Dennis Raphael

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• PhD, University of Toronto
• Professor at York University

Jane Philpott's Health for All is the most recent contribution to policy discourse related to health care and social determinants of health. Unfortunately, the volume is sadly lacking in critical analysis of the current economic and political environment in which health policy is being made.

Bertolt Brecht’s 1938 poem ‘A Worker’s Speech to a Doctor’ has been used by health educators to direct attention to the health-threatening effects of adverse living and working conditions. However, to date there has not been a systematic analysis of these evocations and their goals (eg, develop clinical skills through promotion of empathy, encourag...

Background: While consensus exists that the sources of health inequalities are social inequalities brought on by the experience of qualitatively different living and working conditions, means of addressing these conditions continue to be the subject of dispute. Whether to emphasis education or income as asocial determinant of health is one such exa...

Jane Philpott's book Heath for All: A Doctor's Prescription for a Healthier Canada has been lauded by the powers-that-be as a great contribution to promoting social justice through public health. In reality it is a celebration of the status quo and those who have created the current health inequality polycrisis in Canada.

The growing polycrisis in Canada and elsewhere associated with deteriorating living and working conditions have increased calls for a post-capitalist socialist economy. Among the means of accomplishing this goal is the late Erik Olin Wright's argument for eroding capitalism by developing alternative economic structures and processes. In this paper...

Labour Pamphlet about Social Murder

The past two decades have seen increasing mentions of health equity and the importance of addressing the social determinants of health in USA public health statements. Yet, there is little uptake of these concepts into USA public policy. We see this, in part, as being due to the unwillingness of the USA public health community – including its netwo...

It has been recognized since antiquity that the organization of society and how it distributes resources are the primary determinants of health. Yet most definitions of health in the academic and practice literatures limit their focus to the individual’s experience of health and functional abilities, neglecting the structures and processes of socie...

Despite Canada’s commitment to several international human rights instruments recognizing the right to housing, homelessness remains widespread nationwide. Informed by critical political economy theory and critical discourse studies, we examined relevant literature focusing on homelessness policy-related documents in the Canadian context. The findi...

Bertolt Brecht’s poem “A Worker’s Speech to a Doctor” is frequently cited as a means to raise awareness among health workers of the health effects of living and working conditions. Less cited is his Call to Arms trilogy of poems, which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this a...

The Condition of the Working Class in England (hereafter, CWCE) by Friedrich Engels is a masterpiece of urban research not only for its explicit descriptions of the living and working conditions of members of the Victorian-era working class and their effects on health but also its insights into the sources of these conditions through a political ec...

In 2011 Raphael identified seven discourses on the social determinants of health (SDH). These discourses ranged from ‘SDH as identifying those in need of health and social services’ to ‘SDH and their distribution result from the power and influence of those who create and benefit from health and social inequalities’. Developments since then have le...

The adverse effects of climate change are already apparent with action required to forestall a full blown climate catastrophe. Despite findings that social democratic welfare states – Denmark, Finland, Norway and Sweden – more proactively respond to climate change through environmental policies that complement public policies promoting economic and...

There is increasing interest by academics and mainstream media in the relevance of Friedrich Engels's writings for understanding contemporary economic and political issues. Still, Engels's writing about the adverse effects of the capitalist economic system on the health and well-being of workers, the environment, and society in general remains marg...

Since 1996, we have been working to have Canadian governmental authorities implement health-promoting public policy that would improve the quality and equitable distribution of the social determinants of health, with rather little to show for our efforts. In this commentary, we identify seven emerging themes that can help explain our failures and p...

Fisher and colleagues carefully review the extent to which health equity goals of availability, affordability, and acceptability have been achieved in the areas of national broadband network policy and land-use policy, in addition to the more traditional areas of primary health care and Indigenous health in Australia. They consider the effectivenes...

Critics have identified the corporate and business sector as contributing to household food insecurity through its endorsement of low wages, anti-union activities and lobbying for retrenchment of the Canadian welfare state. It is therefore troubling that this same corporate and business sector has come to dominate positions on the boards of directo...

Literature now exists on how the media reports on health inequalities. One compelling concept as to the sources and impacts of health inequalities is “social murder” as articulated by Friedrich Engels in his 1845 volume, The Condition of the Working Class in England, whereby the capitalist economic system sent workers prematurely to the grave to se...

Health promoters recognize the social determinants of health (SDOH) shape health outcomes yet generally neglect how unionization and collective agreements (CAs) shape these SDOH. This is surprising since extensive evidence indicates unions and CAs influence wages and benefits, job security, working conditions and income inequality, which go on to a...

