Posts Tagged ‘social determinants of health’

Let’s talk about something….

November 11, 2011

We talk a lot about food, and often the topic of the social determinants of health comes up (here, here, and here).  Recently, a link to a nice video developed by the health unit in Sudbury showed up in my inbox.  It helps explain the basics of the social determinants of health and I’m here to share it with you today:

Is food a social determinant of health?  Yes.  An important one.  Did you ever think that food banks are wrapped up in the business of health care?  In a way they are.  You can think of us like paramedics if you’re feeling charitable.  We rush to the scene of crisis, deliver assistance and then move on.  Or perhaps, you can just think of us as good Samaritans who happen on a disaster.  We help as best we can and then maybe the situation improves, maybe it doesn’t.

But to extend the comparison a little further, are we doing enough about the cause of the disaster?  Sure, a little help gets people on their feet.  But who keeps knocking them down?  And what is the long-term consequence of getting pushed down by things like poverty, unemployment, bad housing, limited choices, and bad or no food?

Watch the video, give it some thought and talk to someone you know about it.  Talk to the people you’ve voted for, and who you’re going to vote for next election time.  It’s important for people like Ronald, Andrew, Maria and all the people that we serve.

A solution is only 3 numbers away

June 24, 2011

What do you do if you are concerned about how much alcohol you drink each night, and your inability to stop? Who do you call if you have an eviction notice tacked to your door? What if you just lost your job and are unsure of how you’re going to pay the bills that are piling up?

Take Jay, as a hypothetical example. Against the better advice of his family and school counselors he didn’t finish high school because he wanted to start providing for his girl friend and their new son. Since the birth of his son, he’s had a few casual jobs on construction sites, and some service jobs here and there. In general Jay has worked very hard to keep food on the table. But today, after a series of bad decisions and a good measure of bad luck, he’s a single parent of a toddler with no job, no money and an empty fridge. So what does he do? (more…)

Steps to community integration

April 18, 2011

Hunger is just one side of a very complicated set of problems. Housing, income, employment, food and more are all part of what is called the social determinants of health.

A recent video highlights some new thinking in the region on helping people get off the streets and into housing.  As  our executive director John Neufeld sums up:

“Homelessness is a complex issue that impacts individuals and our community on many levels.  There are no simple solutions but that doesn’t mean we’re unable to create effective change.  The STEP Home video shows how meaningful change can happen when progressive Regional Government, community agencies, and the broader community collaborate to address an issue.  This video reminds people that there are no simple cookie-cutter methods but we can do the work creatively, make a difference, and save money in the broader system.”

We have seen first hand the level of commitment the workers at the various community agencies show.  The House of Friendship’s own Brandon, who speaks in the video, often brings people in to receive a hamper, working closely with them and ensuring that they get whatever support they need.

York University academic Dennis Raphael highlights the role that housing, food and income play in supporting health.  He will be in town April 27 to give a talk organized by the Kitchener Downtown Community Health Centre.  I’ve spoken of him previously (here). I encourage you to have a look at his The Social Determinants of Health: The Canadian Facts (a free .pdf download here) which is an excellent introduction to fact that poverty means more than an empty wallet and fewer options: it cuts years off your life and can burden you with many chronic ailments like diabetes.

More details of his talk can be found by clicking here for a .pdf flyer or by calling Gebre at the Kitchener Downtown Community Health Centre.  His number is (519) 745-4404.

May this video and the upcoming talk spark conversations and awareness, and remind us of our own humanity and call to celebrate and care for each other.

Time to pay some bills. How are you going to do it?

February 21, 2011

Today is Family Day!  You are no doubt enjoying it with your family and maybe even playing a game or two.

Games are important, and at some point in our lives we all play them – young or old.  Board games, hide and go seek and tag are an important part of almost everyone’s childhood.  Modern games are big business, especially video games.   In fact, you have probably played a video game a time or two in your life – be it solitaire or Tetris.  They’re fun, and the best ones teach you a thing or two about the world.

