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I recently presented to a Portuguese-Canadian National Congress action meeting on health. They were discussing the Viva! Health Project, really interesting research on the health situation and challenges of the Portuguese communities. My role was to set the context for this discussion by outlining the social determinants of health that underlie health disparities. But I also wanted to set out some lines of policy and community action that can be taken to address these determinants and disparities.

Blueprint for Action on the Social Determinants of Health and Health Equity

There are two ways to reduce poverty:

The best way is to get money into the hands of low-income people and adopt other practical and effective measures, such as affordable housing, education and training and so on. The other way is to define poverty out of existence by statistical sleight of hand: Tell the poor, and everyone else, that the poor aren’t really poor, and hope that they just go away.

The Fraser Institute, the private-market-obsessed policy institute, opted for numerical dexterity as it published its latest research paper on poverty in Canada. Author Christopher Sarlo makes the astonishing claim that poverty in Canada has shrunk to a statistically tiny level in recent years.

Sarlo’s conclusion is at odds with the wealth of recent income data from Statistics Canada and well-respected policy institutes such as the University of Toronto’s Centre for Urban and Community Studies and the Canadian Centre for Policy Alternatives.

So, how is it that smart and sensible people can come to such widely varying conclusions?

Here are some observations to help make sense of the Fraser’s very odd dollars:

First, COMPLEXITY. “No single indicator or group of indicators can possibly capture the full complexity of income poverty in the UK.” Those are the opening words of an excellent overview of the tricky and politically-charged task of developing reliable poverty indicators by the UK’s New Policy Institute. Unlike Europe, Canada doesn’t have an officially-approved poverty indicator or indicators. Instead, we have two widely-accepted measures called the Low Income Cut-off (LICO) and the Low Income Measure (LIM) which measure relative poverty, or income inequality. And we have a whole variety of “market baskets” which measure absolute poverty by adding up a list of necessities to create a basic income required for meagre existence. Sarlo exploits the lack of consensus in Canada to dance around the methodological questions and create his very own definition of poverty.

Second, RELATIVE POVERTY. Canada’s LIM is very similar to the official poverty measure of the European Union, which counts the number of people who have incomes that are well below the median income (the statistical middle of all incomes). You’d think that Sarlo and the Fraser Institute would love LIM because what it measures, most fundamentally, is access to private markets. Markets for housing, food and all the other private commodities in Canada - at least according to market theorists - respond to average and median incomes. So, a measure that counts how many people are included (or excluded) from markets would seem to be pretty useful. The trouble is, relative poverty measures in Canada have set a disturbing trend: Incomes in the middle are shrinking, while those at the bottom have been growing, along with those at the top. This growing gap between rich and poor makes market purists uncomfortable, so Sarlo rejects relative poverty measures even though most independent statisticians know that they are very useful to measure how widespread low-income (another word for poverty) is. To be technical, relatively measures are used around the world - and here in Canada - by just about everyone except the Fraser Institute to measure the incidence of poverty.

Third, ABSOLUTE POVERTY. There is another measure of poverty that is widely used to gauge the depth of poverty. Sometimes called the “market basket” approach, absolute poverty creates a bundle of basics (housing, energy, food, medicine, drugs, dental, transportation, clothing and so on) and then prices them. Anyone who falls below the income required to buy that basic basket of goods is considered poor. Sarlo says that his basket of goods includes all the basics and is also sensitive to regional variations (it costs more to rent a home in Toronto than, say, Montreal). All well and good, but the “poverty line” that Sarlo sets out on page 8 of his report is so meagre that it’s impossible for imagine anyone could actually survive on that. No wonder Sarlo is able to proclaim that poverty is virtually non-existent in Canada.

Fourth, REALITY CHECK. Sarlo says that his "basic poverty needs income" for a family of one is $10,520. Consider this: If that single person was living in the neighbourhood of the Wellesley Institute (which includes Central Toronto, with some very low-income neighbourhoods such as St James Town, Regent Park and Moss Park), the average annual rent for a bachelor apartment (the cheapest form of accommodation) in 2007 was $10,056. Toronto Public Health reports that in 2007, a nutritious food basket for a single young man was $2,615. A Metropass on the TTC Discount Plan is $1,200 annually (the cheapest transportation option for Toronto). Add up those costs, and our low-income Torontonian already needs an income of $13,871 - and that’s before paying for energy, clothing, medicine, dental, drugs and the other basics that Sarlo says is part of his basket. So, how can Sarlo get his numbers so low, when the real costs are so much higher?

Defining poverty rates so low that virtually no one in Canada could be called poor may make good ideological fodder, but in the real world that most people inhabit, Sarlo’s dollars just don’t make any sense.

The Ontario government launched its public consultation on its proposed Poverty Reduction Strategy with a few bumps this week. Closed-door, invitation-only meetings are not the best way to engage the people of Ontario, including those who have a direct experience of poverty.

