Income Inequality “No Big Deal” according to Economists

By Diana Daghofer

In North America, the Occupy movement cast the spotlight on an issue that has been the focus of grave concern around the world – income inequality. So the media flurry that came with the release of Statistics Canada’s latest report on the Income of Canadians (September 11, 2013) was no surprise. CBC’s Kelowna-based Daybreak South (September 12, 2013) and the CBC national show, The 180 (September 13, 2013), are two examples that featured leading economists, both of whom were completely uninformed of the health, social and even the economic costs of income inequality.

The numbers simply confirm what we all know – the rich are getting richer, leaving the rest of us behind. At an average of $381,000 each, the richest 1% of Canadians earn more than ten times the average Canadian income. More than the numbers, though, it is the response from leading economists that is troubling for the future of our country.

Take, for example, the response to Daybreak South host, Chris Walker’s, excellent question “Why does it matter that there is a gap?”  His guest, UBC Okanagan economics professor Ross Hickey, was pretty nonchalant: “Things have been going better for most of us. The gap matters because people care about it. Extreme wealth bothers people.” The good professor proceeded to talk about the value these wealthy few bring to our nation: “There is no reason to try to trip these people up, because a lot of what they are doing is fuelling the economy and providing jobs for those at the low end of the income distribution.”

On CBC’s The 180, guest Terence Corcoran, editor of the Financial Post, echoed those sentiments, actually saying, “Inequality is not a bad thing. It is inevitable…in any political system.” When asked whether he thought anything should be done about growing income inequality in Canada, he said, “What’s the point? What are we trying to accomplish?” Well, I would ask him, “How about saving lives?”

No reason to reduce the gap?

Public health practitioners, and many beyond our circle, know that the social determinants of health – with income leading the way – are the prime predictors of disease and illness. Living conditions out-trump the effect of any behavioural risk factors, including diet, exercise and even tobacco use.[i]

Here are some of the effects of income inequality on health, comparing those living in neighbourhoods with the lowest 20% average income in Canada to those in the wealthiest 20% average income:

  • Infant mortality is a very sensitive indicator of societal health, and Canada is a healthy place, right? So it would likely surprise most Canadians that 40% more babies die in their first year of life in our poorest neighbourhoods (7.1 of 1000 live births) than our richest (5.0 of 1000 live births).[ii]
  • Suicide rates in the lowest income neighbourhoods are almost twice as high as in the wealthiest neighbourhoods.[iii]
  • Men in Canada’s wealthiest neighbourhoods live, on average, almost 4.5 years longer than those living in our poorest neighbourhoods.1
  • People in our poorest neighbourhoods are almost one and a half time more likely to have a chronic disease than those in the wealthiest neighbourhoods, and almost twice as likely to be hospitalized for them.2

Literally hundreds of research reports show us that health inequities in Canada are widespread and affect us at every stage of life.

Does Wealth = Health?

It is true that, at every step up the income ladder, people are healthier, overall. The economists pointed out that the incomes of the poor are increasing. So, does more wealth mean better health? Not necessarily. It is actually the gap between the rich and poor that is the best indication of health, or the lack thereof. Countries with the smallest gap between rich and poor are those that report the best health of their populations.2 Of course, those countries take an active role in distributing resources more equally among their populations, and tend to invest more in their social infrastructure.1 In other words, income inequality – leaving people in poverty – is a choice that governments (and those that vote them in) make.

The Financial Impact

Leaving lives lost for a moment, more illness clearly increases healthcare costs. In 2010, the cost of ‘avoidable’ and ‘excess’ hospitalizations was over $400 million.3 And it hits us at the other end of the economic scale, too.  When people are sick, they can’t contribute to the workforce and other economic productivity.

So, while Messrs. Hickey and Corcoran could be excused for not recognizing the health impact of the income gap, they should understand its economic impact. In 2011, the International Monetary Fund identified “the increase in inequality (as) the most serious challenge for the world.”[iv]

Researchers, policymakers, the Canadian Medical Association and countless public health practitioners have expressed deep concern about the health, social and economic consequences of the increasing gap between rich and poor in Canada, and around the world. I applaud the media’s efforts to cover the issue, but the next time they interview economists about income inequality, I would ask them to include a public health professional who can bring to light the many evidence-based solution to this problem. Many people believe that poverty is inevitable. It’s time we show them that it is a choice our governments, with voter support, have made.

