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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