Advocacy for Health Promotion Back on the Agenda

1. Advocacy for Health Promotion Back on the Agenda B.C. Coalition for Health Promotion Meeting May 17, 2005

2. Brief History 1974 A New Perspective on the Health of Canadians • Health is influenced by a broad range of factors: • Human biology • Lifestyle • The organization of health care • Social & physical environments

3. 1978 Declaration of Alma-Ata • Health as a state of complete physical, mental and social well-being • Health is a fundamental human right • Targets ‘Health for All’ by the year 2000

4. 1986 Ottawa Charter for Health Promotion • Defined health promotion: • “the process of enabling people to increase control over and to improve their health” • Health pre-requisites: • Peace, shelter, food, income, a stable ecosystem, sustainable resources, social justice and equity • Five strategies for health promotion: • Build healthy public policy • Create supportive environments • Strengthen community action • Develop personal skills • Reorient health services

5. 1986 Achieving Health for All A Framework for Health Promotion

6. 1997 Jakarta Declaration on Leading Health Promotion into the 21st Century • Investment and action on the determinants of health • create the greatest gain • reduce inequities • further human rights • build social capital • Poverty is the greatest threat to health • Transnational factors have a significant impact: • Integration of global economy, financial markets and trade • Media and communications technology • Environmental degradation

7. 2002 Toronto Charter for a Healthy Canada • 75% of our health determined by physical, social and economic environments • Urges action at all levels to improve the social and economic determinants of health

8. Why the shift back to a focus on the determinants of health? • Failure to advance the socio-environmental view of health • Mounting evidence of the impact of social determinants on health • Growing threats to the social determinants of health

9. Failure to advance the socio-environmental view of health • Domination of public health paradigm in health promotion • Failure of health education • Impact of the media • Failure to build broad coalitions • Capacity building without an analysis and without resources • Ameliorative programs rather than social change programs

10. Domination of public health paradigm in health promotion

11. Failure of Health Education Impact of Factors on the Health of Canadians CPHI Public Opinion Survey, 2003 Proportion of Respondents indicating a factor has a strong impact

12. Mounting evidence of the impact of social determinants on health • 22% of premature years of life lost to Canada can be attributed to income differences • Health and quality of life at any one stage is affected by prior circumstances and events • Position on the social gradient has a profound effect on health

13. Those in lowest employment groups have a greater likelihood of illness or injury at every stage of the life cycle • Accumulation of disadvantage linked to health in adulthood • Clear relationships between the power to influence decisions and individual health

14. Physical health problems are 60% more common among socially less privileged children • Low authority over decision-making leads to increased risk of disease (jobs with both high demand and low control carry special risk) • Unemployed people and their families have a substantially increased risk of premature death (job insecurity can be as harmful as unemployment in terms of its health effects)

15. Growing Threats to the Determinants of Health • Income Distribution • Median income of families in Vancouver declined 3.9% between 1990 and 2000 • In Vancouver, the bottom 10% had an average income of $8,700; top 10% an average income $205,200

16. Housing • Decreased housing affordability • 1 in 7 renter households and 1/3 of owner households in GVRD is precariously housed and at risk of homelessness • 1 in 3 renter households in CRD are in core need

17. Employment • Weakening of labour legislation • Decrease in unionization • Increase in part-time low wage jobs • Stagnant rate of unemployment

18. Poverty • 18.4% of children living in poverty in 2000 (1.2 million children - an increase of 40,000 over a decade) • Overall number of people in poverty has risen in the last decade • In B.C. social assistance rates for single employable people: $6,166 (Stats Canada poverty line is $20,337 for a single person living in an urban centre)

19. Food • 10.2% of Canadian households experience food insecurity • Use of food banks has doubled since 1989

20. Why Advocacy Must Be Back on the Agenda • Globalization of the economy • Environmental changes • Stagnant and declining income mobility • Erosion of the social safety net

21. Spill-over effects • Societies with greater economic inequality begin to disintegrate (Wilkinson, 1996) • Economic inequalities contribute to the deterioration of social capital (Kawachi and Kennedy, 1997) • “What matters in determining mortality and health in a society is less the overall wealth of that society and more how evenly wealth is distributed. The more equally wealth is distributed the better the health of that society.” (British Medical Journal, 1996)

22. Goals of Advocacy • Entrench social responsibility for health • Increase investment in social determinants • Consolidate and expand partnerships for health and social development • Increase community capacity and empower the individual • Secure an infrastructure for health promotion

23. Advocacy Strategies • Empower individuals • Deconstructing services and institutions and increasing the individual’s power to choose • Redirect public education • Focusing less on prevention and lifestyles and more on social determinants • Build effective coalitions • Must be centered on the people most affected • Values and mission driven • Focuses on social change, not service provision • Reorient public health practice