Well an American charity called Urban Ministries of Durham has come up with an interesting online game called Spent.  You can play it here and read a little about it here via the Toronto Star.

While some of the situations are unique to the United States (buying health insurance for example) many of them are the same ones our patrons face every week.  Do you pay off a bill collector or buy your kids new shoes?  Do you focus on keeping the lights on or keeping the heat on?  Do you ignore your fever and go to work, or take unpaid time off to go to the doctor knowing that it might mean the difference between eating or not next pay cheque.

Similar to the Do the Math online challenge, (here) this game puts you in the position of someone who has to make some very hard choices.  Many of us don’t realize how many pay cheques away from making these hard choices we are. I hope this game gets you thinking.

What can we do about it?  Well, there are local people today who need help getting through the consequences of making a lot of these choices.  You can support local people who are trying to do just that by volunteering or donating.   But why are so many more people being forced into living spent and not just playing it?  Helping to answer that question will help make Kitchener Waterloo a more prosperous and healthier place.

Eat the math. A tale of two cities…

April 13, 2010

The Stop Community Food Centre is an amazing program in Toronto that we have had the opportunity to visit twice in the last five years.

Their website describes their growth from one of Canada’s first food banks into a “thriving community hub where neighbours participate in a broad range of programs that provide healthy food, as well as foster social connections, build food skills and promote engagement in civic issues.”

They have a real community atmosphere, and their facilities are welcoming friendly spaces that include “community kitchens and gardens, cooking classes, drop-in meals, peri-natal support, a food bank, outdoor bake ovens, food markets and community advocacy.”

This past summer, when we went for our last tour, we were all impressed by the new programs they had added since our previous visit (namely their gorgeous Green Barn), and their commitment to making a difference in the lives of the people coming to their centre and living in the city.

One initiative that they were just in the process of rolling out was Do The Math a web-based excercise that lets people put themselves in the shoes of a Ontario Works recipient trying to budget for a month.  I recommend you do it and share it with everyone you can! It’s a very eye-opening exercise in futility that reveals the brutal choices tens of thousands of people have to make each day in order to survive.

To highlight these choices and how hard their consequences, (i.e. food insecurity and hunger) can be each day they have challenged some high profile Torontonians to see how far they can stretch an emergency food hamper from the Stop and to talk about it on a collective blog.

So far the participants have expressed thoughts and experiences that we often hear at our program from new volunteers, new staff and first time visitors.  They’re overwhelmed by the level of need and the challenge that accessing and using emergency food can be.  In the Toronto Star yesterday  Dr. David McKeown, the Toronto Medical Officer of Health identified the lack of choice as a major difficulty for him, stating:

“Food is a very important part of our life and I didn’t get to eat any of the things that I enjoy. In work settings, and family settings with friends, I couldn’t join in with the food that was part of the events. So there is a sense of isolation that you get when you are not able to be a part of what others who have more resources are enjoying. Food is very much a part of our family and cultural life.”

Hunger is a complicated issue and there are a lot of misconceptions, stereotypes and judgements that get mixed into most public debates about how to address it.  Some of the comments made by Toronto city councilor Joe Mihevc,  at the press conference that kicked off the challenge, highlight the need for a better, broader discussion about the issues.

In fact, Mihevc’s entire family took part in the challenge.  In the Star one of his daughters talks about how her parents used drop in meal programs to help stretch their hamper a little further, stating, “I wasn’t really hungry but that’s because my mom and dad let my sister and me eat before they ate.”

Poverty and food insecurity present you with many stark choices and force you to prioritize.  Visit the dentist or buy a winter coat?   Pay the hydro or the rent (and get evicted later anyways when they shut off your hydro)?  Go hungry so your kids can eat today or all go hungry together later when all the food is gone?

Are these the choices that people should have to make?

