The study, published in the journal听Sociology of Health & Illness, considers progress to reduce health inequalities through public policy action is difficult in Canada, and though researchers and advocates provide data on the sources of these inequalities and means of reducing them, it does not provoke action.

Conducted by researchers from 91亚色 and Ontario Tech University, the study states the causes of health inequalities 鈥� particular groups in Canada coming to sicken and die due to their living and working conditions 鈥� have been neglected by governing authorities. Despite numerous studies suggesting public policies that would address these causes, little if anything is being done.

In this inquiry, researchers examined whether polemics and anger mobilization 鈥� usually absent in health inequalities research and advocacy 鈥� could influence Canadian governing authorities to address health inequalities through public policy action.

Usually, terms such as health inequalities, health inequities and adverse health outcomes are used to describe these processes. To move the health equity agenda forward, the research explores the potential use of high-valence terms 鈥� such as structural violence, social death and social murder 鈥� to force government to understand, and act upon, the sources of health inequalities

鈥淲e conclude by outlining the potential benefits and threats posed by polemics and anger mobilization as means of promoting health equity.

Previous studies show there are two primary approaches taken by Canadian researchers and advocates to create impetus for action: providing statistical data that reflects the extent and sources of health inequalities; and, documenting the lived experiences of those encountering these adverse health outcomes. It has also been reported that researchers who undertake critical analysis of the structures and processes contributing to adverse health dispute the view that providing information to governing authorities will, by itself, provoke action.

鈥淚n this paper, therefore, we explore the value of making explicit the adverse health effects of what the World Health Organization (2008) terms 鈥榓 toxic combination of poor social policies and programmes鈥� by adding terms such as structural violence, social death and social murder to health inequalities discourse,鈥� the study states.

The researchers are documenting the frequency of use of terms such as structural violence, social death and social murder in the academic literature as well as in mainstream and social media, and will investigate the reactions these terms elicit from researchers, advocates and students.

鈥淭hese inquiries will help determine whether polemics and anger arousal are productive ways of provoking public policy responses to health inequalities or, instead, lead to the dismissal of researchers鈥� and advocates鈥� arguments, thereby creating an additional barrier to reducing health inequalities. Evidence of initial success in Canada would see the placing of health inequalities on the public policy agendas of governing authorities,鈥� the study states.

Read the study听.

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The paper, published Oct. 7, finds that the health-promoting possibilities of unionization and working under collective agreements are a neglected area among HPI contributors.

The research team 鈥� 91亚色 graduate students听Jessica Muller,听Faisal A. Mohamed,听Mary Catherine Masciangelo,听Morris Komakech,听Anum Rafiq听and听Azeezah Jafry, along with 91亚色 Professor听听and Ontario Tech University Associate Professor Toba Bryant 鈥� explored reasons for this by drawing on an Organisation for Economic Co-operation and Development report.

The report looks at the importance of collective bargaining and was used to identify areas for health promotion research and action.

Researchers considered 2,443 articles published in HPI since its inception and found that only 87 (3.6 per cent) mention unions, unionization, collective agreements or collective bargaining, with most saying little about their role in promoting health.

Further, the study shows that 20 articles make cursory references to unions, or refer to them as providing support and engagement opportunities for individuals, while 45 depict unions or union members as involved in a health promotion program or activity carried out by the authors or by government agencies.

The study shows that only 33 articles explicitly mention unions, unionization or collective agreements as potentially health promoting, which represents just 1.3 per cent of total HPI content since 1986.

With these findings, the paper suggests the journal can support the promotion of health research and action, and raise awareness, by:

• encouraging engagement with this article through HPI-invited commentaries;
• addressing the issue through special issues with a focus on union and labour influences on health and health-related public policy, as well as industrial relations and health; and
• creating an ongoing section dedicated to industrial relations.

Unionization and working under collective agreements appear to provide many health benefits, said Raphael. The benefits include improving the quality and equitable distribution of the social determinants of health of income through wages and benefits (Western and Rosenfeld, 2011), enhanced job security (Hagedorn et al., 2016) and better working conditions (Zoorob, 2018).

As well, enhanced wages and benefits achieved through unionization positively affect additional social determinants of early child development, food and housing security, and reduce social exclusion.

鈥淐onsidering the growing influence of the corporate sector upon public policy in Canada and the declining numbers of Canadians belong to unions, refocusing on the health-promoting effects of unionization and working under collective agreements seems especially timely,鈥� said Raphael.

To read the full study. 鈥淎 bibliometric analysis of Health Promotion International content regarding unions, unionization and collective agreements,鈥� visit听.

