Increased Risk of Diabetes in Ontario Among Low Income Residents, 199797

1
Increased Risk of Diabetes in Ontario Among Low
Income Residents, 1997/97
Males
Females
5
3.8
4
Diabetes Prevalence Ratio
3
2.3
2
2
1.5
1.4
1.2
1
1
1
0
Low
Low-Middle
Upper-Middle
High
Income Level
2
Diabetes Prevalence in Ontario by Neighbourhood
Income Quintile, 1999
9
7.76
8
7.05
6.78
7
5.76
6
5.12
Diabetes Prevalence Rate
5
4
3
2
1
0
Q1 (Lowest)
Q2
Q3 (Middle)
Q4
Q5 (Highest)
Neighbourhoood Classified by Mean Income
3
Diabetes, Males
ASMR x 100,000
4
Diabetes, Females
ASMR x 100,000
5
(No Transcript)
6
(No Transcript)
7
Critical Periods of the Life Course

• Foetal development
• Birth
• Nutrition, growth and health in adulthood
• Educational Career
• Leaving parental home
• Entering labour market
• Establishing social and sexual relationships
• Job loss or insecurity
• Parenthood
• Episodes of illness
• Labour market exit
• Chronic sickness
• Loss of full independence
  
• -- Shaw et al., The Widening Gap, 1999, p. 106.

8
(No Transcript)
9

• Ten Tips For Better Health - Donaldson, 1999
• 1. Don't smoke. If you can, stop. If you can't,
  cut down.
• 2. Follow a balanced diet with plenty of fruit
  and vegetables.
• 3. Keep physically active.
• 4. Manage stress by, for example, talking things
  through and making time to relax.
• 5. If you drink alcohol, do so in moderation.
• 6. Cover up in the sun, and protect children from
  sunburn.
• 7. Practise safer sex.
• 8. Take up cancer screening opportunities.
• 9. Be safe on the roads follow the Highway Code.
  
• 10. Learn the First Aid ABC airways,
  breathing, circulation.

10
Ten Tips for Staying Healthy - Dave Gordon, 1999.

• 1. Don't be poor. If you can, stop. If you can't,
  try not to be poor for long.
• 2. Don't have poor parents.
• 3. Own a car.
• 4. Don't work in a stressful, low paid manual
  job.
• 5. Don't live in damp, low quality housing.
• 6. Be able to afford to go on a foreign holiday
  and sunbathe.
• 7. Practice not losing your job and don't become
  unemployed.
• 8. Take up all benefits you are entitled to, if
  you are unemployed, retired or sick or disabled.
• 9. Don't live next to a busy major road or near a
  polluting factory.
• 10. Learn how to fill in the complex housing
  benefit/ asylum application forms before you
  become homeless and destitute.

11
Avoiding the Life-Style Trap

• Lifestyle choices are heavily structured by life
  circumstances
• Lifestyle choices by themselves account for
  modest proportions of health status
• Lifestyle choices are difficult to change without
  considering life contexts
• Lifestyle choice emphases can have unintended
  side-effects that work against health

12
Political economy is a study of the natural laws
governing the production and distribution of
wealth.
13
Working-Aged Male (25-64) Mortality by Median
Share
U.S. States and Canadian Provinces
U.S. States with weighted linear fit (from Kaplan
et al., 1996)
800
Canadian Provinces with weighted linear fit
(slope not significant)
MS
LA
675
SC
AL
Rate per 100,000 Population
FL
550
TX
CA
ME
PEI
QUE
425
NH
NS
NB
NFLD
MAN
MN
ONT
BC
ALTA
SASK
Mortality Rates Standardized to the Canadian
Population in 1991
300
0.18
0.20
0.22
0.24
Median Share of Income
14
FlorenceSC
SiouxCityIA
Prince George
MonroeLA
TuscaloosaAL
JacksonvilleNC
ChicagoIL
WashingtonDC
Working Age (25-64) Mortality by Median Share
U.S. and Canadian Metropolitan Areas
U.S. cities (n282) with weighted linear fit
(from Lynch et al. 1998)
600
Canadian cities with weighted linear fit (n53)
(slope not significant)
FlorenceSC
NewOrleansLA
AugustaGA
PineBluffAR
500
NewYorkNY
Rate per 100,000 Population
MonroeLA
400
LosAngelesCA
BryanTX
SiouxCityIA
PortsmouthNH
300
McallenTX
Montreal
Vancouver
AppletonWI
Toronto
Mortality Rates Standardized to the Canadian
Popluation in 1991
200
0.19
0.23
0.15
0.27
Median Share of Income
Oshawa
15
USA, Canada, and Sweden Rankings on Compared to
Other Industrialized Nations (Ranking, 1
is best) Measure USA Canada
Sweden Income Inequality (1990) 18 of 18 11
3 Child Poverty (1990) 17 of 17 14 2 Infant
Mortality (1996) 24 of 29 17 2 Youth Suicide
(1992-1995 15 of 22 16 10 High School Drop-Outs
(1996) 17 of 17 16 10 Youth Homicide
(1992-1995 ) 22 of 22 19 5 Wages (1996) 13 of
23 15 6 Unemployment (1996) 2 of
10 7 8 Elderly Poverty (1990) 15 of
17 4 5 Life Expectancy (1996) 20 of 29 4 3
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Low Income

20
Canadian Policy Directions

• It has become obvious that people on the low
  end of the income scale are cut off from the
  ongoing economic growth that most Canadians are
  enjoying. It is also obvious that in these times
  of economic prosperity and government surpluses
  that most governments are not yet prepared to
  address these problems seriously, nor are they
  prepared to ensure a reasonable level of support
  for low-income people either inside or outside of
  the paid labour force.
• -- Poverty Profile, 1998. Ottawa National
  Council of Welfare Reports, Autumn, 2000.

21
Critical Analysis I Reasons for Resistance

• Lack of Epidemiological Theory
• Health officials and reporters seem unaware of
  recent developments in social epidemiological
  theory and population health research findings.
• Commitment to Ideology of Individualism in
  Health, Illness and Health Promotion
• Assists the neo-liberal and neo-conservative
  agendas of blaming individuals for their health
  problems, absolving governments of blame for
  their health threatening policies that create
  poverty, inequality, and social exclusion.

22
Critical Analysis II Side Effects of the
Biomedical and Lifestyle Heart Health Approach

• Removes the issue of the social determinants of
  cardiovascular disease and diabetes right off the
  public policy agenda.
• Low income people made to feel that they are
  responsible for their own poor health (victim
  blaming).
• Health workers and the media become complicit in
  the process of poor bashing Ignoring facts and
  repeating stereotypes about people who are poor.

23
Critical Analysis III The Holy Trinity

• As with any area of medical or scientific
  research,
• the selection of factors to be studied cannot
  be
• immune from prevailing social values and
• ideologies. ... It is also evident that so called
• lifestyle or behavioural factors (such as the
  holy
• trinity of risks - diet, smoking and exercise)
• receive a disproportionate amount of
• attention. As we have seen, the identification
  and
• confirmation of risk factors is often subject to
• controversy and the evidence about causal links
• is not unequivocal.  
• Nettleton, S. (1997). Surveillance, Health
  Promotion and the Formation
• of a Risk Identity in Debates and Dilemmas in
  Promoting Health.
• London UK MacMillan.

24
Dennis RaphaelSchool of Health Policy and
ManagementYork UniversityToronto,
Canada416-736-2100, ext. 22134draphael_at_yorku.ca