There is real expertise and a great deal of wisdom from the "ground up" about practical solutions to poverty in Ontario - that's been the experience of the Wellesley Institute over the past 10 years as we have been the leader in funding community-based research. And that was the first message that we delivered to Ontario Minister Deb Matthews, who is chairing the Cabinet Committee on Poverty Reduction, during a four-hour session in Ottawa that included representatives from across the province.

Poverty is fundamentally about a lack of income, but there are important dimensions to poverty, including the lack of affordable housing. So, we advised the Minister that there are both important strategic indicators of growing housing need in Ontario (such as Core Housing Need), a reliable set of targets (from the Ontario government's own Provincial Policy Statement 2005), practical and effetive strategies to get us from here to there, and important and tangible ways to measure progress.

Stay tuned as we work with others, including our partners in the 25-in-5 Poverty Reduction Network , to put much more detail on the emerging framework to make a real and substantial reduction in poverty in Ontario.

Toronto City Council's powerful Executive Committee has unanimously adopted a detailed panhandling strategy that bucks the terrible trend throughout North America to criminalize activities associated with homelessness, housing insecurity and poverty. The plan recognizes that there are socio-economic and health issues that drive people to beg for change on the city's streets and, therefore, the best response is not to arrest and ticket panhandlers, but to ensure that they have access to housing, supports and income.

It was particularly heartening to see representatives from Toronto's business, tourism and entertainment all stand in support of this plan - along with the Wellesley Institute. Even Toronto Police Services spoke against criminalizing panhandling and in favour of the approach that tackles the fundamental concerns. Just one year ago, many business groups and others were clamouring for a police-led crackdown on panhandling.

The TO plan, which still needs the approval of City Council later this month, calls for a "housing first" approach to dealing with panhandling. It recognizes that growing poverty and housing insecurity are driving most people to beg on the streets, and that a significant number also suffer from physical and mental health concerns, including substance use. But instead of condemning the poor for being poor, the Toronto plan commits about $5 million to help panhandlers find affordable homes, an adequate income and the supports that they need.

The Wellesley Institute, in our submission to the committee, noted that the Statistics Canada data released last Thursday confirms the dire trend in growing income inequality in Toronto. We also pointed out that many cities - including New York City - have tried to criminalize activities associated with homelessness (including panhandling), only to find that this costs more and doesn't actually reduce the number of homeless people. And we called on the city to re-double its efforts to ensure that there is adequate housing and services for those who need it.

We've noted in our municipal budget submission that Toronto needs to ramp up its spending on housing and services, needs to re-double its efforts to convince senior levels of government to renew critical investments in housing and other social infrastructure and, until a comprehensive housing and anti-poverty strategy is adopted and funded by senior levels of government, needs to ensure that the city's emergency relief system - including homeless shelters - are properly funded.

One key factor that swayed many councillors was a simple message: The cost of doing nothing far outweights the cost of an effective and practical solution. That's the core message from the Wellesley Institute's Blueprint to End Homelessness, which was released in 2006, and city councillors and city officials quoted our Blueprint in support of sensible and humane plan to address the real needs of panhandlers.

The following editorial from the Toronto Star of Sunday, May 4 about says it all:

Children and Youth Services Minister Deb Matthews has begun the process of consulting with communities about how to reduce poverty in this province. But already anti-poverty groups are raising concerns about how she is going about it.

"Matthews, who heads a cabinet committee drafting the government's promised poverty reduction strategy, announced Thursday that she is holding 13 consultation meetings across the province. But the meetings are by invitation only and behind closed doors. "

That has led to fears among groups in the 25 in 5 Network for Poverty Reduction that the consultations will exclude those who need to be consulted the most: people living in poverty.

"We are glad she is getting into the field but we're concerned about how this has been organized and about getting communities engaged to take part," says Peter Clutterbuck of the Social Planning Network of Ontario, a partner in the 25 in 5 Network.

The activists are also concerned that a new government website asking for public input is almost entirely focused on child poverty, ignoring what they see as fundamental issues like affordable housing, minimum wages and affordable child care. Matthews insists her strategy will address those issues as well.

Matthews says she plans to consult poor people themselves by visiting homeless shelters, community agencies and food banks. But the reaction to her first faltering steps in this consultation process should be a warning that the poor do not intend to be ignored any longer.

For more information about 25 in 5: Network for Poverty Reduction visit www.25in5.ca

For more information on the government's consultations visit www.growingstronger.ca

The Last Straw! A Board Game on the Social Determinants of Health, co-funded by the Wellesley Institute, is a fun way for players to learn how the daily life cycles and social conditions of individuals and communities can affect health and illness – think ‘Monopoly’ with social conscience and analysis. The Last Straw! shows how "macro" issues such as political climate, economic structure and environmental change, and "micro" issues, such as individual finances, education, and family dynamics, shape the health of both individuals and communities. It’s a tremendous health promotion tool and has been successfully used to facilitate learning on social determinants of health in practice in many settings.