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

鈥淒ownsview,鈥� 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鈥檚 talk diabetes. Everyone鈥檚 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. 鈥淧eople who are poor don鈥檛 have the resources to be healthy. Diabetes is three or four times more likely to occur among poor people.鈥�

He talked freely as we walked along. 鈥淲e interviewed low-income people. We were struck, when we did the study, by how unable people were to access resources: the poor don鈥檛 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鈥檛 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.

鈥淧eople 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.鈥� That鈥檚 the good news.

鈥淏ut even with those pluses, we found that 72 per cent of the people we surveyed couldn鈥檛 afford the food they needed to be healthy.鈥� He wasted no time in pointing out the irony: 鈥淭he health care system will treat you fine if you keel over, but we won鈥檛 provide you with the resources you need to avoid getting sick.鈥�

An easy fix?

鈥淧eople are suffering, but I see little evidence that things are getting better.鈥� I shivered, not from the cold. We passed a solid little building. He said, 鈥淭he community health centre here is great. And the Community Care Access Centre is great.鈥�

His proof?

鈥淭he people in our study knew about blood monitoring.鈥� That, by the way, is a constant for diabetics. 鈥淎nd they knew about eating healthy food. But we found they didn鈥檛 have the money to afford the food they needed.鈥�

That鈥檚 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: 鈥淚t isn鈥檛 whether you are fat, it鈥檚 whether you are poor.

鈥淐ountries that have low poverty rates are countries that give things like child care, tuition, decent social assistance.鈥� These are countries where 鈥� surprise, surprise 鈥� people鈥檚 health is generally better.

鈥淏ut in countries like ours, where there is a good chance of being poor, you don鈥檛 get those things 鈥� you don鈥檛 get universal child care; you don鈥檛 get good, solid employment insurance.鈥�

Funny how we say we can鈥檛 afford first-rate social programs, and yet many of our neighbours haven鈥檛 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 鈥� 91亚色鈥檚 daily e-bulletin.

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91亚色's Health Leadership & Learning Network has partnered with the Black Creek Community Health听Centre and the to bring members of the community together for the Diabetes: Perspectives for Action听鈥� Community Forum on Nov. 11, from 6 to 8pm at Westview Centennial Secondary School, 755 Oakdale Rd., North 91亚色.

Right: Maps of Toronto show the overlap between听the areas听of low income, visible minorities and the incidence of diabetes. Click maps to see interactive version. Courtesy of the Toronto Star

The听forum will听discuss the increasing incidence of Type 2 diabetes in the Jane-Finch neighbourhood, strategies to prevent it and community resources to improve the health of people living with the disease.

Income inequality is on the rise in Canada along with a parallel increase in diabetes mortality, especially in low-income neighbourhoods such as Jane-Finch, according to a recent 91亚色 study that has been published online and will appear in an upcoming issue of the journal Health Policy.

Dennis Raphael, a professor in the School of Health Policy & Management at 91亚色 and a co-author of the study, says it clearly shows that low income is associated with a higher risk of developing the disease, even when other risk factors such as obesity are taken into account. Separate maps of Toronto that show areas of low income, visible minorities and the incidence of diabetes clearly show the overlap between the three, says Raphael, who will speak first at the event.

Three representatives of the Black Creek Community Health Centre will speak about their work in the community. Community health worker Michelle Westin will discuss her experiences helping residents to identify and address issues related to diabetes prevention and management. Lisa Martin, a registered dietitian and certified diabetes educator, will speak about the importance of access to adequate resources in managing diabetes, as well as healthy lifestyle choices. Carla Da Mota, a diabetes nurse educator who has witnessed an increase in both the number of clients with diabetes and complications they experience due to poorly managed diabetes, will talk about her experiences in promoting prevention and management of the disease through education.

Professor Lesley Beagrie, associate dean, professional & global programs in 91亚色's Faculty of Health, will moderate the panel.

The Toronto District School Board has recently launched a Diabetes Awareness Strategy. Annie Appleby, superintendent of education for Ward 1 in the northwest part of Toronto 鈥� where the incidence of Type 2 Diabetes is at eight per cent 鈥撎齱ill speak about the schools' efforts to promote healthy choices and change the behaviours of staff, students, and even families.

For more information, visit the website.

Republished courtesy of YFile鈥� 91亚色鈥檚 daily e-bulletin

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That鈥檚 contrary to what most Canadians believe, says Raphael in his new book , which looks at who stays healthy, who gets sick and why. It鈥檚 written with the goal of educating the听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 鈥� eating better and exercising will lead to a healthier existence 鈥� a mantra that Canadians have wholeheartedly internalized. But that鈥檚 only part of the equation, and not the biggest part, says Raphael, a professor in 91亚色's School of Health Policy & Management in the Faculty of Health.

