When public policy fails
Canadian health agencies continue to develop diabetes prevention and management strategies that primarily focus on “lifestyle”: poor diet, excess weight, and lack of physical activity. But the exclusive focus on “lifestyle” ignores the important role played by the social determinants of health. A recent paper entitled A toxic combination of poor social policies and programmes, unfair economic arrangements and bad politics: the experiences of poor Canadians with Type 2 diabetes outlines a number of key issues and concerns with this approach:
– While there is a general understanding that social and economic factors play a large role in shaping health, this has not changed how we respond to specific diseases, such as diabetes.
– Canadians with diabetes who live in poverty are still at high risk, despite access to universal health care.
– Low income contributes to many “lifestyle” risks: poor diet, few opportunities for physical activity, high stress, and inadequate housing.
– The result is that mortality rates for Canadians living in poverty who have diabetes has exploded over the past few decades, while mortality rates have remained stable or even declined for the better off.
– These increases in diabetes mortality began in the mid-1980’s, alongside inflation-adjusted declines in minimum wages and absolute declines in social assistance levels.
– These trends suggest that diabetes prevention programs would be most effective if they focused on poverty, and the barriers to healthy lifestyles.
Clearly, there is a continued disconnect between health care services and public policy that supports the health of individuals. When research, analysis, and recommendations are done, they often support the a superficial recommendation to adopt “healthy lifestyles”, rather than public policy that would get at the deeper issues of material and social deprivation that create barriers to healthy lifestyles for those living in poverty.
The public discourse over “lifestyle” must be systematically challenged by everyone in the health care sector, in order to address this disconnect in public policy. Doctors for Fair Taxation is an excellent example of the health care sector lending their voice to the issue of income inequality. The Registered Nurses’ Association of Ontario also regularly advocates on issues related to social determinants of health such as poverty and food security. Ontario’s 74 Community Health Centres ground their work in the social determinants of health and are vocal advocates at the community and provincial level. However, until a consistent and collective voice for change is heard, the disconnect between policy and reality will continue.