The Social Determinants of Health: An Imperative for Canadian Public Health

a 15-year-old boy living in lesotho has about a 10% chance of reaching the age of 60 years, whereas a 15-year-old swede has a 91% chance. sir Michael Marmot often uses this example when discussing the work of the WhO commission on the social Determinants of health which began its work in 2005 and is due to submit its final report in 2008. One does not need to go to foreign countries to get a sense of the importance of social and economic factors in health. a stroll through most of our canadian cities and towns will do as well. For example, the life expectancy at birth for men born in the low-income Montreal neighbourhood of the «clsc des Faubourgs» is 67.8 years compared to 78.4 years for those born in the contiguous territory of the «clsc Metro» neighbourhood just a few streets to the West.1 indeed, there are many examples throughout the country that clearly show that health inequalities are alive and well in canada. although canada has in many ways been central to the development of the concepts of population health, it has to a great extent been less than successful in applying its lessons in its own backyard. the lalonde Report, the Ottawa charter for health promotion, and more recently the work of the canadian institute for advanced Research all contributed substantially to redefining the principles of public health and social interventions to promote a just and healthy society for all citizens. in this vein, the upcoming cpha annual conference (halifax, June 1-4) is focused on the social determinants of health. the conference theme “Reducing health inequalities through evidence and action” was chosen to take stock of the upcoming WhO report and the large body of scientific evidence, and to set the stage for actions to promote health equity within the country and abroad. environmental interventions have always been central to public health, from hippocrates’ On Airs, Waters, and Places to John snow removing the handle of the broad street pump. today, the social environment, including social and economic inequities, are at the root of many diseases worldwide. the canadian public health community must be at the forefront of the interventions and research required to deal with this challenge. Removing that handle will seem like child’s play compared to the tasks ahead, but we, like snow, cannot shy away from our collective responsibility.