He is a professor of health policy & management in 91ŃÇÉ« 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 – 91ŃÇɫ’s daily e-bulletin.

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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 .

"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 91ŃÇÉ«'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 91ŃÇÉ«, 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 91ŃÇÉ«'s Faculty of Health, has researched and written widely on these issues. His recent publications include , , and Health Promotion and Quality of Life in Canada: Essential Readings.

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.

Republished courtesy of YFile– 91ŃÇɫ’s daily e-bulletin.

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