well this is going to be 21 years in 15
minutes so I anticipate that much of
what you'll see you will not exceed
before well the first thing is that
these are the social determinants of
health their economic and social
conditions but more importantly they're
about a decision as society makes as a
whole about what is the rights of
citizenship first thing I always like to
say is we've never been as wealthy as we
are now this is the gross domestic
product frequently you hear in a time of
limited resources now there's no limited
resources there's never been as much
wealth as there is now the question is
how is it being distributed and what is
it being used for well I got started all
of this in the 1990s I had moved up here
in the 70s and I quickly realized I was
it in Kansas anymore
but then the 1990s came along and my
students have no idea these two guys are
hopefully you do and we made a decision
as a society started in 1991 that there
wasn't really a role for government
anymore and in fact not only did we
reduce federal and provincial spending
but in the House of Commons this was
seen as a great achievement that
spending is now at 1950's levels and
people got up and applauded that well
how did you accomplish that how do you
suddenly reduce government spending you
cut billions of dollars for the taxes of
the wealthier corporations
10 15 billion dollars that would have
been available for all of this stuff
that we're talking about today so how do
you make sense out of this well out of
the blue came this book this book was
wonderful this book was what happened on
the Margaret Thatcher for 20 years and
there were more crime there was car
accidents there was a greater gap
between rich and poor reading schools
went down and I figured wow this is like
home movie
he's you know living in Mike Eris's
Ontario Elysee and what was happening in
Ottawa and the issue was that Wow not
only was this stuff written 1996 but
Canada had produced the Ottawa Charter
ad 1886 that Margaret Whitehead in 1991
had come up with the rainbow model that
had been adopted by the European Union
as a shaping public policy the World
Health Organization came out in 1997
with this document and clearly all of
them pointed to the role of public
policy the only problem we have is I was
a psychologist for 30 years I never
heard the word public policy nobody
takes public policy seriously unless you
get a degree in political science and
it's all about public policy and it's
not only about which issues are now
public for example right now if you're a
woman you have a kid what you're going
to do with that kid if you go back to
work is an individual issue everywhere
else in the developed world it's a
public issue and of course it's related
to a set of values so this stuff comes
in Richards book comes out let's get the
message out and pluralism is a theory
luckily my wife had a degree in
political science a pluralism is what
retorted school that we live in an open
democratic society and if we advocate
for public policies governments will do
a cost-benefit analysis and come to the
conclusion that this is worth doing so
we got the word out we had a really big
conference in 2004 this book came out
all-time bestseller from Canadian
scholars press and we got the word out
unfortunately as this article summarizes
not much thing to have happened in fact
things got a lot worse so maybe we need
another theory and this is what's called
institutionalism and this is that
governments are used to doing things in
regular ways and it takes time to change
things but if we talk to the right
people and we lobby good things will
happen
well this is again a little bit of
theory you can buy Tobi's book societal
institutions shape and structure what
policy make it is that we have to change
the way that people think about issues
and that eventually something will
happen so we came up with the Canadian
facts and actually this thing has been
downloaded 550,000 times you are and I
think that for the next edition we're
going to charge it ten cents a copy in
which case at least we'll be doing okay
and indeed things seem to happen I go to
I politics and I see Bennett says new
government will tackle social
determinants of health but then a couple
of days later young Canadian should get
used to precarious employment and as I
said to my students precarious
employment isn't just temporary
employment it's low paid employment it's
lack of training employment it's lack of
benefits so what do we do how do you
make sense out of all of this and we
also see that the Minister Jane Philpott
tells her daughter to speak up about the
social determinants of health
speak up become another Ryan May ally
but then if you go to the Health Canada
website the vision for a healthy Canada
is healthy Edie healthy living healthy
mind so we need another theory as Kurt
Lewin once said and nothing so practical
is a good theory what about political
economy what about power
what about political ideology what about
the fact that it would really be nice if
a single mom living minimum wage had as
much influence on government as the
president the small business Federation
but doesn't seem to work that way so I'm
just going to give you one example I'm
glad to see unifor is a sponsor of this
Jordan Brennan is now a chief economist
at uniform and he has a couple of
documents one's called a shrinking
universe
how concentrated corporate power is
shaping income inequality in Canada and
what do you see well basically the blue
line is corporate concentration and that
is how companies are buying each other
up and becoming bigger and more
influential and as Jordan points out
more profitable and the blue line is in
is family income inequality income
inequality is perfectly correlated with
the power and influence of big
corporations now how that comes about
requires another at least as other 15
minutes which I don't have so I wrote
this article beyond policy analysis the
real politics between our opposition to
healthy public policy and you can
imagine this is what it's all about
we're all concerned with health outcomes
and of course we're concerned with
health determinants and we're also
concerned with distribution of that and
ultimately it's about public policy but
it's not just making public policy
that's heavily influenced by the form of
the welfare state we have and it's not
the most happy things to think about the
