A report released yesterday by York University researchers offers Canadians the opportunity to learn how their living conditions will determine whether they stay healthy or become ill.
Social Determinants of Health: The Canadian Facts shows why these factors are so important for health and documents the state of living conditions in Canada in an accessible manner for the Canadian public. The report finds these conditions are deteriorating, with serious ramifications for the quality and longevity of Canadians’ lives, and outlines specific ways that the situation can be improved. The report is free to the public to read or download. Printed copies are also available to order.
"Our key message is that the health of Canadians is much less determined by the health-care system than we typically think. Much more important are public policies that influence our living conditions," says Dennis Raphael, a professor in York’s School of Health Policy & Management in the Faculty of Health and the report’s co-author.
Raphael and Juha Mikkonen, a visiting scholar at York, explain in everyday language and with compelling graphics how Canadians’ health is shaped by how much income and wealth they have, whether or not they are employed and, if so, the working conditions they experience. They pull together a wide range of research to show how health is powerfully influenced by Canadians’ ability to obtain quality education, food and housing, among other factors.
Contrary to the popular belief that Canada is a caring nation with strong supports for its citizens, the report shows that Canada has one of the worst records among wealthy, developed nations in providing its citizens with the conditions necessary for health. These supports are eroding with significant effects on Canadians’ health, says Raphael.
Left: Dennis Raphael
"This is not a storyline that’s familiar to most Canadians. We’re still stuck in those glory days where Canada really was one of the best places in the world to live. Sadly, that is no longer the case. What’s frightening is that many of these aspects are completely beyond any one individual’s control."
For example, new immigrants have difficulty getting accreditation for their skills, and are forced into service jobs where they can barely afford to feed their families. This leads to a host of problems that directly affect health and overall quality of life. "It’s all interrelated. It’s time to act on these issues," Raphael says.
Another striking example is found in maps that show a clear correspondence between poverty levels, prevalence of adult-onset diabetes and concentration of visible minorities in Toronto neighbourhoods.
Right: Juha Mikkonen
The report was inspired by the 2003 World Health Organization document Social Determinants of Health: The Solid Facts. Raphael hopes it will also spur the public into action. "It really is oriented toward building a social movement," he says.
The report provides concrete recommendations for improving the situation. For example, with regard to the increasing occurrence of hunger in Canada, it recommends increasing minimum wages and social assistance rates to the level where an adequate diet is affordable and that government assure healthy foods, such as milk, fruit and foods high in fibre, are affordable. It also recommends there be a provision of affordable housing and child care that would reduce other family expenses and leave more money for acquiring an adequate diet.
Sobering statistics cited by the report include:
- 15 per cent of Canadian children are living in poverty, putting Canada at a rank of 20th out of 30 of the world’s wealthiest nations as defined by the Organisation for Economic Co-operation and Development (OECD).
- Only 17 per cent of Canadian families have access to regulated child care. Canada ranked last among 25 wealthy, developed nations in meeting various early childhood development objectives.
- Canada is amongst the lowest in its coverage of total health-care costs. Medicare covers only 70 per cent of total health-care costs, giving Canada a rank of 22nd of 30 OECD nations for public coverage of health-care costs.
- Canada is among the nations with the greatest gap between men’s and women’s earnings. Canada ranks 19th of 22 OECD nations in reducing the earnings gap between men and women.
- Over 40 per cent of Canadians with disabilities are not in the labour force, forcing many of them to rely upon social assistance benefits. Canada ranks 27th of 29 in public spending on disability-related issues.
Raphael, who teaches in York’s Faculty of Health, has researched and written widely on these issues. His recent publications include Poverty and Policy in Canada (Canadian Scholars’ Press Inc., 2007), Social Determinants of Health: Canadian Perspectives (Canadian Scholars’ Press Inc., 2nd ed., 2008), and Health Promotion and Quality of Life in Canada: Essential Readings (Canadian Scholars’ Press Inc., 2010).
Mikkonen is a vice-president of the European Anti-Poverty Network (EAPN) Finland and a member of the executive committee of the EAPN. He has held positions in decision-making bodies at the University of Helsinki, the Finnish Student Health Services and the Finnish Youth Co-operation Allianssi, an umbrella organization for more than 100 Finnish youth non-governmental organizations.