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The personal is political, the social is physical
Toronto Star, July 30, 2004

JUDY GERSTEL

A new book published today may not be light summer reading for the cottage
or the beach but it does shed a lot of light on the way we live now as
Canadians.

Social Determinants Of Health: Canadian Perspectives, published by Canadian
Scholars' Press (http://www.cspi. org), is rightly billed as the first
volume of its kind published in this country.

Edited by York University professor Dennis Raphael and with a thoughtful
foreward by Roy Romanow, it's a collection of research and observations by
academics and leading-edge thinkers (a whole new community, in a way,
formed around this issue) about how social determinants of health play out
in Canadian life.

Alas, says Raphael, the way they play out "is certainly not a good news
story."

But then, Raphael is always loud and clear about his agenda: persuading
policy-makers to take action to improve social conditions in Canada and
thereby improve the health of Canadians.

"It's a very political book," he acknowledges. "It's about how governments
and other institutions make decisions on how to allocate resources among
Canadians. So you have someone asking, `Why do only 10 to 15 per cent of
women have access to licensed quality child care in Canada?' And, `Why is
this situation so completely different than it is in northern Europe and
the Scandinavian countries?'"

Raphael points to the final chapter of the book, with a chart showing that
program spending in Canada has declined "precipitously" since 1992, even as
Paul Martin boasted in the House of Commons while this was happening that
"program spending was at the lowest level of the GDP since the late 1940s."

Concludes Raphael: "It comes down basically to the whole approach to
governance now being different from what it used to be in Canada."

Raphael's book explores each of 11 recognized social determinants that
impact on health and well-being in Canada in the context of what exists "on
the ground" ? how theory translates into real life. If a book can walk the
walk as well as talk the talk, this one does. It's a significant resource
for teachers, students and researchers.

But it's also a useful, important and eye-opening reminder for all of us
about how our political and societal choices determine the health ?
literally, the extent of illness, disease, disability, medical costs ? of
Canadians, from heart disease and cancer to psychological impairment and
chronic neuroskeletal problems.

As Romanow reminds us, the first great revolution in the course of public
health was the control of infectious diseases; the second was the battle
against non-communicable diseases.

"The third great revolution is about moving from an illness model to all of
those things that both prevent illness and promote a holistic sense of
well-being," he writes.

While healthy lifestyle choices and a comprehensive, responsive and
accountable national health care system are important and vital, says
Romanow, he emphasizes that the main factors ? "the main `determinants' as
the experts call them ? that will likely shape our health and life span are
the ones that affect society as a whole."

Among them: employment security and working conditions, income and its
distribution, housing, early childhood education, literacy, social
inclusion.

Raphael suggests that the "really key" chapter, the "complete eye-opener"
is Dianne-Gabrielle Tremblay's analysis of the effect of globalization upon
employment security.

She looks at the "new boundaryless careers" ? no longer based on a vertical
promotion ladder but instead nomadic with horizontal movement and new forms
of organization and collaboration: team work, networks and virtual
communities.

While this flexibility may be positive for certain sectors, she writes, it
entails "precariousness, lack of stability and the lack of a career for
others" as well as "`false' self-employment, that is those who are
dependent on one or more order-givers."

The whole concept of "job security" is in doubt, she suggests, and this is
a major factor in health and well-being. Furthermore, notes Raphael, "This
is especially the case among Canadian women."

And yet, with the publication of this book, Raphael is feeling hopeful.

"If you look at the Liberal Party campaign statement, it has a commitment
to social programs, early childhood education, housing. This past federal
election was fought along the issues of values and social programs and a
belief about Canadians caring about each other.

"What you have, one might argue, is a recognition that the issues outlined
throughout the book are worthy of attention.

"Of course, the million dollar question is, `To what extent is there going
to be follow through on this?'"

And, one might ask, how healthy will Canadian society, and Canadians,
choose to be?


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