Poverty, and not medical and lifestyle factors, is the leading cause of cardiovascular disease in Canada, delegates attending a recent international conference were told, and recent political decisions that have exacerbated income and wealth differentials have only made the situation worse.
Dennis Raphael of York University told participants from 54 countries who attended the Conference of the International Society for Equity in Health (www.iseqh.org) in Toronto that Statistics Canada data indicate that Canada will face not only the added costs of treating these health problems but also more than 6000 premature deaths a year.
Other speakers pointed out that Canada still has better health indicators than the US despite spending far less per capita on health care. Claudia Sanmartin of Statistics Canada reviewed Canadian and US data and found a strong relationship between income inequality and mortality in US metropolitan areas. No such relationship was found in Canada, probably because of transfer payments to poor individuals and families. However, she did find that a relationship between unemployment and mortality exists in Canada.
Many speakers, especially those from developing countries, focused on the need to address health inequalities between rich and poor nations. Ron Labonte of the University of Saskatchewan and David Sanders of the University of the Western Cape, South Africa, presented a report card on G8 health and development commitments. They concluded that although some commitments have been met, they have done little to overcome the harmful effects of International Monetary Fund structural adjustment policies that require debtor countries to reduce public expenditures on health, education and social services. They said the highly touted New Partnership for Africa's Development is unlikely to mitigate health inequalities, either between or within countries.
Despite the prominence of the word “equity” in the conference title, many if not most of the presentations dealt with “(in)equalities.” Presenters often used the 2 words interchangeably, despite the occasional admonition that they are significantly different. As one speaker pointed out, equality is a descriptive term, while equity is a normative/ethical term. In other words, not all health inequalities are inequitable. — John R. Williams, Director of Ethics, CMA