Social Determinants of Health. 2nd ed.

K.V. Nagarajan is a professor in the Department of Economics at
Laurentian University.

Ever since the famous Lalonde report was released in 1974, a large body of research has grown in support of a strong relationship between socio-economic factors and the health of a population. This edited textbook, in its second edition, brings together this evidence in a form that is highly appealing to students of public health, policy-makers, and the general public alike. It is so wide-ranging in the number and types of factors covered that it is a virtual encyclopedia of population health.

The theme of the book is clearly outlined in two well-written introductory chapters by editor Dennis Raphael. The essayists take up the issues for an in-depth examination; reading them is a truly eye-opening experience. The inquiries shed light on income distribution, labour market, workplace health, child development, job, food and housing security, discrimination, and Aboriginal health. These essays collectively depict a devastating portrait of the state of population health and their determinants in Canada. The essays document that, over the years, income distribution has become more unequal and jobs have become more precarious. Canadian workplaces have become unhealthy and more dangerous. A vast number of people have come to face food and housing insecurity. Minority and immigrant groups are losing ground. Aboriginal people still suffer from the consequences of colonial domination.

The essays also trace the impact of changing political and ideological landscape on population health. They show that since the 1970s, the Canadian state has been withdrawing from social welfare policy. The rise of market-oriented neo-liberalism is the culprit contributing to deteriorating population health.

How, then, can we reverse this trend and make improvements in population health the focus of public health policy in Canada? In an insightful concluding chapter, the editor takes up these questions. He acknowledges that social determinants of health are outside the mainstream of policy-making and discusses strategies to bring them inside. He draws inspiration from the successful examples among European and Scandinavian countries. He pins his hope on supporting social movements and citizen activism. This book can serve as a field manual for those who want to take up the challenge of addressing the social determinants the centerpiece of health policy in Canada.