Progress in reducing health inequalities through public policy action is difficult in nations identified as liberal welfare states. In Canada, as elsewhere, researchers and advocates provide governing authorities with empirical findings on the sources of health inequalities and document the lived experiences of those encountering these adverse heal...

A recent article brought together the health benefits of unionization and working under collective agreements. It was noted how Canadian health promotion texts, reports and statements made no mention of unionization and working under collective agreements as promoting health. This was seen as a significant omission and reasons for this were conside...

In response to a request from a local community health centre, an inquiry was undertaken into the service needs and day-to-day lives of residents in five social housing complexes in the inner suburbs of Etobicoke, Toronto. Unlike other low-income communities embedded within larger wealthier communities, these complexes have little in the way of hea...

In 1845, Friedrich Engels identified how the living and working conditions experienced by English workers sent them prematurely to the grave, arguing that those responsible for these conditions -- ruling authorities and the bourgeoisie -- were committing social murder. The concept remained, for the most part, dormant in academic journals through th...

For decades critics have identified Walmart Canada’s employment practices – characterized by inadequate wages with few benefits – as contributing to household food insecurity (HFI). Walmart Canada also opposes unionization drives which would result in higher wages and benefits through the collective bargaining process. In a remarkable example of im...

The Society for the Advancement of Science in Africa (SASA) continues with its mission to advance science, improve health, and promote economic and social development on the African continent. SASA seeks to promote continent-wide African innovation and new frontiers of scientific research. It serves to push for Africa-wide innovation and new fronti...

In response to a request from a local community health centre, an inquiry was undertaken into the service needs and day-today lives of residents in five social housing complexes in the inner suburbs of Etobicoke, Toronto. Unlike other low-income communities embedded within larger wealthier communities, these complexes have little in the way of heal...

This paper examines Canada’s liberal welfare state in relation to the COVID-19 pandemic. It argues that contrary to claims that the pandemic is affecting both rich and poor equally, its impact is both gendered, racialized and class-related. It thereby exacerbates existing social and health inequalities. Responsible for much of this is Canada’s welf...

Research on promoting health equity by reducing health inequalities in Africa presents an emerging research frontier. Concepts from the political economy of health literature such as decommodification, stratification, class mobilization, and the relative responsibility ascribed to the state, marketplace, and family in defining the quality and distr...

Between 2015–2016, 201 children were held in detention in the Toronto Immigration Holding Centre (Canada Border Services Agency, 2017). There may have been even more held across Canada, but these figures are unavailable. Child detention is illegal under international law and causes serious mental, physical, and emotional health complications. In th...

In this paper, we explore how corporate domination of two major disease associations in Canada, Heart and Stroke Canada (HSC) and Diabetes Canada (DC), as manifested in membership of their boards of directors may be acting with biomedical complicity to create hegemonic discourse on the nature of cardiovascular disease (CVD) and type 2 diabetes mell...

While it is well-established that Canadian women are more likely to experience precarious work and the prevalence of this is increasing, greater attention needs to be paid to the contributions that social theory can make to both understanding and responding to this issue. This paper considers recent developments in both welfare state and cultural v...

Household food insecurity (HFI) impacts over 1.7 million households in Canada with adverse effects upon health. As a signatory to numerous international covenants asserting that access to food is a human right, Canadian governments are obliged to reduce HFI, yet Canadian governments have done remarkably little to assure that Canadians are food secu...

The welfare state literature on developing nations is concerned with how governmental illegitimacy and incompetency are the sources of inequality, exploitation, exclusion, and domination of significant proportions of their citizenry. These dimensions clearly contribute to the problematic health outcomes in these nations. In contrast, developed nati...

Background: This article overviews Canadian work on the social determinants of oral and general health noting their affinities and differences. Methods: A literature search identified Canadian journal articles addressing the social determinants of oral health and/or oral health inequalities. Analysis identified affinities and differences with si...

There is little doubt that the implementation of a Basic Income Guarantee (BIG) in Canada and other liberal welfare states would alleviate some of the most egregious examples of absolute poverty that contribute to poor health such as lack of adequate food and shelter and inability to meet basic household and personal needs. BIG would likely improve...

This article applies intersectionality analysis to consider women's health and well-being in Canada's welfare state with attention to those occupying vulnerable social locations. Political and economic structures and processes associated with different forms of the welfare state are responsible for producing these vulnerabilities as they differenti...