relative balance between power between
civil society organized labor and the
business and corporate community and
when those things go out of whack
society goes out of whack now you can
imagine the average public health worker
saying my god where do I begin with this
can't I just tell people to exercise it
eat fruits and vegetables and they do
well a little bit about power and
influence the government's on the Left
the welfare states a Social Democratic
welfare stage sores in the middle or
conservative European the ones all
around the right are anglo-saxon liberal
political economies the triangles are
child poverty rate miraculously somehow
in Scandinavia there's all the any child
poverty is it because they work hard
their parents read to them at night they
exercise well it has to do with the fact
that pretty well everybody is
represented by a collective agreement
and pretty well everybody
to a union in the continental countries
it's at ethos that basically we're all
in this together we're all German we're
all French rural Swedes watch the bike
amor film where to invade next and
basically they do okay at poverty rates
a bit higher and in the liberal
countries you have weak unions people
don't have collective agreements and
surprise poverty rates are high so what
do we do well the social democratic
countries are marked by coalition
building between labor and other sectors
the takeaway message here is more
conferences more statements more
research articles that are going to
accomplish anything you literally have
to form interest groups that have power
and influence at the same time we have
to change the way we think about things
and could everybody in Canada recognizes
the value of a public health care system
but we haven't recognized the value of a
public Pharma caste system at least two
governments haven't we don't hear about
childcare we don't hear what happens if
you lose your job and basically the
conservative countries and think red
Tory the old red tour is in Canada
basically this view that we're all in
this together and as you know the CMA
came out with a study we would save
billions of dollars with a fauna care
program well according to pluralism
that's a no-brainer we should have
pharmacare tomorrow but we don't so what
do we do quick wins which again a quick
but not easy collective agreement if you
worked under collective agreement you'd
have higher wages and the Bank of
Montreal would have a bit less profit
maybe they'd have five billion last
quarter instead of six billion again if
you have any doubt about the health of
corporate Canada pick up the Globe and
Mail business section we have to also
communicate the Canadians the need to
distribute risk across the population
and the research literature is very
clear internationally comparatively you
can't do this stuff locally it requires
the institution of left political power
and you can ask me what that means
during the question period so it's about
politics the famous political economist
Laswell says politics is who gets what
wet and how how does that sound for a
Monica to put on social determinants of
health that's what it's all about change
the system I won't go into the issue of
proportional representation but one of
the real stimuli to progressive
government in Scandinavia was the
introduction of proportional
representation early in the 20th century
and we all know where that's going in
Canada however I want to point out that
it isn't just a problem what we're not
doing there it is opposition out there
and this is a wonderful quote that we
have this Christ as the oldest guy but
the new cannot be born in the
interregnum a great variety of morbid
symptoms appear the good news is stats
Canada puts this report out the bad news
is what he do about it I found it by
accident and once we found it it was
really something I mean so what happened
was we basically summarized this from
upstream and one little graphic that
40,000 Canadians would die in
prematurely each year because they
weren't as healthy as a wealthiest 20%
of Canadians at the same time you have
lifestyle drifted other diversions and
what do I mean by that this is not a
little tiny Institute out there these
guys had a budget of two and a half
million dollars and to show you how
influential they are when I go to the
upstream website I don't see Justin
Trudeau that but I do see Justin Trudeau
and what's the takeaway here we are
saying and let's say the Inuit
presentation things are really bad we
got to change things we got to improve
working conditions we got to improve the
conditions of people of the north we
have to improve the conditions of
women and what's the campaign slogan
here don't change much so if you're a
man and it can imagine telling taking
this back with you to the north breathe
deeply
sleep more walk more and of course all
those guys are white
I said well live with these magnificent
houses we have to deal with that so
luckily me and my students are exposing
as we're writing articles but there's a
reason these people are so well funded
and supported so that's my 15 minutes
I'm not sure how long I went but again
the worse things get the more there is
to write about and that's what the UK
researchers learned during the Thatcher
years so the Canadian facts is sitting
on line as it turns out health and
illness is out there if you're going to
really take this stuff seriously you
have to buy the mother of all social
determinants of health books and that is
the third edition and it has everything
and if you really are serious about
public policy change it got to
understand health policy you got to
understand how this stuff all works and
anybody have a European Union Passport
well this woman can get up and move to
Norway unfortunately most of us can but
at least we can get an idea of what
happens in different places and finally
because I live in Toronto and the cab
drivers are really well educated we went
out and we did an edited book on
immigration and public policy but it
would be really nice to think that all
we have to do is have the media pick up
this conference send the tapes off the
government and good things will happen
but it doesn't work that way so I'm not
going anywhere in terms of where I am
and I know where everything is hidden
and buried and that's what I've learned
after 21 years thank you
you
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