Diana Daghofer is a public health consultant living in Rossland, British Columbia and a member of the Public Health Association of British Columbia

References and Further Reading

[i] Raphael D, Social Determinants of Health: Canadian Perspectives, 2nd edition, Toronto, ON, Canadian Scholars Press, 2008

[ii] Raphael D (2010), Health Equity in Canada. Social Alternatives Vol. 29 No. 2, 2010

[iii] Canadian Medical Association (2013), Submission on Motion 315 (Income Inequality), Submitted to the House of

Commons Standing Committee on Finance, April 25, 2013 [cited September 12, 2013]. Available from:

[iv] Philip Aldrick, “Davos WEF 2011: Wealth Inequality is the “Most Serious Challenge for the World,” The Telegraph, January 26, 2011.

Need We Say More

By Ted Bruce

Need we say more? Apparently yes. The evidence on the impact of low income on health such as that described by Dr. Patricia O’Campo just keeps piling up.

When many people working full time cannot get out of poverty. When many people working full time cannot get out of poverty. And when we ignore studies showing that acting on critical social determinants of health such as quality child care makes economic sense for our society, it is clear there is something very wrong. The need to invest in poverty reduction is an elephant on top of the table not under it. Fortunately, we know from other public health efforts that the evidence eventually does lead to action. Just consider the 12 great achievements in public health as recently documented by the Canadian Public Health ssociation:

It can be frustrating to see a lack of action, but that is all the more reason for public health practitioners to speak out about the evidence. Thank you Dr. O’Campo.

Ted Bruce is the Past President of the PHABC

Further reading:

Social policy is health policy. Vancouver Sun Opinion: Poverty linked to multiple health problems in new mothers, study finds | Patricia O’Campo |  August 28 2013

BC’s welfare recipients need immediate relief | Seth Klein, Lorraine Copas, Adrienne Montani | April 24 2012

2012 Child Poverty Report Card | First Call: BC Child and Youth Advocacy Coalition | November 2012

15 by 15: A Comprehensive Policy Framework for Early Human Capital Investment in BC | Human Early Learning Partnership | August 2009

Allies and Advocates for Upstream Action

By Dr. Marjorie MacDonald

In July 2013, the Canadian Medical Association (CMA) released its Town Hall Report called “Health Care in Canada – What Makes us Sick?” [1] Over the past year, the CMA has been hosting a series of town hall meetings in various parts of Canada to gather input on Canadians’ views on the social determinants of health. This followed an initial phase of a National Dialogue on Health Care Transformation in which CMA heard that the health care system was not the most important determinant of health and that social and environmental factors were more important. That understanding is certainly not news –  it goes back many years – but perhaps was most memorably reflected in an internationally influential federal white paper authored in 1974 by then Minister of National Health and Welfare, Marc Lalonde [2]. This was followed by the Ottawa Charter for Health Promotion [3] in 1984 that elaborated on the determinants of health (peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, equity). Since then, the public health community in particular has been grappling with how to address the determinants of health and entire libraries could be filled with what has been written about this. Thus, it is not the news that the Town Hall Report, and the media response to it, seems to suggest.

CMA Town Hall Report: 'What Makes Us Sick?"

CMA Town Hall Report: ‘What Makes Us Sick?”

Perhaps what is news is that the CMA Town Hall report suggests that the Canadian public may now be aware of the importance of the social determinants of health. If that is true, it is definitely a good thing, given public health’s longstanding efforts to inform the public about and to advocate for upstream actions to address the social determinants of health.  I wonder, however, about the extent to which the town hall meetings drew from the ‘usual suspects’ – i.e., those who were already in the know about health equity and the social determinants of health. I could be wrong of course, but a recent British Columbia Medical Association (BCMA) survey [4] found that the public of BC is most concerned with issues of wait times, doctor shortages, the aging population, and hospital overcrowding and not so much about prevention, let alone the determinants of health. The poll also suggests that British Columbians are supportive of moves to make people more responsible for their own health (blaming the victim?), a move counter to an understanding about how living conditions and social disadvantage (i.e., the social determinants of health) can cause inequities in health status. Either the BC public is out of step with the rest of the country, or the results of CMA’s consultations may not be as representative of Canadians’ views as the report suggests. I think we still have our work cut out for us!

The Town Hall Report also states that “the medical profession has the authority and voice to take leadership on these issues” [1, p. 1].  My initial response to this was perhaps a bit of ‘sour grapes’.  How could this group who has historically had such a limited focus on the social determinants now claim a leadership role, particularly when public health has been providing strong leadership for years? Medical standards of practice and the CMA code of ethics [5] do not even reference the determinants of health let alone provide guidance to physicians about how they might enact their “ethical duty to their patients to work toward a society in which everyone has the opportunity to live a healthy life” [1, p. 3].

