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The personal is political, the social is physical [CA]

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Gerstel, Judy
Publication Date: 
30 Jul 2004

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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, 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 foreword 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.

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.

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?

- reprinted from the Toronto Star