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Editorial: Income, Health, and Policy

By Lorne Zon
Network, Fall 2007

“Money can’t buy everything, it’s true,” professed the Beatles. We also know it can’t buy you love. But it can buy you better health.

There are many research reports from the World Health Organization (WHO) and other renowned researchers that make it quite clear that health is directly related to money through such programs as affordable housing and income supports. In a 2003 WHO report entitled “Social Determinants of Health: The Solid Facts,” the author states, “Good health involves reducing levels of educational failure, reducing insecurity and unemployment and improving housing standards.” In this issue ofNetwork, we examine the impacts on consumers, families and communities of inadequate income and financial supports. More importantly, we see what providing those supports can accomplish.

In 1974, Canada became a world leader in health policy frameworks with the release of a report, “A New Perspective on the Health of Canadians.” From such beginnings, the concepts of social determinants of health, healthy public policy and healthy communities have grown and flourished — though mostly outside of Canada. The knowledge that has been gained by research in these areas has influenced but, to date, has failed to lead interdepartmental, inter-ministerial and intergovernmental health policy. Most certainly there have been significant investments in programs and services that address the elements of the social determinants of health, but the failure to integrate and consolidate these efforts has meant that investments have not performed to their fullest potential.

There are many reasons why public policy does not reflect what the research has told us: diffuse jurisdictional responsibilities, poor interdepartmental coordination, lack of political will and the fact that those in need have little political clout. There have been some noteworthy efforts right here in Ontario. In the 1970s, the Ontario government brought in the policy field concept. Under the leadership of a “super-minister,” line ministries were to work together to achieve more coordinated and effective policies and programs. The social policy field included ministries such as health, community and social services, education and housing. As well, policy coordinators from these ministries, along with municipal affairs, finance, and the cabinet office, would meet routinely to discuss upcoming policy initiatives. The attempt was laudable, but the lack of power provided to the super-ministers and real incentives to change decision-making structures meant that good intentions did not necessarily result in better health outcomes.

Fast forwarding to the 1980s, we saw a new vision and a new government. In follow-up to a milestone report, “Health Goals for All Ontario,” the government established the Premier’s Council Health Strategy. Rooted in the WHO concept of health and chaired by the premier, it counted among its members at least half of the cabinet and key business, academic and medical leaders. The council was charged with developing healthy public policy for Ontario. Again, a very admirable initiative, but an election and a change of focus interrupted the process before it took hold.

My brief time with CMHA has already demonstrated to me that our sector not only believes in but also delivers on the promise of the social determinants of health model. Our branches have built delivery systems based on consumer-centred care that address housing, financial supports, care, counselling, life skills, education and employment or employment training. What governments have failed to do, the community has shown it can do when given the chance. In this issue of Network, we celebrate some highly successful examples.

Lorne Zon is the chief executive officer of the Canadian Mental Health Association, Ontario.

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