The Canadian Nurses Association (CNA), by contrast, explicitly includes a focus on the social determinants of health in their Code of Ethics [6] and the Community Health Nurses of Canada are also explicit about the role of nurses in addressing the determinants of health in 6 of their 8 competency domains [7]. The CNA website has 10 full pages of links to publications, policy statements, and advocacy papers dealing with the social determinants of health and providing guidance to nurses. Our own BC Health Officers Council has been a strong advocate for addressing the determinants of health as reflected in several influential documents, including a Discussion Paper on Health Inequities in British Columbia [8]. Other public health disciplines have made similar contributions.

However, we need to take a step back.  I fundamentally agree with and support most of the recommendations in the CMA Report (although their recommendation for a comprehensive drug plan is not really an upstream action, nor does it address the determinants of health). Maybe CMA is a  more recent advocate to this endeavor. But, they are taking an important position that is not being addressed by many provincial medical associations, so CMA should be applauded for this.  We can never have too many influential people advocating for and engaging in upstream actions on the determinants of health. And our physician colleagues do have authority and voice. We need them in the fold.  Welcome CMA, there is a place for you at the table. We are here to support you, to applaud your efforts, and to share our own learning along the way.

– Marjorie MacDonald is the President of Public Health Association of BC

  1. Canadian Medical Association. (2013). Health Care in Canada – What Makes us Sick?
  2. Lalonde, M. (1974). A new perspective on the health of Canadians. Ottawa: Information Canada.
  3. World Health Organization. (1984). Ottawa charter for health promotion.
  4. British Columbia Medical Association. (2012). Charting the course: Designing British Columbia’s health care system for the next 25 years.  BCMA Submission to the Select Standing committee on Health (January 2012).
  5. Canadian Medical Association. (2004, reviewed 2012). Code of ethics.
  6. Canadian Nurses Association. (2008). Code of ethics.
  7. Community Health Nurses of Canada. Standards of practice and professional practice model.
  8. Health Officers Council of BC. (2008). Health inequities in British Columbia: Discussion Paper.

Corporate Determinants of Health

By John Millar

The notion of the corporate determinants of health is gaining traction. Dr Margaret Chan, Director General of WHO recently stated that ‘the formulation of health policies must be protected from distortion by commercial or vested interests’; ‘Big Food, Big Soda and Big Alcohol fear regulation and protect themselves by using …tactics (such as)…front groups, lobbies, promises of self-regulation, lawsuits, industry-funded research that confuses evidence and keeps the public in doubt..(also)…gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens…(and) …place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice.’

Couldn’t have said it better myself!

PHABC is proceeding to recognize ‘healthy corporations’ that meet the following (triple bottom line):  a useful, healthy, ethical product at fair market value; living wage for all employees and outsourced staff; progressive benefits that include  pensions, vacation, parental and other leaves, and day care; workplace wellness; progressive management – control, ownership, profit sharing, unions; corporate social responsibility; and, green policies.

logoIn the United States the idea of B Corporations is spreading with the recent announcement of B Corporation legislation in Delaware. This is legislation that allows businesses to legally incorporate to pursue the triple bottom line (PPP: Profits, People. Planet) – more:

We all have a role to play in building a healthier society. It is time the corporate sector accepted their role as a key contributor to population health.

Dr John_DSC0831– John Millar is a Clinical Professor Emeritus , University of British Columbia School of Population and Public Health, and Vice President of the PHABC.

Further Reading

Address to the 8th Global Conference on Health Promotion  | Dr. Margaret Chan | June 10 2013

A New Kind of Corporation to Harness the Power of Private Enterprise for Public Benefit | Gov. Jack Markell (Delaware) | Huffington Post – Business Canada | July 22 2013

Is The Living Wage a Public Health Issue?

By Ted Bruce

While browsing on-line news recently, I stumbled across an article about protests by American fast food workers and their poverty level wages.

