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Global Analysis of Health and Social Determinants with Dr. Dennis Raphael

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If providing health care and a social safety net for citizens were an Olympic event, the United States would be in a dead heat for last among developed nations. Recently, I had the opportunity to interview Dr. Dennis Raphael a professor at York University in Toronto Canada. Dr. Raphael has done extensive study and research on social systems and health disparities on a global scale. I reached out to Dr. Raphael specifically for his international perspective and global research analysis because I was interested to see how the United States compared to other developed nations. It appears that my suspicions are worst than I had imagined.

Dr. Raphael goes in great detail and provides a host of resources for anyone who may be researching poverty and health care disparities. We have all heard the Liberal and Conservative view points for or against Obamacare, but what does the rest of the world see when viewing the normal course of business and politics in America?

As Americans, we are always ranking things in order to assign value, worth, and level of importance. One of the biggest revelations for me from this interview was seeing how the United States poverty rates compared to other countries. It’s astonishing! Here is what Dr. Raphael had to say:

SWH: Could you tell SWH readers about your background and your work on poverty and health care inequalities?

DennisRaphaelHead2DR: I am a professor of health policy and management at York University in Toronto Canada. I was originally trained in child development and educational psychology and have come to have an interest in health policy as it became apparent that the health and well-being of children and families was tightly related to the public policies that are implemented within a society. These public policies affect the health of citizens through what have come to be known as the social determinants of health. These public policies shape social determinants of health such as income and income distribution, employment and working conditions, food security, housing, and the availability of health and social services.

My work and those of others have also demonstrated that these social determinants of health have a much stronger impact on health than does the usual villains of physical inactivity, excess weight, excessive alcohol use, and even tobacco use. These effects are especially great for those living in poverty.

It is very convenient for governments and governmental authorities to blame individuals for their own health shortcomings by pointing to these so-called lifestyle factors rather than the public policies that have much importance in shaping health. My recent work has focused on differences among nations in these public policies and the social determinants of health such as the USA, Canada, and other wealthy developed countries that are members of the Organization for Economic Cooperation and Development.

SWH: How does the United States Model for Health Care and its social safety net compare to Canada and other developed nations?

DR: What has become apparent and is now well accepted in the literature is that the quality and distribution of the social determinants of health in nations such as United States and Canada lag well behind those seen in other wealthy developed countries. The United States is an especially great outlier as it is the only developed nation that does not provide citizens with healthcare as a matter of right. It also has the most unequal distribution of the social determinants of health and, not surprisingly, has the worst population health profile among all wealthy developed nations with the exception of Turkey and Mexico. US poverty rates are the highest outside of Mexico and Turkey.

I’ve also come to the conclusion that the reason for this has much to do with the dominant political ideologies of those who govern these nations. As unbelievable as it may seem for those of us who live in the United States and Canada, most developed nations are led by leaders who take an active interest in developing public policy that promotes the health and well-being of citizens. Most wealthy developed nations provide universal affordable childcare to all members of society, provide workers with legislative guarantees that provide some semblance of job security but also the availability of job training and if unemployment occurs, payments that allow them to live a life with dignity. For the last 20 years, the United States has been an exceptional outlier in providing people with virtually none of these social determinants of health, and the United States is the only nation that does not provide people with guaranteed vacation time, guaranteed supported maternity leave, and of course health care.

Unfortunately for us living in Canada, Canadian leaders have chosen to emulate the American model of public policy over the last two decades rather than the more sophisticated and helpful approaches adopted among European nations. The result is that Canada’s population health profile and the quality and distribution of the social determinants of health is increasingly beginning to look like that of the United States, with the accompanying expected declines in quality of life and overall health of the population. The primary factor that has become apparent is the nations that take seriously the provision of quality social determinants of health to its population are governed by political parties that are identified in the literature as being either Social Democratic or Conservative.

Despite what many people think, the so-called conservative parties of North America are not really conservative as much as “liberal”. This applies to both the Democratic and Republican parties in the USA. Despite the meaning of the word “liberal” in North America which many people think as meaning progressive, the term liberal in political science and political economy actually refers to a form of governance where governments take little if any interest in providing the population with the means of maintaining and promoting health. I’ve written extensively about the distinction between Social Democratic, Conservative, and Liberal welfare states, and I urge readers to take a look at some of these works. In essence, the approach governments have taken in the United States and Canada towards providing the means of their population to maintain health are incredibly undeveloped as compared to the nations of Europe.

