Speaking Out On Inequities

By Ted Bruce

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

CMA Town Hall Report June 2013

The health care establishment occasionally shows glimmers of awareness that the greatest contributors to health are social determinants. We even see the Canadian Medical Association speaking out about poverty in its report What Makes Us Sick.

But we still have a long way to go in debunking the notion that health is all about personal choices and genes. A good example is the comment made by Nova Scotia’s Health Minister who apparently even suggested that people should demonstrate healthy lifestyles before they can access health care. Fortunately these types of uninformed statements are being challenged as was done in this case by a leading anti-poverty physician Dr. Ryan Meili.

It is discouraging that a Health Minister can be so uninformed but it seems all too common that ideology trumps science in the discourse on health. Nonetheless, the message about the importance of addressing social determinants like poverty is slowly taking hold in the medical community. But it requires challenging those uninformed statements every time we hear them as was done by Dr. Meili.

Public health understands this issue and it is ever more important for each of us to challenge statements that will take us down the wrong path to improving the health of the population and reducing health inequities. We can’t be shy about the importance of creating a more equitable society as the path to better health.

Further reading:

Don’t lecture on lifestyles; level social playing field | Dr. Ryan Mieli | The Chronicle Herald February 28 2014

Healthcare in Canada: What Makes us Sick | Canadian Medical Association Town Hall Report | June 2013

Check out:

Upstream: http://www.thinkupstream.net/

Dr. Ryan Meili is the National Director of Upstream. The organization works with the growing body of evidence on these social determinants of health and uses that knowledge to guide recommendations for change.

Local Actions for Reducing Health Inequalities

By Jalil Safaei 

13275The Social Determinants of Health (SDOH) discourse is getting more practical for improving the health of populations and reducing health inequalities. Following the WHO Commission on SDOH Report in 2008 (Closing the Gap in a Generation), which emphasized acting on SDOH, a recent significant report published by the British Academy for Humanities and Social Sciences titled – “If You Could Do One Thing …” Nine local actions to reduce health inequalities – identifies nine local actions that could be implemented at the local level to improve the community health and reduce health inequalities in the community.

The report consists of nine chapters, each devoted to a specific local action for reducing health inequality. The actions correspond to and address various social determinants of health and health inequality. They include:

  1. Implementing a living wage
  2. Increasing early childhood education
  3. Implementing 20 mph speed limits for cars in residential areas, by shops and   schools
  4. Tackling health-related ‘worklessness’: a ‘health first’ approach
  5. Building ‘age-friendly’ communities and cities
  6. Using participatory budgeting to improve mental capital
  7. Improving the employment conditions of public sector workers
  8. Increasing the scope of adult and further education
  9. Evaluating policies for evidence of cost effectiveness

Written by prominent scholars from various social sciences, the report is a welcome and timely interdisciplinary document for guiding local actions to reduce health inequalities in the communities where people are born, live, work and age. The report provides evidential support to some of the initiatives suggested by our local public health advocates in British Columbia.


Jalil Safaei is a PHABC Board member and Associate Professor at the University of Northern British Columbia.