New book challenges healthy eating and exercising mantra

Eating plenty of fruits and vegetables, exercising regularly and not smoking are touted in Canada as the best ways to stay healthy, but York health policy Professor Dennis Raphael says it’s not true. As editor of the newly published Social Determinants of Health: Canadian Perspectives, Raphael argues it is socio-economic conditions that really determine health and the prospect of illness.

“Activity level, diet and tobacco use are not the best predictors of health,” says Raphael, whose second edition of Social Determinants of Health: Canadian Perspectives is being launched Dec. 11, from 3:30 to 5pm, at the South Riverdale Community Health Centre, 955 Queen St. E. at Carlaw Avenue in Toronto. Dr. Carolyn Bennett, a Member of Parliament and Canada’s first minister of state for public health (2003-2006), will be at the launch. Bennett wrote the book’s foreword and is the author of Kill or Cure? How Canadians Can Remake their Health Care System.

Social Determinants of Health, second edition, is a collection of chapters which look at the social determinants of health today and recent developments, such as the creation of the World Health Organization International Commission on the Social Determinants of Health. The book brings together perspectives on early childhood education and care, education and literacy, employment and working conditions, food security, gender, health services, housing and more, and addresses how these issues affect the health of individuals and families.

“I think we’ve really raised the profile of the social determinants of health and how they affect health,” says Raphael, author of Poverty and Policy in Canada: Implications for Health and Quality of Life and co-author of Staying Alive: Critical Perspectives on Health, Illness, and Health Care.

Evidence shows that housing and living conditions, income, employment and working conditions, food, education, gender, early childhood experiences and access to child care are some of the most important determinants of health, says Raphael. Despite the evidence, public policy has not reflected this reality in this country and media continue to report on the biomedical and behavioural approaches of health, known as the lifestyle model of health.

Right: Dennis Raphael

The general public believes that by exercising, eating right and not engaging in risky behaviours, such as smoking and drinking alcohol, they will lead healthy lives. However, if they are low-income earners subsisting in poor living conditions and lacking affordable child care with little control over their lives, that will play a larger role in their overall health than how many vegetables they eat, he says. “Canada has one of the highest rates of child poverty in the developed world.” Change that and the health of individuals will improve.

Raphael says living conditions have been known to affect health since the mid-19th century. Hundreds of studies have shown that the material and social circumstances people are exposed to in their homes, workplaces and communities in Canada are better predictors of health than people’s lifestyle choices.

Social Determinants of Health explains how these social aspects shape health, including children’s and Aboriginal health, and how the health care system serves as a social determinant of health. The articles also look at the effect of public policy on the social safety net and gender. The book features the work of York Professors Toba Bryant, David Langille and Pat Armstrong, the Canadian Health Services Research Foundation and Canadian Institutes of Health Research Chair in Health Services & Nursing Research..

“Since a social determinants of health approach sees the mainsprings of health as being how a society organizes and distributes economic and social resources, it directs attention to economic and social policies as means of improving it,” says Raphael. Political, economic and social forces also play a part in developing policies.

“The social determinants of health have made it into policy more so than in the past, but there is still resistance to it,” says Raphael. Canada believes in “the ideology of the individual, the idea that the individual is the shaper of their own destiny and the social determinants of health are person problems rather than public issues.”

Even though Canada is known as a leader in health promotion and population health, it has failed to show leadership in implementing public policies reflecting the social determinants of health.

The goal of the book is to promote more accurate public understanding and more mature public policy-making in Canada, says Raphael. “It is reassuring, though frustrating, to note that the social determinants of health concept has taken root and been nurtured in many European nations, such that public policy in the service of health is increasingly common.” Raphael hopes that Canada will soon catch up. The knowledge is there, it just needs to be acted on.

To watch Raphael deliver a lecture on the social determinants of health, click here.