The Canadian Men’s Health Foundation (CMHF) receives significant funding and media attention for its Don’t Change Much initiative, which claims freely chosen small behavioural changes will improve men’s health across Canada. The enthusiastic support for the CMHF’s individual lifestyle interventions that take no account of the structural drivers of...

Individuals in and leaving care within the UK experience numerous dilemmas that include a lack of supportive housing and potential homelessness, lower educational attainment and occupational status, and greater likelihood of moving into poverty. These adverse situations—all of which are interrelated—shape their present and future health status. Mod...

In Canada's liberal welfare state the public is given little exposure by governmental authorities to the importance of promoting health equity through public policy action on the social determinants of health (SDoH). Not surprisingly, Canada lags in implementing health equity-enhancing public policy. In Ontario, Canada's most populous province, a l...

Based on a critical review of the obesity and health literature we provide five models of how the hypothesized obesity and health relationship is conceptualized. We then apply these models to make sense of how recent Canadian public health reports and clinical practice guidelines conceptualize the issue of obesity, its causes and health effects, an...

Aims: Nordic welfare states have achieved admirable population health profiles as a result of public policies that provide economic and social security across the life course. Denmark has been an exception to this rule, as its life expectances and infant mortality rates since the mid-1970s have lagged behind the other Nordic nations and, in the ca...

The origins of this volume are found in my experience of living in a city where over 50% of the population have immigrated from other nations. In the particular case of Toronto, most of this immigration over the last 30 years has come from the developing world and consists of people of colour. Despite admission requirements that immigrants be well...

For over 35 years Ronald Labonté has been critically analyzing the state of health promotion in Canada and the world. In 1981, he identified the shortcomings of the groundbreaking Lalonde Report by warning of the seductive appeal of so-called lifestyle approaches to health. Since then, he has left a trail of critical work identifying the barriers t...

Most Canadians believe that their experiences of health and illness are shaped by luck, treatment options and lifestyle choices. Government, public health units and various disease associations all reinforce this perception by continually extolling lifestyle choices and genetic research as the solution to our illnesses. About Canada: Health and Ill...

Sustained Canadian research activity creating evidence on SDOH. Government reports, public health and health care association statements, conferences and meetings concerned with SDOH. Federal and provincial funding for SDOH research. National Collaborating Centres. Little impact on public policy. Why is there little public policy implementation?

Overview In the current environment of deepening class and income inequality, it is essential to understand the socio-economic conditions that shape the health of individuals and communities. Now in its third edition, Dennis Raphael’s Social Determinants of Health offers a comprehensive discussion of the primary factors that influence the health o...

Dans cet article, nous analysons les différences que l'on observe dans la santé des mères en lien avec les inégalités socioéconomiques dans différents pays. Selon une hypothèse généralement admise, ces inégalités seraient les plus importantes dans les pays où, en matière de politiques sociales, les mères sont considérées comme des aidantes familial...

The insights provided by Gøsta Esping-Andersen's Three Worlds of Welfare Capitalism on the origins and characteristics of social democratic, conservative and liberal welfare states make explicit many of the political and economic structures and processes that can impact on health and create health inequalities. Broad stroke analysis of welfare stat...

The insights provided by Gøsta Esping-Andersen’s Three Worlds of Welfare Capitalism on the origins and characteristics of social democratic, conservative and liberal welfare states make explicit many of the political and economic structures and processes that can impact on health and create health inequalities. Broad stroke analysis of welfare stat...

Abstract Background: Addressing the social determinants of health (SDH) is identified as a role for local public health units (PHUs) in the province of Ontario. Despite this authorization to do so there is wide variation in PHU practice. In this article we consider the factors that shape local PHU action on the SDH through a critical realist analys...

In this article key aspects of a political economy approach to addressing children’s health are identified. These aspects include a concern with how power and influence of various societal sectors come to shape the social determinants of children’s health through the creation of specific forms of public policy. These public policies affect children...

A political economy approach to children’s health considers how the economic and political systems of a jurisdiction influence the public policies that shape children’s health. It moves beyond the concrete and observable to look at the societal structures and processes that distribute the material and social resources to families and children that...

Despite evidence that public policy that equitably distributes the prerequisites/social determinants of health (PrH/SDH) is a worthy goal, progress in achieving such healthy public policy (HPP) has been uneven. This has especially been the case in nations where the business sector dominates the making of public policy. In response, various models o...