The newly calculated 2012 living wage rate for Metro Vancouver stands at $19.62 per hour. Photo Source: A Living Wage for Families (

The newly calculated 2012 living wage rate for Metro Vancouver stands at $19.62 per hour. Photo Source: A Living Wage for Families (

I was reminded of calls for a living wage in BC. Living wage proponents everywhere are starting to gain more attention exactly because of the dynamics described in the article. People are working full time or even at 2 jobs and still may be unable to meet their basic living expenses. I was also struck by the similarity in the arguments by those opposed to living wage policies such as the belief that raising wages is not affordable. Although the article does a good job of debunking that myth (I love the comment on how big corporations are subsidized by food stamps for the poor), it is important for public health advocates to have a fundamental grasp of the living wage. Public health has consistently called for a variety of healthy public policies such as affordable child care. Public policies can directly affect the calculation of the living wage rate and thus the cost of a living wage to employers in any given community. When public health calls for social and income related policies that promote population health, they are in some respects contributing to the debate on the living wage. To learn more about the living wage visit: The living wage discussion raises the broader issue of the corporate determinants of health. This is a topic that is becoming more important as governments downsize and the role and power of corporations in our society increases. PHABC will soon be announcing an initiative on the corporate determinants of health so we can better understand how to advocate within this sector. Stay tuned for a blog by John Millar, PHABC’s Vice President in an upcoming blog on this topic.

Ted Bruce is the Past President of the PHABC

Building the Case for Prevention is Not Easy

By Ted Bruce

The debate over the mandatory use of bike helmets has predictably heated up with the arrival of ideal biking weather. And there is an abundance of population level data being tossed around to buttress both sides of the argument. On one side is the position that mandatory bike helmet use discourages ridership and it is high ridership that creates safer riding environments – thus mandatory helmet laws might impede reductions in injury rates. This argument also suggests that by discouraging cycling, society does not achieve the benefits of more people participating in active transportation. On the other side, there is data showing the lower injury rates associated with helmet use and little evidence that mandatory laws have dampened the uptake of bicycling as form of transport.

There has been an impressive array of data to bolster both sides of the debate. The importance of epidemiology to good policy making cannot be underestimated. But the debate highlights the challenge in securing the quality of evidence we need to advocate for prevention strategies.

Of particular concern is the considerable lag time between a prevention intervention and the measureable benefits it is intended to produce. This is compounded by the reality that the intervention is only one of many interventions that co-exist in a messy policy world. How does one assess the benefits of a specific intervention in a complex, real world, uncontrolled environment where there are many confounding variables that are affecting the measured outcome? In addition, prevention interventions have an underlying problem with generating data since if they are impactful they have prevented an occurrence and there may be limited mechanisms to collect data within our routine normal data collection systems.

The Canadian Best Practices Portal is a source of best practice reviews.

The Canadian Best Practices Portal is a source of best practice reviews.

There are a number of research methods such as cross jurisdictional studies that can assess the benefits of prevention interventions as we see in the case of the debate on bike helmet laws. Rates of injury and disease, for example, can be compared between jurisdictions that implement a prevention strategy and those that don’t. In spite of more innovative methods, many of these studies are still open to challenge because of the differences in real world contexts that are being compared. Fortunately there is an ever increasing body of quality evidence available to argue the case for prevention. Check out this source of best practice reviews: Canadian Best Practices Portal (Public Health Agency of Canda).

While it is never wise to base decisions on individual cases that are not representative of the larger population, the importance of case studies and narrative analysis can be quite informative and convincing. As we all know, it is the “stories” of real people that often influence decisions whether good evidence is available or not.

When the Doctor Comes Calling – For Poverty Reduction

By Ted Bruce

Two recent reports offer very compelling arguments to address the social determinants of health as a societal priority. They also point to the important role public health plays as an advocate for healthy public policy more generally.

The first, published in the British Medical Journal, is yet another piece of evidence that addressing socioeconomic conditions is good for health and an investment in social initiatives may be more effective at improving health than expenditures on health services.

As the study points out: “Although most health reform efforts to improve health status focus on health expenditures, it may be that additional attention on social services is also needed. This approach is consistent with public-health frameworks, which have frequently highlighted the social over the biological and medical determinants of health”.

Many public health advocates in BC have longed encouraged the Ministry of Health and health care leaders to argue for a more comprehensive approach to health care reform that would tackle poverty reduction and end the never ending increase in health care expenditures. Naturally, most health care leaders are reluctant to take this view when they feel the pressures and demands on the health care system. But it does not have to be an either/or approach. What is needed is a cross government or intersectoral approach where at least there is a common understanding of what priorities are needed and every sector makes its contribution. This approach was applied to the government’s now defunct “ACT Now” health promotion initiative aimed at the behavioural risk factors associated with chronic disease. And it is what has been called for in regard to tackling poverty in the province.

