• Photograph by via Twitter

Thinking differently about building a healthy society

By Danyaal Raza

Earlier this month, I had the pleasure of sharing the stage with my physician colleagues Ryan Meili and Ritika Goel at Upstream’s first major public event in Toronto. Thanks to a unique partnership between the Wellesley Institute and MassLBP, over 200 attendees filed into the Li Ka Shing’s main auditorium. Some even had to find extra chairs in aisles at the lecture hall’s edge.

Health providers, politicians, non-profit leaders, activists and students were just a sampling of the diverse group assembled. They heard brief presentations from the three of us, followed by a lively discussion period moderated by the Wellesley’s Kwame McKenzie.

Collecting such a large and varied group of people for an evening weekday discussion on social determinants of health - in the dead of winter no less - would have been inconceivable when I completed my medical training less than four years ago. As a junior medical student less than a decade ago, I remember seeing a list of upstream factors for health in a portion of a single lecture in an otherwise expansive curriculum that dedicated countless hours to health and healing.


The discussion no longer ends with an enumeration of upstream factors responsible for health, but begins by pushing the boundaries on what a truly healthy society looks like

In a short time, so much has changed. The month of our talk also marked my return to academia as a family physician at St. Michael’s Hospital. The audience, both inside the auditorium and those watching from afar, was evidence enough. Thanks to an active online audience, that evening’s #Upstream hashtag hit Twitter with force trending to #4 in Canada. The discussion no longer ends with an enumeration of upstream factors responsible for health, but begins by pushing the boundaries on what a truly healthy society looks like

Posing the question ‘do Canadians have a right to good health?,’ three ‘P’s’ emerged as major themes of the evening. 

Politics Matters

Health providers are increasingly recognizing that while a robust health care system is an important part of promoting Canadians’ health, so is the availability of affordable housing, decent work, and a tightly knit social safety net. Upstream-focused clinical interventions, like the income security program available where I practice, are increasingly meeting that need – but no such program works in a vacuum. In both the prepared remarks and moderated panel, the role of health providers as political agents was brought to the fore.

Many of us optimize the upstream factors in the health of our patients. If we recognize that the limits of our actions are set by public policy and politics, then it’s time to recognize our unique role as health-focused democratic citizens. And that means a responsibility to do more than vote.

UpstreamTO1.jpgPrivilege Matters

When we speak of Canadians’ right to health, who are we talking about? Only those with citizenship? Do refugees, or people in Canada without official status, matter?

Too often, patients and communities living in poverty, both those with status and those without, fall victim to medical education’s hidden curriculum. Implicit paternalism and off-colour humour that diminishes the dignity of patients is far too common.

It’s time for us to role model what truly patient-centered, inclusive care looks like, to incorporate those with lived experience into the education of health providers, and to bring those learnings to bear not only on health care provision, but on the political decisions that determine health as well.

Perspective Matters

Thinking differently requires speaking differently. Each of the presenters shared meaningful stories of their own experiences and stories of the impact of the social determinants of health on the lives of patients they’ve cared for during their careers. From this ‘SDOHrytelling’ to advocating trading the GDP for a measurement of greater meaning like the Canadian Index of Wellbeing, reframing public discourse is an act of social change. 


Photo and drawing by Jason Tan de Bibiana

Reframing public discourse is an act of social change

Upstream’s success finding allies in unexpected places, including working with the Government of Saskatchewan to develop a poverty reduction strategy as a result of the ‘Poverty Costs’ campaign, to Newfoundland’s Progressive Conservative ‘Health in All Policies’ agenda, demonstrates that the power of an upstream perspective is more than an abstract hypothesis – it is a powerful tool for meaningful change.

As Canadians head into a federal election year, we need to put this perspective into practice. Upstream thinking and action on the social determinants of health should not be a single election issue. Rather, this should be the lens we apply to the promises and platforms of all parties, as we ask the key question “what is your plan to improve the health and wellbeing of the people of this country?” That is the standard by which any prospective leader should be judged, and when they are it will empower them to work with Canadians to build a truly healthy society. 


Dr. Raza is a Toronto-based family physician and upstreamist. He serves on the Board of Directors of Canadian Doctors for Medicare and the Poverty & Health Committee of the Ontario College of Family Physicians. Follow him on Twitter @DanyaalRaza

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