The health of Canada's children when placed in comparative perspective with other wealthy developed nations is mediocre at best. Much of this has to do with the social determinants of children's health (SDCH) in Canada being of generally lower quality and more inequitably distributed than is the case in most other wealthy developed nations. The SDC...

Despite a history of conceptual contributions to reducing health inequalities by addressing the social determinants of health (SDH), Canadian governmental authorities have struggled to put these concepts into action. Ontario's-Canada's most populous province-public health scene shows a similar pattern. In statements and reports, governmental minist...

Recent studies have suggested that the career interests of many social work students are inconsistent with the traditionally defined concept of social work identity. The current study conceptualized, operationalized, and developed measures of the prevalence of various interests, preferred activities, and self-identifications associated with social...

Aims: Finland, Norway, and Sweden are leaders in promoting health through public policy action. Much of this has to do with the close correspondence between key health promotion concepts and elements of the Nordic welfare state that promote equity through universalist strategies and programs that provide citizens with economic and social security....

Aims: Finland, Norway, and Sweden are leaders in promoting health through public policy action. Much of this has to do with the close correspondence between key health promotion concepts and elements of the Nordic welfare state that promote equity through universalist strategies and programs that provide citizens with economic and social security....

To date, Ontario public health units (PHUs) have generally neglected the social determinants of health (SDH) concept in favor of risk aversion and behaviorally oriented health promotion approaches. Addressing SDH and responding to the presence of health inequities is required under the Ontario Public Health Standards and is a component of provincia...

To explore the influence of social work education on students' professional identification and practice interests (and to examine recent concern that students' career goals no longer match social work's traditional mission), authors of this study surveyed 180 graduate students at one school of social work at the beginning and end of the 1991-92 aca...

Despite the general acknowledgement by health researchers and authorities that living and working conditions—the social determinants of health (SDH)—are important predictors of health and illness, there is little application of this concept in discussions of the incidence and prevalence, as well as the management of chronic diseases such as cardiov...

Despite the Canadian public health community’s commitments to promoting public policy that supports health, evidence indicates that Canada’s public health picture continues to decline. This may be due in part to the failure of public health agencies and local public health units to engage in public policy advocacy and public education about the soc...

Despite Canada's history of developing health promotion and population health concepts, Canada falls behind other wealthy nations in having these ideas implemented in the form of public policy that strengthens the social determinants of health (SDH). Much of this has to do with the lack of awareness by Canadians about the SDH that stems from the la...

Type 2 diabetes (T2DM) is a serious life-threatening chronic disease whose prevalence is especially high among Canadians living in poverty. And these Canadians with T2DM in poverty are especially likely to experience serious consequences of the disease. Of special concern is Statistics Canada reporting an explosive increase in mortality rates from...

This paper sheds light on the dynamic relationship between people's experiences of low income and the development of type 2 diabetes (T2DM) by moving beyond the static perspective provided by cross-sectional studies to a long-term approach informed by longitudinal analyses. We analyzed data from the Canadian National Population Health Survey (NPHS)...

Objectives: To identify a) ways of enhancing health services for vulnerable populations with type 2 diabetes, taking into account the social determinants of health; and b) health and social policy approaches to reducing the incidence of type 2 diabetes and improving its management. Methods: Focus groups were held with 18 community healthcare pro...

Canada is a leader in developing health promotion concepts of providing the prerequisites of health through health-promoting public policy. But Canada is clearly a laggard in implementing these concepts. In contrast, France is seen as a nation in which health promotion concepts have failed to gain much traction yet evidence exists that France does...

Governmental authorities of wealthy developed nations differ in their professed commitments and activity related to the provision of the prerequisites of health through public policy action. Part 1 of this article showed how nations identified as social democratic or liberal welfare states were those where such commitments are present. Nations iden...

The social determinants of health (SDH) concept is common to Canadian policy documents and reports. Yet, little effort is undertaken to strengthen their quality and promote their more equitable distribution through public policy action. Much of this has to do with the SDH concept conflicting with current governmental approaches of welfare state ret...

This paper contributes to a growing body of literature indicating the importance of income as a key socioeconomic status marker in accounting for the increased prevalence of type 2 diabetes (T2DM). We analyzed data from the Canadian Community Health Survey cycle 3.1 conducted by Statistics Canada. Descriptive statistics on the prevalence of self-re...

This article explores the dearth of coverage of the social determinants of health by the Canadian mainstream media. It is argued that this neglect is primarily a reflection of political and economic societal structures that has been associated with increasing corporate control of the mainstream media. Applying a critical political economy lens, it...