It is clear from this study that intersectoral approaches are critical if we are to get the investments in place that will produce the results we need. In fact, it may be the only way forward to improve health and contain health care costs. We can all learn more about how to approach intersectoral work later this year as the theme of this year’s PHABC Annual Conference is on this very topic. ( .

cma reportBut when it comes to getting upstream of illness and truly tackling the root causes of the health inequities that drive so much of our health care expenditures, health care leaders have tended to stay silent – but not so much anymore as evidenced by the report and position now taken by the Canadian Medical Association (CMA).

Most health care providers see the impact of poverty on health every day in their practices, but generally they feel helpless to act on it. Naturally there is a tendency to think governments will show the leadership to tackle these serious social problems. Or they defer to the efforts of their public health counterparts to “fight the good fight”. But the need for action by government is so pronounced that health inequities and their root social causes are now entering the mainstream of advocacy by organized medicine.

While certain groups of physicians have been active in advocating for social justice and poverty reduction, this effort by CMA represents a major shift in thinking about the role of medicine in creating a new paradigm for health. As more partners like the CMA join the call of public health advocates for a broad approach to poverty reduction, food security and social housing, we will see the intersectoral approaches that are necessary to reduce health inequities – and ultimately slow down the rate of growth in health care expenditures.

Ted Profile– Ted Bruce is the Past President of the PHABC

Further reading:

12 Great Public Health Achievements – Acting on the Social Determinants of Health | by the Canadian Public Health Assocation

“Recognition that health is influenced by many factors outside the health care system has strengthened public health’s commitment and leadership in activities that address the broad determinants of health, such as income, education, early childhood development and social connections.” Read more…

Canadian Milestones: Acting on the Social Determinants of Health |  by the Canadian Public Health Assocation

Advocacy is Not Always Popular

By Dr. Trevor Hancock

Public health is political – always was, always will be. Ideologically, we believe in the collectivity, in using the power of the state to manage, control, tax, enforce and even punish (we do all these, for example, with respect to tobacco control, perhaps the most lauded public health success in the past 50 years).

Whether we are trying to control tobacco and alcohol use, unsafe food system practices, unhealthy working conditions, environmental pollution or junk food, we are going to irritate powerful ideological and thus political opponents; both those who believe in individual freedoms more than in collective responsibility and those who believe in unfettered free enterprise.

Nothing new in that: In the 15th century, Carlo Cipolla tells us in his 1976 book Public Health and the Medical Profession in the Renaissance, that the Health Officers for the Boards of Health complained about the hostility of the merchants, who in turn complained that their economic well-being was disrupted by the regulation of trade and commerce by the Boards, who were trying to enforce quarantines to control the spread of infectious diseases such as the plague.

It is not our role to try to be ‘neutral’ in these situations; we are not neutral, we are very clearly pro-health, which means we are very clearly opposed to health-damaging activity, no matter the source. If we are not biased, we are not doing our jobs. If we do not speak out in oppostion to policies, programs and practices harmful to health, be they from the public, private, non-profit, faith, academic or any other sector, we are not doing our jobs.

You only need to look at the recent policy positions of the Canadian Public Health Association to see such opposition in practice.

Opposed to minimum sentences

In favour of firearms control, opposed to closing the gun registry

Today twenty-eight medical, nursing, allied health and suicide prevention organizations and thirty-three professionals in the same fields, released an open letter to Members of Parliament in order to underscore the importance of the gun registry in helping to prevent domestic murders, accidents and suicides.

“For almost twenty years the Canadian Public Health Association has advocated for stronger gun laws including the licensing of all gun owners and registration of firearms because of their potential to prevent death and injury. We are seeing encouraging results from Canada’s progressive gun laws. Firearm related deaths in Canada have reached a 30 year low and of particular note is the dramatic decline in the misuse of rifles and shotguns, the target of the 1977, the 1991 and the 1995 legislation.”

Opposed to continuing support for the mining and expert of asbestos

CPHA calls once again on the Government of Canada to support the listing of chrysotile asbestos under the Rotterdam Convention, and as well urge the GOC to take actions to:

  1. Introduce legislation to ban the mining, use, and export of asbestos
  2. Cease funding the Chrysotile Institute

In favour of supervised injection facilities

CPHA commends and supports the Supreme Court of British Columbia’s ruling granting Insite, Canada’s first supervised injection facility (SIF), a constitutional exemption from the application of sub-section 4(1) and 5(1) of the Controlled Drugs and Substances Act (CDSA).