鈥淒ecades 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听鈥� the factors that will give us longer, better lives听鈥� are to be found not in those much-discussed areas, but rather in the actual living conditions that Canadians experience on a daily basis,鈥� says Raphael in About Canada: Health听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 鈥渁re crucial factors in the health and well-being of Canadians,鈥� he says.

鈥淐ontrary to the assumption that we have personal control over these factors, in most cases these living conditions are 鈥� for better or worse 鈥� imposed upon us in the normal course of everyday life.鈥�

Left: Dennis Raphael

That鈥檚 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 鈥渨hat happens when Canadians lose their jobs during economic downturns such as the one that Canada began experiencing in 2008,鈥� says Raphael.

鈥淕overnments 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.鈥�

Raphael wants to see changes in听public policy that will affect Canadians鈥� health in a positive way. Through About Canada: Health听and Illness, he wants the average Canadian to understand the role social determinants听play in shaping health and what can be done to improve the situation through better public policies.

Raphael is the editor of , co-editor of and author of . He served as an adviser to the California Newsreel documentary series and the Deveaux Babin Productions Canadian documentary .

By Sandra McLean, YFile writer

Republished courtesy of YFile 鈥� 91亚色鈥檚 daily e-bulletin.

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We鈥檙e products of our environment and our living conditions determine if we stay healthy or become ill, a 91亚色 study says.

鈥淗ealth and poverty are directly linked,鈥� Vaughan Community Health Centre executive director Isabel Araya said in response to Social Determinants of Health: The Canadian Facts. 鈥淭he poorer you are, the sicker you are.鈥�

The report, co-authored by Dennis Raphael, a professor in 91亚色鈥檚 School of Health Policy & Management in the Faculty of Health, and visiting scholar Juha Mikkonen, finds conditions are deteriorating, with serious ramifications for the quality and longevity of Canadians鈥� lives, particularly the poor.

The study profiles how our health is shaped by how much income and wealth we have, if we鈥檙e employed and, if so, the working conditions we experience. The researchers pull together a range of data to show how health is powerfully influenced by our ability to obtain quality education, food and housing, among other factors.

The complete .

on the report May 11:

Dennis Raphael knows who gets sick and why. But to make it better he needs you to know, too.

So the professor at 91亚色鈥檚 School of Health Policy & Management teamed up with visiting scholar Juha Mikkonen to produce a free public primer. Social Determinants of Health: The Canadian Facts is a 62-page report suggesting the primary factors shaping the health of Canadians are not medical treatments or lifestyle choices, but living conditions.

鈥淲e鈥檝e been trying for years to put out something for the public,鈥� says Raphael, 鈥渂ecause the average person doesn鈥檛 go to Health Canada鈥檚 website or the Canadian Public Health Association website.鈥�

Raphael credits his tech-savvy co-author in helping to get the message out. 鈥淲ith Juha visiting from Finland, I came across someone who not only had the content expertise, but was also able to master the desktop publishing and setting up of the website. Now when someone asks what it鈥檚 all about, instead of directing them to a World Health Organization report of 300 pages or my textbook of 600 pages, they can be directed to an accessible document.鈥�

Since its launch on April the 28, has had more than 5,000 visitors, says Raphael.

Income, housing and social exclusion are three of the 14 social determinants of health the report identifies and seeks to improve. The notion that living conditions affect health is not new, but for some reason Canada has been slow to implement it into public policy, according to Raphael.

鈥淚鈥檓 not making this up. If you were to type in social determinants of health you鈥檇 see that for 30 years Health Canada has been putting this stuff out. So this is really commonplace accepted information, but it鈥檚 been more acted upon in Europe and Australia at this point.鈥�

also covered the study April 28:

A 91亚色 study has found enormous gaps in the quality of life and health among Canadians, and those lines are largely drawn along income and wealth.

The 62-page report found that while Canada is among the richest countries in the world, it鈥檚 more than willing to let its poorest citizens fend for themselves when hard times strike.

Noting that an average person鈥檚 health can be determined by a number of factors, including housing, food security, social exclusion and income, the report claims Canada鈥檚 safety net isn鈥檛 sufficient.

The cumulative effect of these inequalities, the report says, is inferior public health, increased expenditure on front-line health care and increased mortality.

The complete article is .

