The Hon. Monique Bgin, PC, FRSC, OC

1

The Causes and the Causes of the Causes of Health

• by
• The Hon. Monique Bégin, PC, FRSC, OC
• University of Ottawa
• WHO Commission on Social Determinants of Health
• Town hall meeting Sunday, March 9, 2008 - 200pm
  Holy Rosary Parish Hall, 354 St.Clair Ave. West

2
 Why are some people healthy and others
not  ? "People with PhDs live longer than
those with masters degrees. Those with a masters
live longer than those with a degree, while those
with a degree live longer than those who left
school early.Similarly, actors who have won an
Oscar will live on average 3 years longer than
those who were nominated for the award but missed
out. "
3
Today

• We want to explore  
• If genetics and individual risk factors are not
  the best predictors of staying healthy or
  becoming ill, what are the predictors society
  should know about?

4
Different socio-economic status different
health status

• The first observation one must make is that of
  health inequality People are not all healthy the
  same way, at the same level. Is it only due to
  biology and ones genetic make-up? Or to
  unhealthy individual life style?
• NO!

5
The  classless  society?...

• Canadians and Americans like to think that they
  are very egalitarian and dont have social
  classes.
• We mask reality by referring to  socio-economic
  status .
• The Brits who acknowledge that their society is a
  well-entrenched class system have a long
  tradition of research of the connection between
  health and class.

6
Two famous British studies

• Black
• Whitehall

7
The Black Report

• Sir Douglas Black et al
• First released in 1980
• Tracked patterns of inequalities of health
  across Britain through health records.
• Thatcher tried to suppress the report.
• Finally published in 1988

8
The Whitehall Study I II

• Sir Michael Marmot (joined in 1976)
• Published 1986-87
• 10,000 male civil servants, studied over 10
  years.
• Divided in 4 groups
• Administrative (top)
• Professionals
• Clerical
• Unskilled

9
Researchs assumption was

• Individuals with big jobs and big
  responsibilities are those prone to cardiac
  accidents.

10
Research results
11
(No Transcript)
12
Whitehall I and II concluded

• People at the bottom of the hierarchy had a
  higher risk of heart attacks. The lower you were
  in the hierarchy, the higher the risk.
• The same applied to all the major causes of death
  -- cardiovascular disease, gastrointestinal
  disease, renal disease, stroke, accidental and
  violent deaths, cancers that were not related to
  smoking as well as cancers that were related to
  smoking.

13
Whitehalls social determinants

• Low job control.
• Job stress, tension
• Lack of skill utilization
• Lack of clarity in tasks.
• Household income or wealth
• Conflicting work and family demands.
• No socially cohesive neighbourhood, etc.

14
The Black, Whitehall and other studies have told
us about

• The social determinants of health factors other
  than genetic/biological do determine health
  status.
• The gradient theory social classes or
  different socio-economic status do predict health
  status in every society.

15
Health gradients in British households

Office for National Statistics (2001). Living in
Britain results from the 2000 General Household
Survey. London Stationery Office
16
The same within most countries

• arriving home in Marylandlife expectancy is 77
  years.

• Leaving downtown Washington (DC) at 5 P.M., life
  expectancy is 57 years.

17
Probability of Survival From Age 15-65 Years
Among US Blacks Whites
probability of survival
US White Poor White US Black Poor Black Males
Males Males Males
Geronimus et al, NEJM 1996
18
Fair/poor self rated health 3 times more likely
among lower income men and women in Canada
Note Adjusted for age, social roles, and health
behaviours. Source Orpana, H. Lemyre, L.
(2004). Explaining the social gradient in health
Using the National Population Health Survey to
examine the role of stressors. Int J Beh Med.
11(3) 143-151.
19
Aboriginal health (2001)
20
and health inequalities exist between countries
21
PROBABILITY OF DYING BETWEEN AGES 15 AND 60
(males)
SOURCE THE WORLD HEALTH REPORT 2004,WHO
22
Inequality

• What matters most is not whether you have a
  smaller or larger home or better or lesser care
  but what these differences mean socially and what
  they make you feel about yourself and the world
  around you.
• (Richard Wilkinson, University of Nottingham, UK)

23
Kashechewan (ON) 1,100 Crees evacuated FOR
MONTHS because of contaminated water October
2005
24
Jane Finch, in Toronto, has been fighting for
four decades to overcome isolation, hardship, and
stigma.
25
Montreal has the highest rate of low incomes of
all the Quebec regions. That rate of 21.5 means
that 1 Montrealer out of 5 lives with very little
financial means. Institut de la Stat. du Québec
2005
26
From health inequality to health inequity

• Health inequality
• An observable, often measurable, difference in
  health status between individuals or between
  groups, whatever its cause.

• Health inequity
• A moral category rooted in social
  stratification, embedded in political reality and
  the negotiations of social power relations.

27
Narrowing health gaps

• Health inequality is the gap between the health
  of the best-off and worst-off groups.
• Narrowing health gaps means raising the health
  of the poorest, fastest.
• It requires both improving the health of the
  poorest and doing so at a rate which outstrips
  that of the wider population.

28
How egalitarian a society are we?

• There is now good evidence that the healthiest
  and happiest societies are those with the most
  equal distribution of income.

29
UN Agency states that Canadais failing the poor

• Over last 10 years, welfare benefits are dropped
  in most provinces below half of basic living
  costs.
• In 2001, just 39 of unemployed Canadians were
  eligible for unemployment insurance benefits. The
  program must be more accessible.
• Minimum wages are inadequate to achieve a decent
  standard of living.
• Homelessness and housing constitute a national
  emergency.
• Reference UN Committee on Economic, Social and
  Cultural Rights report (2006)

30
Is action possible?...

• Yes it is, and its urgent!
• How? By shedding the culture of contentment in
  which we live.
• By saying loud and clear that social policies do
  matter to Canadians.
• By addressing upstream factors through
  whole-of-government policies instead of
  focusing
• on downstream problems

31
More information

• Research reports of the Commission
  www.who.int/socialdeterminants
• Early child development
• Gender
• Social exclusion
• Employment conditions
• Health systems
• Urban settings
• Priority public health issues
• Globalisation
• www.phac-aspc.gc.ca/sdh-dss
• www.parl.gc.ca/common/Committee (Senate)
• www.moniquebegin.telfer.uottawa.ca