What makes us sick? Is it genetics or lifestyle? Is it too many burgers, too much alcohol, not enough exercise? Not according to York Professor Dennis Raphael, who, like the fourth-century BC philosopher Plato, attributes poor health to living conditions. Things like income level and people’s access to food, housing, education, and health and social services, are what determines whether people are ill or healthy, he says.
That’s contrary to what most Canadians believe, says Raphael in his new book About Canada: Health and Illness (Fernwood Publishing, 2010), which looks at who stays healthy, who gets sick and why. It’s written with the goal of educating the informed Canadian, as well as university students.
Most people think luck, treatment options and lifestyle choices shape whether they are healthy or not. After all, that is the current mantra – eating better and exercising will lead to a healthier existence – a mantra that Canadians have wholeheartedly internalized. But that’s only part of the equation, and not the biggest part, says Raphael, a professor in York’s School of Health Policy & Management in the Faculty of Health.
“Decades of research and hundreds of studies in Canada and elsewhere tell a different story: the primary factors that shape the health and well-being of Canadians – the factors that will give us longer, better lives – are to be found not in those much-discussed areas, but rather in the actual living conditions that Canadians experience on a daily basis,” says Raphael in About Canada: Health and Illness.
These factors include whether people are wealthy or poor, employed or not, working conditions, access to quality education, health and social services, and the basics of food and affordable housing. These social determinants “are crucial factors in the health and well-being of Canadians,” he says.
“Contrary to the assumption that we have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us in the normal course of everyday life.”
Left: Dennis Raphael
That’s in large part because of the policies, regulations and laws enacted by governments at all levels, which influence employment income, family benefits and social assistance, as well as the quality and availability of affordable housing, health and social services, and recreational opportunities. That includes “what happens when Canadians lose their jobs during economic downturns such as the one that Canada began experiencing in 2008,” says Raphael.
“Governments also determine whether our children have access to affordable and high-quality child care and better-quality schools, the working conditions that we experience, and whether as seniors we receive levels of public pensions that allow us to live in dignity.”
Raphael wants to see changes in public policy that will affect Canadians’ health in a positive way. Through About Canada: Health and Illness, he wants the average Canadian to understand the role social determinants play in shaping health and what can be done to improve the situation through better public policies.
Raphael is the editor of Social Determinants of Health: Canadian Perspectives (Canadian Scholars’ Press Inc., 2nd ed., 2009), co-editor of Staying Alive: Critical Perspectives on Health, Illness, and Health Care (Canadian Scholars’ Press Inc., 2nd ed., 2010) and author of Poverty and Policy in Canada: Implications for Health and Quality of Life (Canadian Scholars’ Press Inc., 2007). He served as an adviser to the California Newsreel documentary series Unnatural Causes: Is Inequality Making Us Sick? and the Deveaux Babin Productions Canadian documentary Poor No More.
By Sandra McLean, YFile writer