91��ɫ

The sky in Lawrence Heights is low and the horizon is as wide as it gets in the city; no skyscrapers here. Dennis Raphael and I were walking through the neighbourhood on a chilly day, wrote columnist :

He is a professor of health policy & management in 91��ɫ University’s Faculty of Health, and he is an observant guy. No skyscrapers?

“Downsview,” he said.

I should have known. The airport; incoming likes it low. But there are other features of the neighbourhood that are much more notable, in particular the overlapping of the maps of poverty, illness and crime.

What kind of poverty? Crushing. What kind of crime? You name it. How about illness?

Let’s talk diabetes. Everyone’s talking about it these days. The national public broadcaster even has a bunch of people eating lettuce and doing jumping jacks on TV.

Is it lifestyle? Fooey.

Raphael did a health study in a while back. His findings show that the correlation [of poverty and poor health] is not between the couch and the potato. “People who are poor don’t have the resources to be healthy. Diabetes is three or four times more likely to occur among poor people.”

He talked freely as we walked along. “We interviewed low-income people. We were struck, when we did the study, by how unable people were to access resources: the poor don’t go to ball games, to movies. They never spoke of recreation, of volunteering, of going out with friends.In other words, the poor have fewer ways to relieve their stress, and stress is a factor of the disease of diabetes, and I don’t know any poor people who are relaxed.

I was going to ask about other factors when he said something that is encouraging and ridiculous at once.

“People with life-threatening illnesses overwhelmingly say they get good health care. And most people on disability get free meds, diabetes test strips, monitors, feet and eye exams; and, overwhelmingly, they had public housing.” That’s the good news.

“But even with those pluses, we found that 72 per cent of the people we surveyed couldn’t afford the food they needed to be healthy.” He wasted no time in pointing out the irony: “The health care system will treat you fine if you keel over, but we won’t provide you with the resources you need to avoid getting sick.”

An easy fix?

“People are suffering, but I see little evidence that things are getting better.” I shivered, not from the cold. We passed a solid little building. He said, “The community health centre here is great. And the Community Care Access Centre is great.”

His proof?

“The people in our study knew about blood monitoring.” That, by the way, is a constant for diabetics. “And they knew about eating healthy food. But we found they didn’t have the money to afford the food they needed.”

That’s an outrage, or it ought to be.

I noted that some people seem to think that if you are fat, you are more prone to diabetes. Raphael hammered away at his original theme: “It isn’t whether you are fat, it’s whether you are poor.

“Countries that have low poverty rates are countries that give things like child care, tuition, decent social assistance.” These are countries where — surprise, surprise — people’s health is generally better.

“But in countries like ours, where there is a good chance of being poor, you don’t get those things — you don’t get universal child care; you don’t get good, solid employment insurance.”

Funny how we say we can’t afford first-rate social programs, and yet many of our neighbours haven’t got the money they need to be healthy. The dots ought to be easy to connect.

Raphael has published extensively about the , and the social determinants of health in Canada and internationally.

Posted by Elizabeth Monier-Williams, research communications officer, with files courtesy of YFile – 91��ɫ’s daily e-bulletin.