SWH: Can you provide a snapshot of major social safety net programs put in place by the Canadian government to address income disparities and to assist vulnerable populations within your country?

DR: The most apparent difference between Canada and the United States in terms of social safety net programs is that in Canada every Canadian is entitled to the provision of healthcare as a matter of right. While this may seem exceptional to Americans, this is also the practice in every other wealthy developed nation that belongs to the Organization for Economic Cooperation and Development. For people like me and others who work in health, it is almost unbelievable that the United States does not provide health care to citizens as a matter of human rights. It should not be surprising that this lack of any kind of coordinated system in the United States leads to the United States having the most expensive and apparently least effective health care system among nations in the developed world. The US also has exceptionally high poverty rates which are particularly ironic considering its overall wealth.

Canada provides other aspects of the social safety net that are not available to Americans. In Canada the so-called RAND formula stipulates that once a union is certified in the workplace, all employees must belong to that union. In the United States the so-called “right to work laws” actually weaken unions and the economic and social security Americans obtain and as a result, Americans have some of the lowest wages among the Organization for Economic Cooperation and Development and the highest poverty rates among virtually all wealthy developed nations. Only 7% of Americans belong to unions and as a result their job security and working conditions, as well as their wages, are among the lowest of those working in wealthy developed nations.

In contrast, in the Scandinavian nations over 80% of people belong to unions and an even greater proportion of them work under collective agreements. Even in the conservative nations of Continental Europe, when unions themselves have lower membership than in Scandinavia, virtually all workers are covered by collective agreements. As a result, they experience greater job security, more employment and training opportunities, and generally greater security which translates into better health, and their poverty rates are the lowest among wealthy developed nations.

 In Canada, 31% of workers belong to a union and while this figure is low in comparison to other nations, it is of course rather high as compared the United States.

Other social safety net programs that Canadians have access to are guaranteed maternity leave that is supported through the employment insurance system. Women who have been employed are entitled to close to 60% of their average salary during the 12 months that constitutes maternity leave in Canada. In the United States there are no such provisions. Even then, provisions are stronger in many European countries where women are entitled to close to 100% of their average salary during their maternity leave. And even then there are nations in Europe when men are entitled to paid maternity leave.

SWH: Over the course of your work, have you done any comparisons of the Canadian and USA  social security systems to those of other industrialized nations, and what were your findings?

DR: I have written numerous articles that have compared the differing situations between the United States, Canada and other members of the Organization for Economic Cooperation and Development. Two of these articles recently appeared in the journal Health Promotion International and these titles are appended at the end of this interview. In addition, I recently published a book entitled Tackling Health Inequalities: Lessons from International Experiences. This book consists of a number of case studies of differing wealthy developed nations and includes a chapter on the United States in addition to ones on the United Kingdom, Canada, Australia, Finland, Norway, and Sweden. I urge readers to take a look at these documents and to consider the United States situation in relation to that seen in other wealthy developed nations.

To summarize the findings succinctly, United States is an incredible outlier in its approach to providing citizens with the conditions necessary for health. Canada does somewhat better and for many Canadians the comparison to United States gives cause for much satisfaction. However, when the Canadian situation is compared to the situation in other wealthy developed nations Canadians have much less to be happy about and there are many individuals, groups, and professional associations that are trying to move the public policy picture in Canada to that of these other wealthy developed nations and away from the United States model.

SWH: In your opinion, how has austerity measures implemented by various governments in developed nations contributed to or helped alleviate health inequalities of its citizens?

DR: In a nutshell, the austerity measures implemented by developed nations have served to contribute to the health inequalities that are apparent among the citizens. I direct your readers’ attention to three books in particular: To Live and Die in America, Class, Power, Health and Health Care by Robert Chernomas and Ian Hudson (2013), Social Murder and Other Shortcomings of Conservative Economics by Robert Chernomas and Ian Hudson (2007), and The Body Economic: Why Austerity Kills: Recessions, Budget Battles, and the Politics of Life and Death by David Stuckler and Sanjay Basu (2013).

