourses and Implications for Public Health Action" by yours truly,
Moving On the Economic Inequality, Poverty, and Health Agenda
A number of actions areas can be outlined to move the economic inequality,
poverty, and health agenda forward.
Develop Communication Between Various Sectors Concerned With Economic
Inequality
While there is some communication among the health, social development,
policy organizations, and municipal sectors, more needs to occur. One
example of such communication sees the Centre for Health Promotion of the
University of Toronto's working with the Ontario Social Development Council
on developing a Quality of Life Index for Ontario municipalities.78
Additionally, Linda McQuaig, the author of many volumes on the causes of
economic and social inequality in Canada, addressed the 1997 annual meeting
of the Canadian Public Health Association in 1997 and the 1999 annual
meeting of the Ontario Public Health Association. This year's annual
meeting of the Ontario Public Health Association is being addressed by John
Ralston Saul who, in his book The Unconscious Civilization79 outlined the
dangers associated with the rise of corporatism in Canada.
Other potential actions include the organization of interdisciplinary
conferences and colloquia focused on the relationships among economic
inequality, poverty and health, and the creation of collaborative working
groups to highlight and publicize these issues. The Montreal Health
Department's Social Inequalities in Health report contains many ideas for
such collaborations.12
Contribute Papers to Academic and Professional Journals on Developments In
Canada and their Potential For Affecting the Health Of Canadians
There is to date little written about economic inequality and poverty
effects upon health in the Canadian academic literature. This is beginning
to change with increasing number of papers being published. Academics at
the University of Alberta have been particularly productive in their
analyses of the impact of poverty on health.47-49
At the University of Toronto, the Critical Social Science Interest Group
has produced a series of papers that have examined various discourses on
health including critiques of the notion of population health.44,80,81
Coburn42 has recently examined the impact of neo-liberalism on both
economic inequality and health, while Raphael62 has outlined potential
public health responses to health inequalities and considered the impact of
economic inequality upon the health of Canadians and their communities.
Tarasuk50-51 at the University of Toronto has carried out a series of
studies on food security that highlights a significant outcome of increased
economic inequality and poverty, hunger. Shah82 has written on the health
effects of unemployment and was instrumental in having the Canadian Public
Health Association address the issue of unemployment 10 He also has
written extensively about the health status of aboriginals in Canada, a
situation that continues to be particularly problematic for Canada.83
While at Dalhousie University, Travers examined the structural issues
associated with hunger among low income people84 and McIntyre, Travers, &
Dayle, considered some of the unintended consequences of feeding programs
in the Atlantic provinces.85 At the University of Manitoba, economist
Chernomas86 has produced a monograph that examines how the different phases
of capitalism have determined the health status of Canadians and the forms
and distribution of illness across the population. These papers need to be
publicized and more needs to be written.
Use The Media To Educate Canadians About The Consequences Of Increasing
Economic Inequality and Poverty Upon Health
The media has been very slow to report issues related to economic
inequality and poverty effects upon health. It is not particularly clear
why this has been the case. One reason may be the reluctance of public
health departments to highlight these issues. Also of significance is the
media's continuing tendency to equate health issues with medical issues, a
phenomena that was recently described in Australia.87 Clearly, there is a
need to educate media medical and health reporters of recent findings
concerning the determinants of health and how economic inequality and
poverty affect health.
Lobby Local Health Departments To Begin Taking Seriously a Determinants Of
Health Approach Including Consideration of the Importance of Economic
Inequality and Poverty
Members of all of the sectors concerned with economic inequality and
poverty effects upon health should petition their local public health
departments to address these issues. Most departments and units in Canada
are led by citizen boards. The information increasingly becoming available
should be presented to them in a manner that will lead to increased
understanding of these issues and increased willingness to move on such
issues.
These lobbying efforts should be accompanied by appropriate presentation
of documents such as the Ottawa Charter for Health Promotion88 that will
help legitimate actions in the policy development and advocacy spheres.
The presence of government documents that acknowledge the importance of
economic inequality and poverty as determinants of health will also be
useful in educating these citizen members of health departments, as well as
health department staff.
Lobby Governments To Maintain the Community and Service Structures that
Help to Maintain Health And Well-Being
The work being carried out by the Federation of Canadian Municipalities39
on quality of life indicators should be linked to the increasing evidence
concerning the role of social infrastructure in supporting health. Advocacy
and lobbying activities can be carried out to highlight the importance of
infrastructure and detailing how policies that increase economic inequality
both weaken these infrastructures and help to produce poverty and poor health.
Begin to Understand the Forces that Create Economic Inequality and Poverty
Finally, those concerned with economic inequality and poverty effects upon
health must begin to educate themselves and others about the causes of
economic inequality.89-90 Mutaner and Lynch91 have pointed out that the
research on the economic inequality and health relationship has been
primarily carried within social epidemiological frameworks. The emphasis to
date has been on examining the health effects of economic inequality rather
than considering how economic inequality is created. The question remains
of how does economic inequalities come about and what are the forces that
maintain and increase it?
Muntaner and Lynch argue for moving beyond "neo-Durkheimian" theories of
social cohesion towards analyses that draw upon neo-Marxist, e.g., control
over productive assets and neo-Weberian, e.g., labour market position
perspectives. This perspective urges health workers to look beyond
ameliorative public health measures to one that will identify the processes
that lead to the health problems associated with economic inequality
Within Canada there are many resources available to assist in this
analysis. Volumes such as Richer and Poorer: The Structure of Inequality in
Canada92 provide background to the economic inequality issue in Canada. As
noted earlier, the Growing Gap report1 provides documentation of increasing
economic inequality in Canada. Linda McQuaig's volumes outline the causes
of inequality5-8 and the Centre for Policy Alternatives provides
Alternative Federal93 Budgets and ongoing analyses of current economic and
political trends from a progressive perspective. The Caledon Institute for
Policy Analysis has also been carrying out a series of studies that have
examined the impact of spending cuts upon Canadians' well-being.94
Coburn's42 analysis of the role of neo-liberalism in creating economic
inequality is especially timely and reflects the increasing interest in
these issues among university health science academics.
While some initial beginnings have been made in bringing together some of
the economic inequality, poverty, and health literature, this information
needs to be consolidated, shared with others concerned with the health of
Canadians, and linked with effective ongoing action to improve health. Most
importantly, Canadian public health workers have to become reacquainted
with the basic principles of health promotion and begin to seriously
address the determinants of health in their practice.
Visit our Web Site for information about our Seniors Participatory and
Community Quality of Life Projects! Free Reports Also.
http://www.utoronto.ca/qol http://www.utoronto.ca/seniors
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Long have I looked for the truth about the life of people together.
That life is crisscrossed, tangled, and difficult to understand.
I have worked hard to understand it and when I had done so
I told the truth as I found it.
- Bertolt Brecht
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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]
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