Great new report – Social Determinants of Health: The Canadian Facts

Posted on in Health Policy Context

Source: — Authors: – listserve – York U health researchers produce public primer on who gets sick and why
May 3, 2010.   Rob Rainer

Two health researchers at York University last week issued a great new report – Social Determinants of Health: The Canadian Facts.  See the press release below and access the report at Congratulations to Dennis Raphael and visiting York U. scholar, Juha Mikkonnen, for developing an accessible and compelling resource for those seeking to improve health outcomes by getting at root causes of ill health.

Rob Rainer
Executive Director / Directeur executif
1210 – 1 rue Nicholas Street
Ottawa, ON K1N 7B7
(613) 789-0096 (1-800-810-1076);;

If you really want to advocate for health, if you really want to make changes to health, you have to start to make fundamental changes to the way society is structured.  You have to deal with issues like poverty.

Dr. Jeffrey Turnbull, President-Elect, Canadian Medical Association


York U health researchers produce public primer on who gets sick and why

TORONTO, April 28, 2010 – A report released today by York University health researchers offers Canadians the opportunity to learn how their living conditions will determine whether they stay healthy or become ill.

Social Determinants of Health: The Canadian Factsshows why these factors are so important for health and documents the state of these living conditions in Canada in an accessible manner for the Canadian public.

“Our key message is that the health of Canadians is much less determined by the health care system than we typically think. Much more important are public policies that influence our living conditions,” says Dennis Raphael, Professor in York’s School of Health Policy & Management and the report’s co-author.

Raphael and visiting scholar Juha Mikkonenexplain in everyday language and with compelling graphics how Canadians’ health is shaped by how much income and wealth they have, whether or not they are employed and if so, the working conditions they experience. They pull together a wide range of research to show how health is powerfully influenced by Canadians’ ability to obtain quality education, food and housing, among other factors.

The report finds these conditions are declining with serious ramifications for the quality and longevity of Canadians’ lives, and outlines specific ways that the situation can be improved. The report is free to the public at

Former Minister of Health and Welfare Monique Bégin states in the report’s foreword: “While one of the world’s biggest spenders in health care, we have one of the worst records in providing an effective social safety net. What good does it do to treat people’s illnesses, to then send them back to the conditions that made them sick?”

Contrary to the popular belief that Canada is a caring nation with strong supports for citizens, the report shows that Canada has one of the worse records among wealthy developed nations in providing Canadians with the conditions necessary for health. These supports are eroding with significant effects on Canadians’ health, according to Raphael.

“This is not a storyline that’s familiar to most Canadians,” he says. “We’re still stuck in those glory days where Canada really was one of the best places in the world to live. Sadly, that is no longer the case. What’s frightening is that many of these aspects are completely beyond any one individual’s control.”

For example, new immigrants have difficulty getting accreditation for their skills, and are forced into service jobs where they can barely afford to feed their families. This leads to a host of problems that directly affect health and overall quality of life.

“It’s all interrelated. It’s time to act on these issues,” Raphael says.

A striking example is found in maps that show a clear correspondence between poverty levels, prevalence of adult-onset diabetes, and concentration of visible minorities in Toronto neighbourhoods.

The report provides concrete recommendations for improving this situation. For example, in regard to the increasing occurrence of hunger in Canada, it recommends:
• Increases in minimum wages and social assistance rates to the level where an adequate diet is affordable.
• Governments assuring that healthy foods are affordable (e.g. milk, fruits, and foods high in fiber).
• Provision of affordable housing and childcare that would reduce other family expenses and leave more money for acquiring an adequate diet.

Sobering statistics cited by the report include:

– 15 per cent of Canadian children are living in poverty, putting Canada at a rank of 20th out of 30 of the world’s wealthiest nations as defined by the Organisation for Economic Co-operation and Development (OECD).

– Only 17 percent of Canadian families have access to regulated child care. Canada ranked last among 25 wealthy developed nations in meeting various early childhood development objectives.

