Raphael presents strong links between poverty
and poor health

Says Swedish policies the best
for public health

PETERBOROUGH ON—Dr. Dennis Raphael presented a compelling link between low income and poor health at the Peaceful Communities annual general meeting last night. And, he called on audience members to do something about it.

Considered one of the foremost proponents of progressive health for over a decade, Dr. Raphael is an associate professor at the School of Health Policy and Management for York University. His research interests include the health effects of inequality and the impact of government decisions on health.

His presentation to a packed Whetung Theatre at Sir Sandford Fleming College in Peterborough contained an effective mix of statistics and personal anecdotes that was clearly well-received. He says there is a strong link between income and disease. In fact, the professor says it is one of the most well established findings in the health sciences, yet the least publicized. "There is a real gap between knowledge and action," notes Dr. Raphael.

"Social determinants predict the greatest proportion of health status variance," he says.

The link between poverty and poor health occurs across the spectrum of diseases, says Dr. Raphael, but none so compellingly as cardiovascular disease. Throughout Canada, the U.S. and United Kingdom, studies have consistently shown that poverty and low incomes are much more important than medical and lifestyle risk factors such as cholesterol levels, a lack of exercise, or tobacco usage. However, he says all governments and public health communities want to focus on is the peripheral matters – such as cholesterol screening, drug therapies, and lifestyle changes.

The York professor says Canadians, in 1991, had a lower incidence of heart disease and total death rates than did people in the U.S. But at the same time in Canada, poverty rates were far lower and the social safety net was substantially higher. Since then, though, the gap between the rich and poor has increased in Canada and social services spending has declined. Research both here and in other nations has found these kinds of policies to be clearly related to far greater incidences of heart disease.

Since 1991, Dr. Raphael has researched and spoken out on the effects of reduced spending on government social programs. A transplanted American, Dr. Raphael points out that the U.S. spends the second most amount of money in the world when it comes to health (as a percentage of GDP) but has little to show it for it with their increasing disparity between the rich and the poor. Canada ranks eighth in spending and Sweden ranks only 17th. Yet it is the latter nation that intrigues Dr. Raphael, he says, for its willingness to focus on the root problem – poverty.

The new national health policy for Sweden outlines six overarching areas that will ensure Sweden will be the model to emulate, says Dr. Raphael. Those policies are: to increase social capital, promote better working conditions, improve conditions for children and young people, improve the physical environment, promote healthy lifestyles and provide good structural conditions for public health.

"There is no indication that Canada or Ontario are even showing recognition for the real problems plaguing health care," according to the York professor.

However, Dr. Raphael says the worst thing to think would be that there is nothing that can be done. "We have to reduce the incidences of low incomes, reduce the incidences of social exclusion and we have to restore supports to Canadians who need assistance," he says.

The York professor told audience members to lobby their local health unit to recognize the link. He also told them to contact their government representatives to pressure them to restore and maintain the social service structures that help those in need.

To view Dr. Raphael’s website, click here.




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