Our premiers all assure us that they are concerned with maintaining thehealth of Canadians and assuring the sustainability of the health caresystem. Health Canada and Canadian Public Health Association statements and documents argue that the means of accomplishing these worthy goals is topromote population health by focusing on the determinants of health:income, working conditions, housing, food availability, education andhealthy child development.

Yet, the premiers shower us with exhortations toimprove our lifestyles and make healthy choices. They do so at the sametime that their policies maintain very high levels of child poverty andthey reduce the social and other services that keep us healthy. It isdifficult to believe that these developments are unrelated. The premiersweaken the determinants of Canadians’ health, and they then divertattention from these activities by blaming Canadians for their own healthproblems by promoting lifestyle explanations for disease.

It is increasingly clear that how a society produces and distributessocietal resources among its population are the prime determinants ofpopulation health. These links become clearer as evidence accumulates ofhow societal factors such as income distribution, employment conditionsand availability of social and health services are the primary determinantsof population health. Health is an important priority for Canadians, butpolicymakers rarely consider these health determinants and the politicaland economic forces that shape their quality.

For 30 years Health Canada and Canadian Public Health documents havehighlighted the role of healthy public policy in supporting health andpreventing disease. But Canada is increasingly looking like the U.S.and UK in its approach to public policy. These nations have the lowestexpenditures on health care and the lowest coverage of health costs bypublic medical care. Wages are low, and income inequalities and povertyrates are the greatest.

Similar patterns are seen when the U.S., Canada, andSweden are compared on a number of health determinants (incomedistribution, wages, support for families and children) and healthindicators such as infant mortality and childhood death from injuries.Sweden fares the best, U.S. the worse, and Canada comes up the middle. And itis clear that Canadian public policy is moving more and more towards the U.S.model. These issues — not healthy lifestyles — are the primary threats tohealth and the sustainability of the health care system and should be theconcern of policymakers. Why is this not the case?

Our governments — and our premiers — are implementing neo-liberalpolicies that emphasize the “market” as the arbiter of societal values andresource allocations. Unfortunately, these political and economic policiesfoster income and wealth inequalities, weaken social infrastructure,threaten employment security and working conditions and make life difficultfor families and children. The neo-liberal emphasis on reducing income andcorporate taxes benefits the wealthy and creates increasing social andeconomic inequality. Changing all the lifestyles in the world willaccomplish little in light of the health effects of such policies.

The best means of promoting health therefore, involves Canadians beinginformed as to the primary determinants of health in a society. They canthen consider — and attempt to influence — the political and economicforces that influence these determinants. Rather than being told to improvetheir lifestyles, Canadians need to reflect upon the kind of society inwhich they wish to live and work. Who will help bell this cat?