Like any major economic or social policy shift, the Henry Review – or at least the Government’s actions arising out of it – will have significant implications for the community’s health.
A new publication from Canada – Social Determinants of Health: The Canadian Facts – provides a timely reminder of the importance of economic and social policy for health.
A summary of the document says:
“The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience. These conditions have come to be known as the social determinants of health. This information – based on decades of research and hundreds of studies in Canada and elsewhere – is unfamiliar to most Canadians. Canadians are largely unaware that our health is shaped by how income and wealth is distributed, whether or not we are employed and if so, the working conditions we experience.
“Our health is also determined by the health and social services we receive, and our ability to obtain quality education, food and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us by the quality of the communities, housing situations, work settings, health and social service agencies, and educational institutions with which we interact.
Improving the health of Canadians requires we think about health and its determinants in a more sophisticated manner than has been the case to date.”
The publication considers 14 social determinants of health:
1. Income and Income Distribution
2. Education
3. Unemployment and Job Security
4. Employment and Working Conditions
5. Early Childhood Development
6. Food Insecurity
7. Housing
8. Social Exclusion
9. Social Safety Network
10. Health Services
11. Aboriginal Status
12. Gender
13. Race
14. Disability
Here are a few of the policy recommendations that caught my eye because of their potential relevance to Australia:
Income
• This is probably the most important social determinant of health. “There is an emerging consensus that income inequality is a key health policy issue that needs to be addressed by governments and policymakers,” the report states.
• Increasing the minimum wage and boosting assistance levels for those unable to work would provide immediate health benefits for the most disadvantaged Canadians.
• Reducing inequalities in income and wealth through progressive taxation is a highly recommended policy option shown to improve health.
Early childhood development
• Governments must guarantee that affordable and quality child care is available for all families regardless of wealth or income level.
Housing
• Housing policy needs to be more explicitly linked to comprehensive income (including a jobs strategy), public health, and health services policy.
Health services
• Health authorities must find means of controlling the use of costly but ineffective new treatments (e.g., pharmaceuticals and screening technologies) that are being marketed aggressively by private corporations.
Aboriginality
The 1996 Royal Commission on Aboriginal Peoples made a number of recommendations, virtually all of which have not been implemented. These include:
• Recognition of an Aboriginal order of government with authority over matters related to the good government and welfare of Aboriginal peoples and their territories.
• Replacement of the federal Department of Indian Affairs with two departments, one to implement a new relationship with Aboriginal nations and one to provide services for non-self-governing communities.
• Creation of an Aboriginal Parliament.
• Initiatives to address social, education, health, and housing needs, including the training of 10,000 health professionals over a 10-year period, the establishment of an Aboriginal peoples’ university, and recognition of Aboriginal authority over child welfare.
Gender
The report notes that both men and women’s health can suffer because of issues related to gender.
It says, however, that women in Canada experience more adverse social determinants of health than men. The main reason for this is that women carry more responsibilities for raising children and taking care of housework. Women are also less likely to be working full-time and are less likely to be eligible for unemployment benefits. In addition, women are employed in lower paying occupations and experience more discrimination in the workplace than men. For these reasons, almost every public policy decision that weakens the social safety net has a greater impact on women than on men.
• Improving and enforcing pay equity legislation would improve the employment and economic situation of Canadian women.
• Providing a national affordable high quality childcare program would provide opportunities for women to engage in the workplace and improve their financial situations.
Race
Canadians institutions must recognise the existence of racism in Canada and develop awareness and education programs that outline the adverse effects of racism.
• Governments must enact laws and regulations that allow foreign-trained immigrants to practice their occupations in Canada.
• Authorities must strongly enforce anti-discrimination laws.
• Since people of colour are experiencing especially adverse living circumstances, governments must take an active role in improving their living conditions.
The publication ends on a quote from Carolyn Bennett, an assistant professor at the Department of Family and Community Medicine at the University of Toronto and an MP. She was Canada’s first minister of state for public health from 2003–2006. She said:
“The profound structural change needed to secure investments in the social determinants of health in our complex federal system will occur only if we succeed in raising public awareness and developing political will.”
Now Croakey isn’t a keen punter generally, but would be happy to take a bet that the coverage and analysis we see of the Henry Review in coming days pays very little attention to the implications for the social determinants of health.
* The authors of the Canadian report are Juha Mikkonen (Helsinki, Finland), a vice-president of the European Anti-Poverty Network Finland, and Dennis Raphael (Toronto, Canada), a professor of health policy at the School of Health Policy and Management at York University.
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Mikkonen and Raphael’s Facts has much relevance for both Australians and people in the USA. Australia is close to being the healthiest nation and an article in the Medical Journal of Australia asks the question what would it take? (Ring, I. T. and J. F. O’Brien (2007). “Our hearts and minds – What would it take for Australia to become the healthiest country in the world?” Medical Journal of Australia 187(8): 447-451.) So perhaps the ideas in the Canadian Facts coupled with the Henry Review might make that a possibility.
The USA stands in stark contrast with its people dying younger than pretty well all the other rich nations and some poor ones despite spending half of the world’s health care bill (see Bezruchka, S. (2010). Epidemiological Approaches to Population Health. Staying alive : critical perspectives on health, illness, and health care. D. Raphael, M. H. Rioux and T. Bryant. Toronto, CSPI: 13-40. under resources at the Population Health Forum’s website: http://depts.washington.edu/eqhlth/ ).
The Canadian Facts is a prescription for attaining health in a nation that requires the people to demand dispensing the cure!
Well you’re bet was right. Some of the Henry Report’s recommendations had the potential to significantly influence the social determinants of health but they’ve been ignored. So we really should be looking at a ‘Marmot Review’ process in this country as a means to highlight and act on the relevant recommendations. Because clealry, equity in health and social justice generally have been ill served by the government’s failure to act.