About Canada: Health and Illness

205 Pages·2016·3.62 MB·English

by  Dennis Raphael

HEALTH AND ILLNESS
HEALTH AND ILLNESS
Second Edition
DENNIS RAPHAEL
HALIFAX & WINNIPEG
Copyright © 2016 Dennis Raphael
All rights reserved. No part of this book may be reproduced or transmitted in any
form by any means without permission in writing from the publisher, except by a
reviewer, who may quote brief passages in a review.
Editing: Brenda Conroy
Design: John van der Woude
Printed and bound in Canada by Hignell Book Printing
eBook: tikaebooks.com
Published in Canada by Fernwood Publishing
32 Oceanvista Lane, Black Point, Nova Scotia, B0J 1B0
and 748 Broadway Avenue, Winnipeg, MB R3G 0X3
www.fernwoodpublishing.ca
Fernwood Publishing Company Limited gratefully acknowledges the financial
support of the Government of Canada through the Canada Book Fund and the
Canada Council for the Arts, the Nova Scotia Department of Communities, Culture
and Heritage, the Manitoba Department of Culture, Heritage and Tourism under
the Manitoba Publishers Marketing Assistance Program and the Province of
Manitoba, through the Book Publishing Tax Credit, for our publishing program.
Library and Archives Canada Cataloguing in Publication
Raphael, Dennis, author
Health and illness / Dennis Raphael. -- 2nd edition.
(About Canada series ; 4 )
Includes bibliographical references and index.
Issued in print and electronic formats.
ISBN 978-1-55266-826-9 (paperback).--ISBN 978-1-55266-902-0 (epub).--
ISBN 978-1-55266-903-7 (kindle)
1. Public health--Social aspects--Canada. 2. Public health--Economic aspects--
Canada. 3. Medical policy--Social aspects--Canada. 4. Social medicine--Canada.
I. Title. II. Series: About Canada series ; 4
RA449.R36 2016 362.10971 C2016-904980-9 C2016-904981-7
CONTENTS
Acknowledgements
Chapter 1 Who Stays Healthy? Who Gets Sick?
Chapter 2 Living Conditions, Stress and the Human Body
Chapter 3 Income, Education and Work
Chapter 4 Early Child Development, Food Security and Housing
Chapter 5 Social Exclusion
Chapter 6 Public Policy and the Social Determinants of Health
Chapter 7 What Needs to Be Done?
Notes
Appendix
Index
ACKNOWLEDGEMENTS
One of the greatest pleasures of my professional life has been the
opportunity to meet and work with committed researchers and policy
advocates from across Canada — people from the wide range of
sectors that have come to be known as representing the social
determinants of health. Much of this book represents an integration
and synthesis of their work, and I have made every attempt to
recognize and communicate their contributions.
These individuals include Carolyne Alix, Laura Anderson, Pat
Armstrong, Nathalie Auger, Toba Bryant, Tracey Burns, Ann Curry-
Stevens, Janice Foley, Martha Friendly, Grace-Edward Galabuzi,
Lars Hallstrom, Michelle Firestone, Andrew Jackson, Ronald
Labonte, David Langille, Elizabeth McGibbon, Lynn McIntyre,
Barbara Ronson McNichol, Michael Polanyi, Govind Rao, Irving
Rootman, Michael Shapcott, Peter Smith, Janet Smylie, Emile
Tompa, Diane-Gabrielle Tremblay, Valerie Tarasuk and Charles
Ungerleider.
All of these people practise what University of Washington
professor Katharyne Mitchell calls “public scholarship.” They
recognize the need to move their research findings and
recommendations beyond the academy in the service of influencing
public policy. Their activities have promoted better understandings of
what needs to be done.
But to date our attempts to prod our governments and elected
representatives to implement health-promoting public policy have
fallen well short of what is being accomplished in other nations. This
book is one more attempt to move this agenda forward.
I am very appreciative of Fernwood Publishing — especially Wayne
Antony and Beverley Rach — and the others involved in producing
this book — Brenda Conroy and Debbie Mathers — for their support
of this effort.
In these difficult times, it will do us well to recall Bertolt Brecht’s
words from his poem “The World’s One Hope.”
All those who have thought about the bad state of things
refuse to appeal to the compassion of one group of people for
another.
But the compassion of the oppressed for the oppressed is
indispensable.
It is the world’s one hope.
1
WHO STAYS HEALTHY? WHO GETS
SICK?
The high burden of illness responsible for appalling premature
loss of life arises in large part because of the conditions in which
people are born, grow, live, work, and age — conditions that
together provide the freedom people need to live lives they
value. — World Health Organization1
“It’s not as if we won’t die. We all die,” Nancy Krieger of Harvard
University’s School of Public Health reminds us. “The question is: At
what age? With what degree of suffering? With what degree of
preventable illness?”2
Staying healthy and avoiding disease and early death is probably
one of the greatest concerns of all Canadians. But how do we go
about doing this? What do we know about keeping Canadians alive
and healthy for as long as possible?
In the traditional model of health, the body is seen as a machine
that is either running well or in need of repair. If it is infected with
germs or afflicted with system or organ malfunctioning, the remedy
lies in medical or curative care, which is located in the health care
system and administered by doctors and nurses. Canadians are
therefore urged to pay attention to medical discoveries and treatment
— especially access to doctors and hospitals — and to be mindful of
how our “lifestyle choices” could affect these problems. Newspapers,
television, documentaries and other media overflow with information
about hospital costs, wait times, the supply of doctors, and what to
eat and why we should exercise. While any individual experiencing
illness will certainly value medical treatment, this traditional model of
health says little if anything about what drives most diseases and
illnesses.
Decades of research and hundreds of studies in Canada tell the
real story about the important factors that make us healthy or ill. The
factors that give us longer, healthy lives or shorter, sick lives are not
these much-discussed medical and lifestyle ingredients, but rather
the living and working conditions we experience from day to day. The
World Health Organization calls these health-shaping characteristics
the “social determinants of health” (SDoH). This term has become
widely used and accepted in the last couple of decades.3 In a
nutshell, SDoH refers to the social and economic conditions that
shape whether people and groups of people are healthy or ill. The
Health Council of Canada recognizes the importance of the SDoH
and provides a description of these social determinants:
The reality is that our health — and our ability to live a healthy
lifestyle — is affected by a … [broad] range of factors. These
factors, called the [social] determinants of health, include how
much money we have, our early childhood experiences, and our
level of education. They include whether or not we work (and the
kind of work we do), our relationships with family and friends,
how connected we are to our communities and society, whether
we have easy access to affordable healthy food, and the quality
of our health care services. Belonging to a specific racial, ethnic,
or cultural group can also influence our health.4
It would be comforting to believe we can choose these living and