Health, Illnesses, and Disability in Canada

• Health


  Complete physical, mental, and social well-being, not merely negatively as the absence of disease or infirmity
• Measuring health


  • Physical health tends to follow a biomedical model
  • Mental health is often invisible and hard to identify
  • Social well-being refers to environments and relationships surrounding an individual
• WHO Principles of Health

  • The enjoyment of the highest attainable standard of health is a fundamental right
  • The health of all peoples is fundamental to peace and security
  • The achievement of any State in health promotion is of value to all
  • Unequal development in health promotion and disease control is a common danger
  • Healthy child development is of basic importance
  • The extension of medical, psychological and related knowledge is essential
  • Informed public opinion and active cooperation are important
  • Governments have a responsibility for the health of their peoples
• Redefining health


  • Contention around the notion of "complete" health
  • Some advocate for refocusing health around resilience and adaptability
  • Resilience is measured at the individual level and the societal level
• Operationalizing health and illness

  • Objective measures: biomedical, standardized approach
  • Subjective measures: personal experiences and opinions of individuals
  • Epidemiologists study distribution and determinants of health and diseases in a population
• People's lived experiences are more complex than physical symptoms and diagnoses
• Notions of social well-being are socially constructed
• Leading causes of death

  • Source: Statistics Canada
• Top 10 and bottom 10 world rankings for happiness and well-being

  • Source: https://s3.amazonaws.com/happiness-report/2018/WHR_web.pdf
• Social determinants of health

  The social, political, cultural, and economic factors that contribute to both positive and negative health outcomes
• Three recommendations for action on social determinants of health


  • Improve daily living conditions
  • Tackle the inequitable distribution of power, money, and resources
  • Measure and understand the problem and assess the impact of action
• Shifting from one-dimensional to intersectional health research

  • In order to address health inequity, we must address distal or fundamental causes of disease
  • Instead of individual level causes, we should ask, why do some people have better access to exercise, healthy food, etc.?
  • Intersectional lens is important
  • Five socio-demographic factors known to influence health/illness: gender, race/ethnicity, socioeconomic status, age, social location
  • Cannot study these factors in isolation
• Benjamin Chavis: 'Racial discrimination in environmental policy-making, the enforcement of regulations and laws, the deliberate targeting of communities of colour for toxic waste facilities, the official sanctioning of the life-threatening presence of poisons and pollutants in our communities, and the history of excluding people of colour from leadership of the ecology movements.'
• Baskut Tuncak, United Nations Special Rapporteur on human rights and hazardous substances and wastes, 2019: 'Throughout the lifecycle and value chain of economic activity in Canada, indigenous peoples appear to be disproportionately located in close proximity to actual and potential sources of toxic exposure. Indigenous peoples live next to refineries and other manufacturing facilities. Existing and proposed pipelines crisscross their lands. Landfills, incinerators and other waste disposal sites are often closest to their reserves. This proximity and issues of access to justice and remedy (further below) raise questions of dignity and equality.'
• Indigenous health in Canada

  • Colonization has had a negative impact on Indigenous people's health
  • First Nations people living off reserve have lower than average life expectancies, and birth weights, higher (infant) mortality and rates of mental illness and suicide, than non-Indigenous people
  • Health status of First Nations people is compounded by low education, unemployment, low income, inadequate housing
• Environmental justice


  Environmental justice embraces the principle that all people and communities are entitled to equal protection of environmental and public health laws and regulations
• Environmental justice groups in Canada

  • Ecojustice: https://ecojustice.ca
  • Indigenous Environmental Justice Project: https://iejproject.info.yorku.ca
• Health throughout the life course

  • Life course research: intersectional health research that examines the impact of exposure to social inequalities over time, during different developmental stages, and for specific cohorts
  • Latent, pathway, cumulative effects
  • Early childhood SES has long-term consequences for adult health
  • When, how much, and for how long poverty lasts is important for health
• Disability


  • A social category that contributes to the exclusion of and prejudice against people with bodily or cognitive variations
  • Social constructionist lens: there is nothing inherently wrong with having different abilities
  • Critical disability studies draws on the lived experiences of marginalized people with impairments; intersectional and transdisciplinary lens; promotes greater inclusivity in society
  • Need to understand that experiences of ability/disability are not the same for everyone, everywhere
• Disability and the life course

  • The age of onset can affect how people experience and understand themselves; also affects life course trajectory
  • For example, aging with disability is experienced differently if one is born with disability vs. becomes disabled as an adult
• Questioning power, knowledge, and authorities

  • The cultural approach in critical disability studies questions existing socially created definitions of disability, impairment, and normality
  • What does it mean to be able-bodied vs. disabled?
  • Critical disability studies refute the notion that experts have knowledge, power, and authority to define what constitutes a disability and what does not
  • People with lived experience are the real experts
• Medicalization


  • Behaviours that were once labelled deviant, immoral, "crazy" have now been medicalized
  • Possible consequences: more illnesses = more profit for pharmaceutical companies, more treatments without regard for individual and social well-being
  • Addiction and mental health were once seen as deviant and have now been medicalized
• Is addiction a disease?

  • Moral model of addiction vs. medical model of addiction
  • Medicalization allows for more humanitarian approach, but the medical model emerged because of increasing power of physicians, economic and political incentives
  • Addiction as a disease is socially constructed
  • Move toward a biopsychosocial model
• Advantages and disadvantages of medicalization

  • Advantages: Recognizes a condition as beyond the control of the individual, allows for diagnoses and treatment, more research is conducted, individuals can find support
  • Disadvantages: Assumes behaviours are inherently abnormal, labels lead to stereotypes and stigma, medicalizes natural life processes, ignores social determinants of health, is driven by pharmaceutical companies