– Canada is amongst the lowest in its coverage of total health care costs. Medicare covers only 70 per cent of total health care costs, giving Canada a rank of 22nd of 30 OECD nations for public coverage of health care costs.

– Canada is among the nations with the greatest gap between men’s and women’s earnings. Canada ranks 19th of 22 OECD nations in reducing the earnings gap between men and women.

– Over 40 per cent of Canadians with disabilities are not in the labour force, forcing many of them to rely upon social assistance benefits. Canada ranks 27th of 29 in public spending on disability-related issues.

What People are Saying about The Canadians Facts

“This wonderful document, Social Determinants of Health: The Canadian Facts is about us, Canadian society, and what we need to put faces and voices to the inequities – and the health inequities in particular – that exist in our midst. Only when we see a concrete description of these complex and challenging problems, when we read about their various expressions in all the regions of the country and among the many sub-groups making up Canada, can we move to action.”
Hon. Monique Bégin, PC, FRSC, OC from the Foreword. (Member of WHO Commission on Social Determinants of Health, and Former Minister of National Health & Welfare of Canada)

“Congratulations on this most valuable contribution to Canadians’ understanding of what really needs to change in order to improve population health. My hope is that it also sends a strong yet accessible message to those of us in the Canadian health system about how we need to change our practice.”

Dr. Penny Sutcliffe, MD, MHSc, FRCPC, Chief Executive Officer, Sudbury & District Health Unit

“Juha Mikkonen and Dennis Raphael have created a resource that is at once educational, easy to read, evidence-based, and a powerful call to action. I hope to see this document open on the desks of policy makers, public health professionals, students, and front line health providers. This important contribution to the dialogue around social determinants of health in Canada offers both an accessible resource, and a straightforward guide to what we need to do to reduce inequities in health.”

Dr. Gary Bloch, Family Physician, St. Michael’s Hospital, Toronto; Assistant Professor, University of Toronto

“This is a superb document for getting the message out there regarding the politics of health. There is nothing like it in Canada. The text and the graphs will enlighten even the skeptics. The cover art is great. The layout is engaging and the whole thing is entirely readable. I’ll be using it in every class I teach.”

Dr. Elizabeth McGibbon, St. Francis Xavier University

“Under the International Covenant on Economic, Social and Cultural Rights, everyone has rights ‘to an adequate standard of living’ and ‘the enjoyment of the highest attainable standard of physical and mental health.’ Nonetheless, the evidence for comprehensive action on the social determinants of health is overwhelming. Like highly skilled trial lawyers, Juha Mikkonen and Dennis Raphael have assembled this evidence, concisely, clearly and compellingly, into a single document. As a result, the prospect of realizing the rights that constitute an international standard for a decent human life is that  much brighter. Bravo!”

Rob Rainer, Executive Director, Canada Without Poverty

“The Canadian Facts so succinctly described in this readable little book are not nice ones. But beneath the intersecting pathways by which social injustices become health inequalities lies the most sobering message: Things are getting worse. We have lived through three decades where the predatory greed of unregulated markets has allowed (and still allows) some to accumulate ever larger hordes of wealth and power while denying others a fair share of the resources they need to be healthy. This book is a fast-fact reference and an invitation for Canadian health workers to join with social movement activists elsewhere to reclaim for the public good some of these appropriated resources.“

Dr. Ronald Labonté, Professor and Canada Research Chair, Globalization
and Health Equity, University of Ottawa

“With unusual clarity and insight, this informative resource will help change the way readers think about health.  It renders visible how underlying social and economic environments influence health outcomes even more than personal behaviors, genetic profiles, or access to healthcare. Solutions, it reminds us, lie not in new medical advances or even ‘right choices’ but in the political arena: struggling for the social changes that can provide every resident the opportunity to live a healthy and fulfilling life.”

Larry Adelman, creator and executive producer, “Unnatural Causes: Is Inequality Making Us Sick?

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