Visit the Last Straw! for more information.

The City of Toronto is building a 10-year housing strategy called Housing Opportunities Toronto. The city's plan was launched one year after the Wellesley Institute released our Blueprint to End Homelessness in Toronto, which includes both the basic 10-year plan plus a much-more-detailed framework document with lots of background material. We've prepared a number of backgrounders on the HOT proposal, including recommendations to Toronto's 2008 budget process to finance the housing plan.

The City of Toronto has announced a series of public meetings to hear recommendations about the HOT plan. These include:

Wednesday, May 14 – Scarborough Civic Centre, 6:30 to 9 p.m.
Wednesday, May 28 – North York Civic Centre, 6:30 to 9 p.m.
Wednesday, June 4 – Etobicoke Civic Centre, 6:30 to 9 p.m.
Monday, June 16 – Affordable Housing Committee                       
Deputations – 1:30 p.m., City Hall, Committee Room 2

The KU Work Group on Community Health and Development provides a range of useful planning resources on community development as one crucial direction for improving population health and addressing health inequities. Established in 1975, it was designated by the World Health Organization as a WHO Collaborating Centre in 2004 Its core values and assumptions are:

1. Building healthy communities involves improving conditions and outcomes for the health and well-being of the population as a whole.
2. This requires changing conditions, including environmental and policy conditions, that affect behaviors and related outcomes.
3. Since health and human development outcomes are caused by multiple and interconnected factors, single interventions are likely to be insufficient.
4. Since environmental influences occur in different contexts, collaborative efforts must bring about changes in multiple sectors and systems.
5. Local people, including those most affected, should be active participants in changing local conditions.
6. Justice requires health and well being for all, including for marginalized groups that have different exposures, vulnerabilities, and consequences related to their situations.
7. To improve health for all requires addressing broader social determinants, such as social inclusion, income equality, and efficacy or the ability to have influence on conditions.
8. Collaborative partnerships act as catalysts for change; they convene key parties, broker relationships, and leverage needed resources.
9. The aim of support organizations is to build capacity to address what matters to people over time and across concerns.
10. Community health and development involves interdependent relationships among multiple parties in which none can function fully without collaboration with others.

The Work Group's Community Tool Box (CTB) is the world's largest resource (over 7,000 pages of content) for building capacity for community health and development. They also publish many guidelines and tool kits for health planning and community development, and provide links to a range of articles and reports.

Today is Earth Day 2008 - and a very happy birthday to a much-abused dear old planet Earth!

Statistics Canada has released this morning an update to its Human Activity and the Environment series that reports, among other things, that the emission of green house gases are up by 25% from 1990 to 2005. Lots more troubling indicators, including a stunning chart showing the remorseless rise in mean global temperatures.

Clean air and moderate temperatures are fundamental to good health. As Toronto braces for more smog days and extreme heat alerts, it’s important to remember that a safe and healthy environment, like most other determinants of health, is a fundamental health equity concern.

Some people in our city are more financially able to mitigate some of the worst effects of smog and heat than others (with air conditioning, vacations out of the city, etc.). 

Toronto enjoyed a spectacular weekend this past Saturday and Sunday – and we also puffed our way through the first two smog days of 2008. These smog days have come about a month earlier than expected. If this keeps up, we’ll be on track to beat the last record for smog days set in 2005. In that year, Toronto’s Medical Officer of Health released an epidemiological report surveying death data over several decades and reported that many more Torontonians are dying of heat and smog-related causes than cold injuries.

On the good news front, the provincial government announced today new rules to ban cosmetic pesticides and herbicides. They have taken the lead from the City of Toronto, which adopted its own anti-pesticides bylaw several years ago thanks to a vigorous campaign that was led by Toronto Environmental Alliance staff and volunteers.

It's been more than two years since Toronto City Council adopted an Urban Heat Island Mitigation Strategy - an acknowledgement of the serious environmental issues facing the city from killer heat and killer smog. Practical and effective action is still required.

One precondition for successfully addressing health disparities is to build on local community-based initiatives and on the needs and perspectives of local residents. Incorporating the views, experience and priorities of residents, especially from the most disadvantaged and marginalized communities, into planning and resource allocation processes is vital to regional health planning and delivery that can effectively focus on health disparities. Diversity and equity-driven community engagement is one vital enabler of successful local and regional action on health equity.

Here are two interesting resources. The first is a recent handbook from CPRN (the Canadian Policy Research Network) on citizen engagement. It reviews several health examples, including the extensive community engagement strategy developed by Vancouver Coastal Health.

The British health research and knowledge exchange foundation NICE conducted a systematic review of the impact of community engagement on addressing social determinants of health in 2007.