Professor both affirmed and frustrated after health policy paper named most influential

York University Professor Dennis Raphael‘s resume, which lists 16 books, 65 chapters and more than 300 scientific publications such as the third edition of his highly influential book Social Determinants of Health: Canadian Perspectivesnow includes another remarkable accomplishment as his 2014 paper “Beyond policy analysis: the raw politics behind opposition to healthy public policy” was recently chosen as one of the eleven most influential or impactful papers published in the journal Health Promotion International in reference to public policy for health promotion since 1986.

Dennis Raphael
Dennis Raphael

Raphael, who teaches in York’s School of Health Policy and Management, says the recognition is both affirming and quite frustrating. “Despite the importance of public policy and equitable distribution of economic and social resources, none of those lessons seemed to be taken up by governing authorities,” he said.

Raphael’s influential paper, which has been cited 56 times, explores how the Canadian business and corporate sector has increasingly come to dominate the public policy making process since the 1980s. “This has led to growing corporate concentration, declines in union membership and the skewing of income and wealth towards the top 1 per cent of Canadians with resultant declines in the quality and equitable distribution of the factors that shape health,” Raphael explained. “This has adversely affected the health of many Canadians.”

Raphael laments the ways mainstream health disciplines and the media have neglected the vital role public policy plays in shaping the health of Canadians compared to where these policies rank on the public and political agendas in other countries and especially in Europe. “When people ask me what influence my work has had, I say, ‘sadly, rather little in Canada, but certainly a lot elsewhere,'” he said.

According to Raphael, understandings about health continue to be limited among the public and the media to “biomedical, behavioral and lifestyle approaches,” despite growing evidence about the importance of public policy in shaping health and health care systems. “In some ways it’s the most obvious thing in the world,” Raphael continued. “When you have 19 per cent of children living in poverty in Canada and 26 per cent living in poverty in Canada’s largest city, Toronto, and it is well documented that living in poverty as a child is the best predictor of adverse health outcomes during both childhood and adulthood, how can you ignore the health implications?”

For Raphael, the situation has only worsened in the six years since his influential paper was published. He notes increases in housing costs and precarious work as drivers of adverse health outcomes and explains that concentrated corporate media only exacerbates the issue by diverting attention from broader factors to so-called lifestyle choices which have minimal effects upon health. Raphael is interested in inequalities in health, and the differences in the social circumstances that drive them. “The lens shouldn’t be on the individual, the lens should be on society.”

Raphael believes that the policy making gaps identified in his paper are indicative of the important work being done at the School of Health Policy and Management, and that the recognition this work is receiving further highlights the necessity of exploring health and health policy from a critical social science perspective. “This really affirms what this entire school of health policy and management is all about,” he exclaimed.

Raphael intends to remain a loud voice calling for health policy that focuses on equality and equitable distribution of economic and social resources. His current research exploring the role of language in narratives about health will appear in the forthcoming second edition of Oppression: A Social Determinant of Health, in a chapter fittingly titled “Raising the volume on the social determinants of health in Canada and elsewhere.”

Health Promotion International contains refereed original articles, reviews and debate articles on major themes and innovations in the health promotion field. The journal expressly invites contributions from sectors beyond health, including education, employment, government, the media, industry, environmental agencies and community networks, and in particular theoretical, methodological and activist advances to the field. Raphael has been published in the journal 15 times. All eleven of the most influential articles on public policy and health promotion can be read on the journal’s website.