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Our premiers all assure us that they are concerned with maintaining the health of Canadians and assuring the sustainability of the health care system. Health Canada and Canadian Public Health Association statements and documents argue that the means of accomplishing these worthy goals is to promote population health by focusing on the determinants of health: income, working conditions, housing, food availability, education and healthy child development.
Yet, the premiers shower us with exhortations to improve our lifestyles and make healthy choices. They do so at the same time that their policies maintain very high levels of child poverty and they reduce the social and other services that keep us healthy. It is difficult to believe that these developments are unrelated. The premiers weaken the determinants of Canadians' health, and they then divert attention from these activities by blaming Canadians for their own health problems by promoting lifestyle explanations for disease.
It is increasingly clear that how a society produces and distributes societal resources among its population are the prime determinants of population health. These links become clearer as evidence accumulates of how societal factors such as income distribution, employment conditions and availability of social and health services are the primary determinants of population health. Health is an important priority for Canadians, but policymakers rarely consider these health determinants and the political and economic forces that shape their quality.
Similar patterns are seen when the U.S., Canada, and Sweden are compared on a number of health determinants (income distribution, wages, support for families and children) and health indicators such as infant mortality and childhood death from injuries. Sweden fares the best, U.S. the worse, and Canada comes up the middle. And it is clear that Canadian public policy is moving more and more towards the U.S. model. These issues - not healthy lifestyles - are the primary threats to health and the sustainability of the health care system and should be the concern of policymakers. Why is this not the case?
Our governments - and our premiers - are implementing neo-liberal policies that emphasize the "market" as the arbiter of societal values and resource allocations. Unfortunately, these political and economic policies foster income and wealth inequalities, weaken social infrastructure, threaten employment security and working conditions and make life difficult for families and children. The neo-liberal emphasis on reducing income and corporate taxes benefits the wealthy and creates increasing social and economic inequality. Changing all the lifestyles in the world will accomplish little in light of the health effects of such policies.
The best means of promoting health therefore, involves Canadians being informed as to the primary determinants of health in a society. They can then consider - and attempt to influence - the political and economic forces that influence these determinants. Rather than being told to improve their lifestyles, Canadians need to reflect upon the kind of society in which they wish to live and work. Who will help bell this cat?
- reprinted from rabble.ca