Social Determinants of Health in Canada

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An overview of the impact of poverty and income inequality on the health of Canadians is provided. Increasing poverty is seen to go handin-hand with increasing income inequality.

Both poverty and income
inequality result from governmental social and economic policy decisions. Poverty is also increased by weakening of social safety nets and other supports. Documentation is provided of the growing incidence of poverty and income inequality and how both of these impact upon the health of Canadians.

Poverty directly harms the health of those with low incomes while income inequality affects the health of all Canadians through the weakening of social infrastructure and the destruction of social cohesion. Recommendations for addressing increasing poverty and income inequality are provided. It is emphasized that reducing poverty and income inequality should be grounded in an approach that recognizes the importance of citizen participation and civic involvement.

The purpose of this paper is to consider the issue of poverty, income and health in Canada. This analysis is based on what are termed the social determinants of health (Marmot & Wilkinson, 1999; Wilkinson & Marmot, 1998). This literature links health outcomes to how societies are organized and resources allocated. And one of the most important societal factors related to health appears to be the degree of poverty present within a jurisdiction (Reutter, 1995; Haines & Smith, 1997; Warden, 1998). After considering the evidence concerning the incidence of poverty in Canada, I examine how poverty is linked to poor health. I will argue that the health consequences of the growing levels of poverty in Canada are profound and will be longstanding whatever efforts may eventually be made to reduce its incidence. Finally, I present means by which poverty could be reduced were the political will to do so present (Yalnizyan, 2000).

It has been known for many decades that the profound improvements in health in Canada and other industrialized countries have primarily been due not to advances in medicine or health care but rather in the kind of societies in which we live. As one illustration, the most profound causes of the reduction of deaths from infectious diseases such as typhoid, influenza, and diphtheria were not implementation of immunizations or medical cures but rather improvements in general living conditions (McKinlay & McKinlay, 1987).

More recently, it has been hypothesized that lifestyle differences are the source of population differences in the occurrence of heart disease, stroke, and cancer. But careful studies have indicated that most of the variation among individuals in health cannot be accounted for by lifestyle factors alone (Marmot, 1986) suggesting that lifestyle issues are embedded within broader factors that predict illness and death. What might these factors be?

The Ottawa Charter for Health Promotion (WHO, 1986) identifies prerequisites for health as being peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. Health Canada (1998a) has outlined income and social status, social support networks, education, employment and working

conditions, physical and social environments, biology and genetic endowment, personal health practices and coping skills, healthy child development, and health services as key determinants of health. British workers have identified the social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food, and transport as key determinants of health (Marmot & Wilkinson, 1999; Wilkinson & Marmot, 1998). It is obvious that poverty is a key factor underlying whether these determinants of health can be attained. Poverty can affect health in a number of ways. Income provides the prerequisites for health, such as shelter, food, warmth, and the ability to participate in society; living...
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