Being born, living, working and growing old in an underprivileged neighbourhood has much more of an impact on health - and on longevity - than people think. Nearly 10 years, in fact, depending on whether you live in the Montréal neighbourhoods of Outremont or Hochelaga-Maisonneuve. This is one of the findings reported by Dominique Forget, from the magazine L'Actualité, during the CMA's May 8 town-hall meeting in Montreal. The goal was to determine participants' opinions on various social factors or determinants that affect health.
The meeting, organized jointly with the Quebec Medical Association (QMA), L'Actualité and CPAC, brought together participants who, for the most part, are well aware of the social disparities between rich and poor neighbourhoods: community associations or groups, as well as medical students and ordinary citizens.
Of course, the participants did not fail to express their disenchantment, along with a healthy dose of cynicism, regarding recent political decisions by different levels of government. "I'm worried about these policies, especially those concerning welfare recipients and employment insurance," lamented Dr. Marie-France Raynault, executive director of the Centre de recherche Léa-Roback on Montreal's social inequalities in health.
Dr. Gilles Julien, a pediatrician whose foundation helps vulnerable children, spoke out about "the 'acute structuralitis' that is prevalent in governments and elsewhere and which does not promote community integration."
"Governments are not interested in long-term, constructive measures, only in electoral ones," he added.
Among the social determinants directly related to health, the issue of housing - or rather, the lack of affordable housing, took up a significant portion of the discussion. No fewer than 22,000 households are waiting for such housing, said Hélène Bohémier of the Office municipal d'habitation de Montréal (OMHM). Homelessness among men, and increasingly among women, suggests a disturbing situation for the future, with potential homelessness facing entire families. This problem also greatly affects immigrants and Aboriginals, whose extreme vulnerability often results in them living in substandard housing. But what about the children in all of this?
"If the future of children is not a priority, we are not a healthy society," said Julien. "Living in such conditions causes a toxic level of stress and impacts the development of a child's brain. The brain of a child at risk is much smaller, and consequently the rest of his or her life is predictable, with dropping out of school, violence and crime, obesity, etc."
Town-hall participants said they wish to attack these problems and develop a community approach based on prevention. Julien's community-integrated medical work reaches many people, rather than favouring the curative approach.
"Cuts are being made in prevention projects, not in curative ones. But hospitals cannot continue to occupy such a central and predominant place in the health care system, and the public needs to take an interest," said Raynault.
At present, "too much of the work is unfortunately done by people working in parallel groups," added Bohémier. Some participants said the answer is to move toward a transversal approach because "it's the community groups that have the field expertise." In that regard, several participants pointed out that the integration of community resources is problematic, as there are issues of control and power.
The public town-hall meeting in Montréal, moderated by reporter and author Daniel Lessard, was the fifth in a series; others have been held in Winnipeg, Hamilton, Charlottetown and Calgary. The CMA intends to publish a report shortly that will contain recommendations put forward by all participants. This report will be shared with members and then submitted to various levels of government.
"The issue is one of redefining the physician's place within society," said Dr. Laurent Marcoux, the QMA president, who chaired the meeting. The town-hall panel included Julien, Bohémier, Raynault and Forget, who is health columnist for L'Actualité.