Clearly, the CPHA policy positions, based on public health values and evidence, are in opposition to declared federal policy and practice.  The Harper government, it has recently been revealed, has an enemies list – their word, not mine. Not an opponents list – an enemies list.

Well, if standing up for good public health policy and practice makes us not just opponents of the government, but enemies, so be it. We should all be on the list; I certainly hope I am on it, and will be offended if I am not! (see my letter to the Globe and Mail, July 18th)

Trevor Hancock crop_0

So are you on the enemies list? If not, why not?

Dr. Trevor Hancock is a Professor and Senior Scholar, School of Pulic Health and Social Policy at the University of Victoria

Government Must Be Accountable for the Costs of Poverty

By Ted Bruce

A report on the rising poverty rate among new immigrants to Canada ran side by side with an article on BC’s version of austerity as the government moves to deal with a declining economic situation.

The report on poverty notes that the failure to address this rising poverty sets up a “tinderbox” of discontent. A similar message has been repeatedly stated by the public health community. There is ample evidence as demonstrated by epidemiologists Richard Wilkinson and Kate Picket and documented so well in their book The Spirit Level that societies with high levels of economic inequality perform very poorly. And it is clear that the public wants government to address poverty as is shown by the recent polling done by the BC Healthy Living Alliance.

Is government’s “austerity” response the solution? Governments that essentially ignore poverty reduction policies say that they can’t afford them or that policies related to job creation will be the best solution to the problem. The economists can debate this but there is ample evidence that the cost of poverty is greater than the cost of the investments that could alleviate it. The study by the Canadian Centre for Policy Alternatives (supported by PHABC) provides a startling analysis of the costs of not acting.

But even if politicians believe their austerity and trickle down growth paradigm is correct, they have an obligation to demonstrate that it works. So why not set some timelines and targets as has been called for by public health organizations like PHABC and the Health Officers Council of BC? If our elected officials believe they are building a better society for citizens through their policies, it is not asking too much for them to show us they can reduce poverty. Let’s measure it and report on it. That is not asking for too much.

Ted Bruce is the past-president of the PHABC


Great Ideas Have Long Lives

By Ted Bruce

The election is over and, as they say, the hard work starts. The spin doctors, backroom strategists, pundits and pollsters take a break and the world of policy development and advocacy carry on. Policies that are essential to improve the health of the population require a long and sustained effort. Public health policy work is arduous and although there are quick wins for the most part the complex web of causality requires multiple policy and program interventions implemented over a long time. And often efforts must push against countervailing forces that at times seem insurmountable.

But they are not insurmountable and the ideas behind population health are not easily dismissed. Social justice, fairness, health and wellbeing are foundational to the notion of reducing health inequities and preventing disease before it sets its roots.

The election campaign proved an opportunity to raise awareness of health inequities and the importance of poverty reduction and disease prevention. In looking at the election campaigns, political party platforms and the media and political dialogue, there was certainly considerable interest in the idea of poverty reduction. Although there was not agreement on the policies needed to reduce it, it is safe to say that it will likely maintain momentum as a post election topic. The need for a new prevention paradigm for health care did not get much discussion. Clearly, public health has a way to go to captivate the political dialogue on that issue.

This is not new. These issues have been at the forefront of public health for a long time and will continue so. Why? In part because the alleviation of human suffering and the promotion of health and well being are central to public health and the root causes of health inequities must be a central focus if public health is to be successful in its mission to improve health for all citizens – not just some citizens. And the policy agenda is complex. The solutions require a huge paradigm shift in a policy environment that has diminished the valuing of public services and has emphasized individualism over collective action. And they require considerable vision and commitment on the part of government and non-governmental leaders. Election time is a window to push for that vision. Post election is a time to continue to educate the public, to bring the evidence forward to the decision-makers and to do the hard work of policy change.

PHABC’s website for the election has some great resources for the continuing dialogue about health inequities, poverty reduction and disease prevention. PHABC has had considerable feedback that an on-line toolkit and the social media campaign were an effective contributor to the dialogue on public health. As co-chair of the PHABC Policy Advocacy Committee, I know this strategy will continue.

Change does not come easy. There are risks associated with change but great ideas deserve risks.  Health and well being for all citizens, social justice and public health – these are great ideas. Elections come and go. Great ideas have long lives.

– Ted Bruce is the past-president of the PHABC