Diabetes and the social determinants of health

April 6, 2010

Yesterday I talked about a hamper we gave to a single senior who is struggling with her low-income as well as her diabetes. Today, I’m going to talk a little bit more about how her low-income has an impact on her health.

Not many people understand the role that income plays in their health.  On the surface, I think most people assume that it has at least a small, probably temporary, impact.  Sure, if you’re broke, you probably can’t eat all the fruits and vegetables Canada’s Food Guide suggests, but is it really going to harm you in the long-term? As long as you exercise a little bit and stay away from fatty foods, too much alcohol, drugs and tobacco you should be OK right?

The answer is found in a large body of research on the social determinants of health that describe how things like not having enough to eat, substandard or no housing and especially income determine how long you’ll live and how likely it is that you’ll have chronic health conditions. For the Canadian context check out what the Public Health Agency of Canada has to say.

Many people, based on their observations and conventional wisdom, believe that behaviours like not getting much exercise, smoking and poor diet are the best way to predict if someone is going to be healthy or sick.  People are often surprised that how much money you make is often the better indicator for your health, and that when you look at who is sick and who is healthy things like smoking, poor diet and lack of exercise fall to the wayside when you’re comparing people who are higher income and lower-income.

Looking at who has cardiovascular disease, and especially type 2 diabetes income becomes very important as a recent fact sheet by Canadian academic Dennis Raphael and his colleagues highlights.

In their words:

Type 2 Diabetes is a complex, chronic condition resulting from the body’s inability to either adequately produce and/or effectively utilize insulin. It accounts for 90% of cases of diabetes in Canada. The mechanisms by which type 2 diabetes comes about are not well understood.

Traditional explanations focus on genetic and lifestyle causes, but increasing evidence is coming to support the view that type 2 diabetes is primarily a disease of material and social deprivation associated with poverty and marginalization. If not controlled, it can lead to serious complications such as heart disease, kidney failure, lower limb amputation and blindness.”

Looking at two very large public health surveys, the Canadian Community Health Survey (CCHS) and the National Population Health Survey (NPHS) they found lower-income people are more likely than higher income people to develop type 2 diabetes by a significant amount.  That’s even after taking into account things like diet and excercise.

Facts and figures are always interesting, but in addition to crunching the numbers they also talked to low-income people with type 2 diabetes to understand how their income affects their ability to cope with the disease.

Two of the people they talked to said:

“On welfare I lived in a rooming house. We had four or five people using one fridge. I couldn’t leave anything in the fridge, it disappeared. And the things the dieticians tell you — I know they mean well, but I just couldn’t afford it… Once I did go to a food bank, but the stuff they give you is the stuff I’m not supposed to have… I used to get a hundred and something [dollars in special diet supplement] but now they cut it back to sixty something.” [man, unable to work, income provided by the Ontario Disability Support Program].

“I look at which food is cheaper because my money is very small, so after giving rent, I just have a little bit of money. Sometimes, after the 20th [of the month] my money is finished. It’s very tight. So then I buy rice, and some protein and eggs. But when I eat cheap rice my sugar goes up… Sometimes I borrow money because I have to be conscious about my health… Sometimes my daughter’s school wants money for things. But I don’t have it. How can I give? And I feel very sad. I try to manage. Sometimes I use my daughter’s child benefit. And sometimes I don’t buy. Last month my money was finished but I had no food at my home and I didn’t buy any. I didn’t eat. And sometimes I need shoes, but I don’t buy them because I have to pay for food. Food is my basic need.” [42-year-old married woman].

These are familiar scenarios to many of our patrons and they are familiar to my coworkers and I as we go through our intake procedure each day.  We’d like to think that by giving people food we’re helping them but for many of the people we see each day any relief we can provide is largely temporary.  Income is key, and addressing a lack of food today with what food we can provide, does not necessarily mean that next week, or next month,  people will not be hungry. And, as researchers studying the social determinants of health find, that lack of income and hunger have major consequences in the long term.