Posted by Elizabeth Monier-Williams, with files courtesy of YFile鈥� 91亚色鈥檚 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 91亚色'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 91亚色, 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 91亚色'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鈥� 91亚色鈥檚 daily e-bulletin.

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Diabetes risk among immigrants from South Asia is three to four times higher than in immigrants from western European countries, says a study released Monday by the .

But , a well published 91亚色 professor in the School of Health Policy & Management in the Faculty of Health, says he has been studying the same finding for years. 鈥淛ust about every group in Canada outside of white European people are identified as having a greater risk for Type 2 diabetes and it鈥檚 even higher around the world in populations where they鈥檙e having difficult life circumstances with poverty and equality,鈥� Raphael said.

鈥淚f you want to understand which populations around the world are more likely to have diabetes, it鈥檚 usually people with difficult life circumstances. The one commonality is all these groups experience greater unemployment, greater poverty and greater stress as immigrants,鈥� Raphael said.

Raphael said the solution to curbing the risk of diabetes in immigrant populations is to ensure everyone has enough economic resources to have a better quality of life.

The

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Co-edited by 91亚色 School of Health Policy听& Management Professors and , along with University of Toronto health studies Professor Toba Bryant, the second edition of Staying Alive (Canadian Scholars鈥� Press Inc.) has been thoroughly updated.

It features a new chapter on research methodology; expanded discussions of inequality, women鈥檚 health, public health and public policy; more material on First Nations health; and a new discussion of the historical development of the Canadian medicare system.

"The first edition sold really well and there isn鈥檛 another source out there that covers the same material in one book," says Rioux, who also directs the 91亚色 Institute for Health Research. "A second edition was needed."

The collection also includes chapters on pharmaceutical policy, social class, race, gender and care, as well as the social construction of illness and disability. In addition, it looks at approaches to promoting population health that include insights into the impact of economic forces such as globalization and privatization.

Left: Dennis Raphael

鈥淐oncerns about health and the health-care system have reached a fever pitch in Canada in recent years,鈥� write the editors. 鈥淭he public is subjected to a daily onslaught of media stories about the causes and treatment of disease and the threats to the sustainability of the Canadian health-care system.鈥�

The book strives to bring together isolated yet important perspectives in identifying key issues in health, illness and health care, relating them to current policy environments as a means of identifying the complex origins of the problems identified and contributing in a meaningful way to their solution.

It focuses on the Canadian scene with relevant comparisons to the United States and other countries and is organized in four parts. The first part provides an overview and critical review of four major health paradigms 鈥撎齮he epidemiological, sociological, political economy and human rights perspectives 鈥� and a new chapter on research paradigms and methodologies.

Right: Toba Bryant

The second part explores the emerging field of the social determinants of health with a focus on social class, gender and race as indicators of differential access to the economic and social resources available within a society.

In the third part, a comparative history of the Canadian health-care system is provided, along with an overview of current attempts at reform and a detailed analysis of the effects upon the system and its participants of recent trends toward privatization.

Left: Marcia Rioux

The final part considers critical issues in health and health care that illustrate some of the key themes of the volume, including gender and its interaction with health and health care; the construction of illness and disability; health policy through the lens of pharmaceutical policy and the health-care system; and public health concerns of varying national jurisdictions.

Staying Alive is expected to be of interest to a wide range of readers in the fields of health studies, nursing and social policy. In addition to traditional health sciences and sociological approaches, the book provides human rights and political economy perspectives on health, focusing on Canada and the United States within an international context.

For more information, visit the Web site.

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Saskatchewan was panned Thursday over its high infant mortality rate by the author of ain the journal , wrote the (Regina, Sask.) Jan. 22.

In his article, 鈥淭he health of Canada鈥檚 children: Part 1鈥�, released Thursday, 91亚色 Professor Dennis Raphael, of 91亚色鈥檚 , in the Faculty of Health, cites a 2008 Statistics Canada report pegging Saskatchewan鈥檚 infant mortality rate at 8.3 deaths per 1,000 live births, the highest of any province.

鈥淪askatchewan has this dubious distinction. The single best indicator to represent the health of the population is infant mortality,鈥� Raphael said in an interview Thursday.

Factors affecting infant mortality include the growing gap between rich and poor and the child poverty rate, he said. The article also pegs Canada鈥檚 child poverty rate well below average.

Canada has 15 per cent of its children living in households with less than 50 per cent of the Canadian median income. Denmark, Finland, Sweden and Norway all come in at five per cent or less. 鈥淲e are not doing well in terms of taking care of everyone,鈥� Raphael said.

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