By Rob Rainer and Linda Silas
July 15, 2012
The top determinants of health in order are income status, education, social support networks, employment and working conditions, early childhood development, physical environment, personal health practices and coping skills and biological and genetic factors. Access to health care is ninth as a determinant of health.
Income status tops the list for good reason: poor people die younger. In the landmark Code Red project in Hamilton, researchers documented a 21-year difference in life expectancy between residents of lower and higher income neighbourhoods.
Education is next for good reason: Code Red found that 662 of every 1,000 adults in a high income neighbourhood have a university degree while in the low income neighbourhoods, only seven of 1,000 adults completed university.
By tackling each of the social determinants of health with intelligent public policy informed by evidence-based best practices, our governments will knock down Canada’s unconscionable poverty rates ranging from about 4 to 45 per cent or more, depending on the demographic group and measurement tool chosen. For example, UNICEF recently reported that Canada’s child poverty rate is 13.3 per cent, placing us 24th of 35 developed countries on this telling metric of progress.
By tackling the social determinants of health our governments can promote human capital, creativity and productivity while reducing health-care costs. For inspiration they should know that an estimated 20 per cent of health-care costs are attributable to health inequities such as poor health brought on by poverty. They should know that poverty costs Canada an estimated $72 billion to $86 billion per year, about 5 to 6 per cent of our GDP.
How can our premiers get started? First, for a convincing case statement, read A Healthy Society: How a Focus on Health Can Revive Canadian Democracy, by Saskatoon family physician Dr. Ryan Meili.
Second, set the goal of being in the top five nations for five key health outcomes by 2017 by, among other things, implementing the recommendations of the World Health Organization Commission on Social Determinants of Health, as advocated by the Canadian Nurses Association’s National Expert Commission:
• Improve the conditions of daily life — the circumstances in which people are born, grow, live, work and age.
• Tackle the inequitable distribution of power, money and resources — the structural drivers of those conditions of daily life.
• Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.
Third, agree to a whole-of-government approach at all levels. Co-operate nationally to create and implement a national poverty prevention and health promotion strategy shared by the federal, provincial, territorial, aboriginal and municipal governments, engaging business and civil society.
Fourth, agree to use — as recommended by the Canadian Medical Association and already in place in Quebec — health impact assessment as a tool to assess the costs and benefits of major public policies in which health is implicated. On this, CMA past-president Dr. Jeff Turnbull has said that “evidence shows that every action with a negative effect on health will incur heavier costs to society down the road. Looking at policy development through a health lens would have a dramatic impact with regard to poverty which hinders both Canada’s human potential and economic growth.”
The great Dr. Norman Bethune believed that “the protection of the people’s health should be recognized by the government as its primary obligation and duty to its citizens.” In this spirit, when they meet soon in Halifax, Canada’s premiers can make health attainment the highest priority of their governments — and request the federal government do the same.
Rob Rainer is executive director of Canada Without Poverty. Linda Silas is the president of the Canadian Federation of Nurses Unions.