SWH: Do you have any current projects and/or publications that you are working on or recently released, and how does someone find more of your research?

DR: In addition to my recent book Tackling Health Inequalities: Lessons from International Experiences that was published in 2012, I have written numerous articles that document how public policy is related to the health and quality of life of citizens in wealthy developed nations such as United States and Canada. More recently I’ve been examining how differing ways of thinking about health among public health departments lead to different directions in approaching their mandate. I’ve also written extensively about the mainstream media and how these media think about health and means of promoting public education that can lead citizens to think differently about health and become more involved in the public policy process in order to create the conditions necessary for health. People can see some of these recent articles by going to this link, and  I’ve also produced a primer that should be of interest to all readers entitled Social Determinants of Health: The Canadian Facts. This can be obtained online at http://thecanadianfacts.org.

Thank you for the opportunity to contribute to this ongoing discussion that is of such importance for those of us living in North America.

Relevant Readings:

Raphael, D. (2012). Tackling Health inequalities: Lessons from International Experiences. Toronto: Canadian Scholars’ Press.

Bryant. T., Raphael, D., and Rioux, M. (2010). Staying Alive: Critical Perspectives on Health, Illness and Health care, 2nd edition. Toronto: Canadian Scholars’ Press.

Raphael, D. (2013). The political economy of health promotion: Part 1, national commitments to provision of the prerequisites of health. Health Promotion International, 28, 95-111.

Raphael, D. (2013). The political economy of health promotion: Part 2, national provision of the prerequisites of health. Health Promotion International, 28, 112-132.

Raphael, D. (2011). Mainstream media and the social determinants of health in Canada: Is it time to call it a day? Health Promotion International, 26, (2), 220-229.

Photo Credit: Picture of Family Courtesy of  www.mlive.com

Deona Hooper, MSW is the Founder and Editor-in-Chief of Social Work Helper, and she has experience in nonprofit communications, tech development and social media consulting. Deona has a Masters in Social Work with a concentration in Management and Community Practice as well as a Certificate in Nonprofit Management both from the University of North Carolina at Chapel Hill.

1 Comment
Paul Bywaters says:

Social work colleagues who have been interested by this article might like to join the Social Work and Health Inequalities Network which has over 350 members worldwide. The Network aims to promote the role of social work in tacking inequalities in health taking action in practice, policy, research and education. The Network provides a regular stream of information about the social determinants of health and health inequalities. To find out more go to http://www.warwick.ac.uk/go/swhin or contact me by email: Professor Paul Bywaters at [email protected]

Child Welfare

How to Support Foster Children

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When you choose to become a foster carer the rewards can be great. Supporting a child through a difficult period in their life, watching them grow and develop into a well-rounded individual; it’s understandable why so many choose to pursue this worthwhile vocation.

However, as with any profession, it does come with some downsides. Primarily helping some children to cope with the trauma and stress that being in foster care can evoke.

So, how can you best support a foster child in a meaningful way? One that will be beneficial to the both of you.

Listen

Feeling like the most overlooked member of society can have a damaging and long-lasting effect on foster children. Meaning that the simple act of offering them an ear to vent their worries, experiences or anything at all can be extremely positive. It establishes you as a point of reason in their life.

You can’t always solve the issues that are brought up during these moments. Nor should you try, but it is worthwhile simply being there to hear. Because, at the end of the day, your foster children deserve to be listened to.

Celebrate

Birthdays. Christmas. Halloween. Important events can often go overlooked as a foster child. So, taking the chance as a foster parent to celebrate these milestones – no matter how little or big – can be the change that a child needs. Simple things such as helping put up a Christmas tree could be a moment they will remember for a long time to come.

And at the end of the day events like Halloween and Birthdays are fun – something every child needs a little more of in their lives.

Playdates

Your support is vital, but often the support of peers can also be invaluable for the wellbeing of those children in foster care. Setting up playdates – even for older children – can be a great way to help them interact and enjoy time with children their own age.

