Living a long, healthy life is one obvious goal of pretty much all of us. We are told, over and over, to change our “lifestyles” and accept that if we become ill, we have likely brought it on ourselves. Yet, hundreds of studies, over the past four decades, tell the real story: the living and working conditions we experience every day play a determining role in our health. How income and wealth, housing, education and adequate food are distributed, whether or not we are employed, and the working conditions we experience — not medical treatments nor so-called wellness lifestyles — determine whether we stay healthy or become ill. These living and working conditions reflect the social inequalities that are associated with social class, gender, race and other social locations in Canadian society.

The third edition of Health and Illness shows how inequitable distribution of the social determinants of health are determined by public policy decisions. Dennis Raphael updates information that connects health and illness to the worsening levels of inequality in Canada – the rich are getting richer and the rest of us are getting sick! This edition also includes a chapter on the social determinants of who got sick and died from COVID-19. The experiences during the COVID-19 pandemic make the clear case that we need to restructure work and living conditions through public policy that more equitably distributes economic resources. It is only through such actions that we will be able to promote the health of Canadians and prevent illness in an effective manner.

Dennis Raphael, PhD, is a Professor of Health Policy and Management at York University. The most recent of his over 250 scientific publications have focused on the health effects of income inequality and poverty, the quality of life of communities and individuals, and the impact of government decisions on Canadians’ health and well-being. Dr. Raphael is editor of Tackling Health Inequalities: Lessons from International Experiences and Health Promotion and Quality of Life in Canada; co-editor of Staying Alive: Critical Perspectives on Health, Illness, and Health Care; and author of Poverty in Canada: Implications for Health and Quality of Life.

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