Book explores social predictors of a person’s health

Even before it has been officially launched, Dennis Raphael’s new book is appearing on required reading lists for university courses across Canada.

Called Social Determinants of Health: Canadian Perspectives, it is the first of its kind, says Raphael and his publisher, Canadian Scholars Press. “Nothing has been done in Canada like this before,” says the health policy professor, who edited the 23-chapter book. “Research on this topic has been scattered all over the place. This is the first time it has all come together in one place – and focused on Canada.”

It summarizes how socio-economic factors affect the health of Canadians. Edited by Raphael, the book features chapters by leading academics and experts on the current state of 11 social determinants of health. These include aboriginal status, early life, education, employment and working conditions, food security, gender, health care services, housing, income and its distribution, social safety net, social exclusion, as well as unemployment and employment security.

Raphael has long advocated health policy based on such social determinants of health. “We’ve got to get off the lifestyle, tobacco and obesity focus and look at the real roots of ill health,” he says.

“The book really comes out at just the right time,” says Raphael (left), referring to research documenting the growing income gap, job insecurity and determinants of health, and to such reports as the United Way of Toronto’s Poverty by Postal Code. “People are trying to understand what is going on and what to do about it. The data is coming out just when everybody is expressing concern about the urban agenda, social infrastructure and deteriorating social conditions,” he says.

Professors here and at Queen’s, Alberta and Dalhousie universities have already put in orders for their September classes, says Raphael.

It doesn’t hurt that Roy Romanow has written the foreword. The former Saskatchewan premier’s report on the future of health care in Canada came out while York was hosting a national conference on social determinants of health in November 2002. Chapters in the book are based on presentations made at the conference, and Romanow’s views show clear parallels with those of presenters. “Even the best health-care system in the world will only be one of the ingredients that determine whether one’s life will be long or short, healthy or sick, fulfilled or empty,” Romanow wrote in The Globe and Mail May 9. “We’ve known for a long time that money is the single largest determinant of health. Many are familiar with the old adage ‘health is wealth.’ That may be useful as a metaphor for what’s important in life, but as far as a predictor for the future, it’s quite the opposite. The reality is, that in the majority of cases, ‘wealth is health.’”

Raphael wrote the introduction and co-wrote the conclusion to the new book. Two other York professors also contributed: Toba Bryant wrote a chapter on Housing and Health; and sociologist Pat Armstrong wrote a chapter on Health, Social Policy, Social Economies and the Voluntary Sector.

Raphael will launch the book at Meeting of the Minds: Creating a Healthier Atlantic Canada, the first Atlantic Summer Institute on Healthy and Safe Communities, in Charlottetown, PEI Aug.22-25, and in Toronto in September.