Older children or teens may be unreceptive to you making playdates for them. But, arranging ‘coincidences’ of kids their age coming over can always be an alternative solution. What they don’t know…

This can also be beneficial for any of your own children that may also be in the house. A disgruntled foster child can be a distressing presence in the home, so balancing this out with a familiar friend and playmate is often needed to offset this. All of the children in your home can benefit from socialising with others both in and outside your own home at times,

Getaway

Sometimes life can get a little too much when you are forced to come and go through a number of foster homes, which is a reality for many foster children. A day out – not even an expensive day out or holiday – can be a bright spot in an otherwise overcast moment in their lives. The zoo, beach, museum and even the park can be an adventure.

It’s not always clear what a child is going through, nor will they always express their emotions in healthy ways. Removing them from the environment which creates these feelings can be a relief in many cases.

Help with School

On average, foster children tend to do worse academically and behaviour wise in school than other children. The reasons are often self-explanatory, but it is something which you can positively influence whilst they are under your care.

Helping with homework, actively engaging with teachers over what you can do further to help and encouraging after-school activities are some ways to do this. Goals should be set, but ensure they are realistic and rewarded when surpassed.

Overall, being a foster parent is a big task but one that can bring so much enrichment to a child’s life. As a solid figure in their life, you can help ensure the rest of their life is more positive than the start. Supporting a foster child can be a challenge, but that makes it all the more rewarding when you see a positive effect on the life of a child.

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Global

A Student Perspective: Social Work and First Responders

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It may be rare for a social work student to reflect on an assignment as something inspirational rather than a stressful experience with a deadline, but at the end of  3rd year of my social work degree, one assignment was a challenge filled with hope. The assignment allowed me to contribute to a program that will give insight to other helping professionals about the mental health of first responders: police, firefighters, paramedics and others who respond to emergencies on the frontline.

The University of Newcastle has a particularly effective way of integrating workplace experience based learning with academic learning throughout the degree. The program options offered in third year which allow students to develop a program for a real agency was the most useful for me. To know your work might form a foundation for a real program in the community was a great honour and challenge to work on.

In the beginning, I was unsure of what to expect from the program development project. I was apprehensive about working with a professional capacity with a real agency, but I was excited also to learn more and try something new. There were diverse programs offered- from gardening programs to developing group projects designed for children and developing a program for professionals working with first responders.

The university gave us a chance to preference our interests and I was fortunate enough, with some other amazing women to be selected for the first responders team. The aim of our project was to put together a draft training package for helping professionals to enhance understanding of first responder mental health.

This topic drew my interest as it was beyond my scope of knowledge and I have a keen interest in mental health, so it was intriguing to me on both a personal and professional level. On starting, I very quickly became aware that I had actually put very little thought into the work first responders do in our communities to keep us all safer.

I learned just how complex the actual work of first responders can be, I learned the challenges that first responders face as a consequence of their work, the most traumatic of which is often invisible to the communities that they protect. I learned how repetitive exposure to trauma can complicate all aspects of first responder’s lives if they don’t or can’t seek or obtain support. I learned how much awareness is lacking within the multiple levels of the community, which is needed to enact change for first responders and their families.

Also, I learned the difficulties that can be faced by first responders and their families when attempting to access help. Whilst organisational supports are in place for some of the services, the stigma, shame and potential for the loss of their profession is very real. I heard stories about those medically discharged dealing with the grief and loss of their profession and identity.

My part in the group was to examine the supports already in place for first responders. I was concerned at the limited avenues for assistance and the extent of the difficulties for first responders to seek help. Besides limited services, stigma and organisational culture are barriers to effective help seeking. I found attempting to identify potential services to be frustrating, especially when looking for options within communities rather than those which are employer organisation based. My mind quickly went to how this frustration might feel for someone who was attempting the same whilst being unwell.

Gaining insight and recognition into the role first responders play, the impacts on their mental health, their relationships and all aspects of their lives and the flow on effect to their wider social ecology,  I  realised just how large the scale of first responder post-traumatic stress and other mental health consequences have on our community overall.

The hardest part of this learning experience was seeing the end of the project. The topic is so significant, it is hard to not to explore the topic further.  To me, this feels like a core social work and social justice issue, yet one which is invisible much of the time. My learning from this project has given me a totally new perspective. I have a renewed respect and a much deeper understanding of the issues faced by police, firefighters, paramedics and all others who work on the frontline in emergencies.

