http://www.torontolife.com/blog/preville-politics/2007/nov/16/when-paradigm-turns-smug/
Preville on Politics 
When a Paradigm Turns Smug
Posted on November 16, 2007 by Philip Preville
The blog entry you are about to read probably should have been posted one 
week ago, when its topic?diabetes in suburbia?was more prominent in the 
news. But reading the Toronto Star?s coverage of the issue had me so hot 
under the collar I thought I ought to cool off before I wrote anything. 
A recent Star cover story proclaimed that, according to a new study, 
?Diabetes lurks in suburbs.? The coverage included a map showing how the 
far reaches of Etobicoke and Scarborough had the highest rates of diabetes 
in the city. What frustrated me was the suggestion?forcefully made by the 
story?s authors, despite the researchers? quotes to the contrary?that 
somehow car culture was partly to blame for the epidemic. This angle was 
even more pronounced in an ensuing Christopher Hume column, covering a 
second report on the matter by the Ontario Professional Planners 
Institute, which argued that the suburbs were unhealthy and that ?planners 
must be on the front lines in the battle to get drivers out of their cars 
and build ?active communities.? 
What?s pernicious about all this is that it overlooks numerous basic facts 
inherent to the situation. One: driving a car doesn?t cause diabetes. Two: 
even if it did, the people who are afflicted with obesity and diabetes in 
these communities are too poor to own a car. The real chain reaction at 
work here goes like so: malnutrition causes diabetes, and poverty 
contributes to malnutrition. And the story of how poverty found its way 
out to the suburbs is more fascinating and more regrettable than anything 
that?s been reported thus far. 
Not long ago, common sense held that downtown was the unhealthy place to 
live. The poor gravitated there; the streets were unclean and unsafe. So, 
the affluent (affluence being evidenced by ownership of a car) moved to 
the suburbs, where living was believed to be healthier and safer?which, if 
we?re going to be honest about the matter, it truly was, at least for a 
while. The built form helped make it so: low-density single-family housing 
meant cleaner air (at least in its early days) and also made it easy to 
keep track of your neighbours (you could count them on two hands, and you 
recognized their cars), which in turn made strangers immediately 
conspicuous. 
Today, downtown has returned to a period of ascendancy. Gentrification is 
everywhere, and condos are selling like hotcakes. But gentrification is a 
culprit here because it has displaced those too poor to own a car to areas 
of the city where car ownership is essential to their ability to stay 
connected to the rest of the world. The affluent moved to the suburbs as a 
lifestyle choice, but the urban poor did not. 
Yes, built form plays a role in the current problem. When fast-food 
outlets are more numerous and more easily accessible than grocery stores, 
as is the case in the suburbs, it can contribute to malnutrition. But it?s 
not the source of the problem. The evidence is right there on the Star?s 
map: the still-affluent suburban corridor up Yonge Street, where people 
own lots of cars and use them for all their basic routines?getting to and 
from work, school, the grocery store, the drycleaner, the fitness 
club?shows no evidence of succumbing to the diabetes scourge. One of the 
lessons here is that you can forge a healthy lifestyle out of any built 
environment if you have enough money. 
But what?s truly bizarre about this debate is the general willingness to 
view a human-health problem as a bricks-and-mortar one?to turn a story 
about diabetes into a story about low-density housing. The buildings don?t 
need fixing; the people need help. And given that gentrification played a 
role in creating this problem, I am not inclined to believe that some sort 
of downtown-style re-gentrification of the suburbs will solve it. 


Of related interest:

Poverty and Policy in Canada: Implications for Health and Quality of Life 
by Dennis Raphael
Foreword by Jack Layton
http://tinyurl.com/2hg2df

Staying Alive: Critical Perspectives on Health, Illness, and Health Care, 
edited by Dennis Raphael, Toba Bryant, and Marcia Rioux
Foreword by Gary Teeple
http://tinyurl.com/2zqrox

Social Determinants of Health: Canadian Perspectives, edited by Dennis 
Raphael
Foreword by Roy Romanow
http://tinyurl.com/yptzae

See a lecture!  The Politics of Population Health
http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d

Also, presentation on Politics and Health at the Centre for Health 
Disparities in Cleveland Ohio
http://video.google.com/videoplay?docid=-4129139685624192201&hl=en
 
Dennis Raphael, PhD
Professor and Undergraduate Program Director
School of Health Policy and Management
York University
4700 Keele Street
Toronto ON M3J 1P3
416-736-2100, ext. 22134
email: [log in to unmask]
http://www.atkinson.yorku.ca/draphael