I know I’ve only scratched the surface of the knowledge it takes to work with first responders and enact positive change in their lives. I hope more research is completed and potentially more opportunities for training and professional development come up for social workers, whether it be integrated into core teaching within university programs or externally in workplaces.

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Education

Need to Learn a New Language: Modern Technologies That Will Help Beginners

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The first time people thought of using computers. Previously called Computer-Assisted Language Instruction and the Computer-Assisted Language Learning (CALL), the general concept has its humble roots in the 1960s. With the invention of the microcomputer, the CALL technologies moved away from the mainframes of major universities and into the wider population. Today, when most people have a supercomputer, they are proliferated to include everything from a gamma to a virtual reality.

With the list of ever expanding options, here are some of the most popular technologies that can help all language learners:

Video calls help connect the world

There is no way to underestimate the effect of Skype, FaceTime, and Google Hangouts. Before these technologies became widespread, meeting and having a face-to-face conversation with somebody from another country. Now, you can find a conversation in your target language in the blink of an eye and having online lessons has never been easier. There are all platforms dedicated to finding and setting up your first online language exchange or lesson. All of this makes the language in your living room easy and comfortable.

A recent development that language learners might want to use with video calls is the Skype Translator. Especially for beginners, it can help (almost) real-time video calls. While it might be considered cheating, it can also prove to be a great tool for you.

Gamification makes learning fun

A surprising benefit of being always connected to the internet. When “language learning” is used to mean cramming vocabulary and grammar, these apps have very successfully gamified learning, making it more addictive than ever. These certainly help Although the most beginners, they’re also a great way of squeezing in some language practice in between lessons and keeping your brain active and focused on your target language.

The ruling king of language learning apps right now must be Duolingo, but you can also give busuu a try. Memrise is a great way to learn new vocabulary, especially if you prefer a lot of repetition. The newcomer Lingvist promises to teach you a language in 200 hours, although their selection of languages is currently quite limited.

New types of translators

Naturally, you do not need to be a language learner to use translators. Indeed, most of the time, text translators are used by people. But you can also use translators to assist you with learning. Picking up new vocabulary is the easiest when you have a handy device that can translate new words quickly and conveniently.

Starting with the (almost) real-time Skype translator, tech companies have been pouring money into new types of translation services, including text and visual translation. There’s the much-used and known Google Translate which is useful even without its more exciting add-ons. Once you download their app, once you download their app, once you get their Google app, you can use Google’s visual translations – just take a picture of whatever (road sign, menu item, sentence, etc.) English. Other companies are taking these technologies even farther, providing almost instant speech-to-speech and speech-to-text translations.

While, in the long term, these technologies can instantly be translated, for, they can surely help.

Artificial Intelligence – the way of the future

Artificial Intelligence has had another hot topic these past few years. From being hailed as the salvation from everyday labor to us. For us, AI can also be herald as a new era in Computer-Assisted Language Learning. Although, so far, the machines still find a human language rather confusing, so much so that they’ve even led to their own bot-talk to communicate. Be that as it may, the implications are still groundbreaking.

For example, the European Union is currently funneling money to get AI robots teaching preschool children a second language. On a less ambitious scale, AI can be used to also take language learning apps to the next level. Imagine programs that take into account your personal learning style and adapt appropriately, teaching you-specific vocabulary. Although this technology might still be a bit further down the road, Duolingo has already started engaging its users with AI-powered chatbots, a sign of things to come.

Virtual reality will transform immersion

It’s generally agreed that total immersion is an effective way to learn a language. The idea is simple. So far, the only way to really immerse yourself, however, is to travel to the country. Thanks to virtual reality, this is now changing.

There are already apps that make use of virtual reality to create a quick back-and-forth, much like an actual conversation with a native and definitely a step above Duolingo’s chatbots. The future regards virtual reality and language learning. ImmerseMe is a language start-up that is planning on creating authentic virtual realities to help you immerse in your target language. Since culture and travel are such good motivators for learning a foreign language, it’s easy to see why people are getting excited.

Conclusion – technology can make language learning more exciting and enjoyable

Already, several scientific studies have been provided with evidence on how to assist in acquiring a second language. While some of the technologies mentioned above are still just getting started, video calling and visual translators have already made language learners. Only time will tell how much simpler acquiring a second language can become.

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