The arts and humanities can direct attention to the health-threatening effects of adverse living and working conditions and the political and economic systems that spawn them. In pursuit of this goal, we presented 15 undergraduate health studies students and alumni with drawings by artist Georg Grosz that depicted the profound social inequalities of Weimar-era Germany and then had them explore the relevance of these drawings to the present-day Canadian scene. Students found the eight drawings which depicted topics of (1) Income and Wealth Inequality, Poverty and Food Insecurity; (2) Capitalism; (3) The Nature of Charity; and (4) Responses to the Polycrisis engaging and relevant, reporting discussion of these drawings reinforced their learning and were consistent with their own lived experiences. Several themes from the discussions emerged, such as Class Relations, Adverse Health Effects of Problematic Living and Working Conditions, the Nature of Charity and Barriers to Progress, which showed remarkable similarity with what is known about Grosz's motivations for these drawings. Regarding their potential for promoting health equity, students believed engaging with Grosz's drawings could provide means for mobilising healthcare and public health students and workers, as well as the public, to demand that governing authorities respond to these issues.

BackgroundDespite a robust research literature on the importance of promoting health equity and stated commitments by public health authorities to this goal, progress in doing so has been disappointing in Canada. One reason is the failure to mobilize the public in support of this goal. Almost a decade ago, Sir Michael Marmot called for a "social movement" to promote health equity but there are reasons for why such a movement has not taken hold in Canada.PurposeWe carry out a critical narrative review and case study of Canadian health equity activities that examines the intersection of these activities with definitions of what constitutes a social movement.AnalysisEmploying Harvey's concept of critical social research as not taking for granted apparent social structure and processes, we look beneath the surface of appearances to ask why health equity activities have generally failed in Canada such that a social movement - as defined in the social movements literature - is required to move forward.FindingsSocial movements engage the public to resist problematic social conditions outside of established governance structures and processes yet for the most part, health equity advocacy in Canada has been limited to those who do so as part of their paid employment or research funding by Canadian governing authorities whose policies create these conditions. As a result of these arrangements, health equity advocacy cannot readily meet the conditions necessary for a social movement: communicating the need for such a movement; identifying those responsible for health inequities; establishing networks supporting such a goal; and cultivating a distinct health equity identity.ConclusionWe suggest reviewing the structures, processes, and successes and failures of a variety of social movements, e.g., Social Medicine, Environmental, Labour, and Anti-Globalization, among others, to identify lessons and insights that may assist in the development of a health equity social movement in Canada.

The Quality of Life Research Unit was established in 1991 at the Centre for Health Promotion at the University of Toronto for the purpose of developing an instrument package for assessing the quality of life of people with developmental disabilities. Over the following 30 years it carried out projects that developed and validated a variety of additional quality of life instruments that came to be employed in research and practice activities across the globe. The Unit has ceased to operate but has made available the instruments developed during its operation. These include measures of quality of life of people with developmental disabilities, people with physical and sensory disabilities, and people with schizophrenia. It also developed and has made available instruments for use with general populations of adolescents, adults, and seniors, and a process for assessing community quality of life. In this time of threats to the welfare state and decaying public policy environments, the availability of these instruments can allow researchers and workers to assess the effects of these threats on the quality of life of individuals in general, those with specific disabilities, and the communities in which they reside. This article reviews these instruments and their applications and makes the case for renewed use of them for assessing the effects of the contemporary neoliberalism-inspired polycrisis.

There is growing concern about the health and overall well-being of societies stemming from neoliberal-oriented governments reducing their management of the economy, weakening programs and supports for the population, and shifting public goods to the private sector. As a result, a polycrisis exists in many nations related to various key social determinants of health. In this paper, we argue the Canadian polycrisis is due to the contradictions within Canadian society between the economic and political imperatives of capital accumulation (ie, profit making) with social reproduction (ie, societal continuity) associated with late-stage global capitalism. These contradictions threaten societal functioning: declining redistribution of income and wealth, reduced social spending, unwillingness to manage the market economy, and unrelenting privatization of activities once part of the public sphere. The result has been a Canadian polycrisis of growing food and housing insecurity, precarious employment, widening income and wealth inequalities, and a healthcare crisis. We argue responding to the polycrisis requires recognizing and dealing with the contradictions generated by neoliberal capitalism through profound reform or even transformation of the economic system toward a post-capitalist, socialist economy. We consider how such reforms or transformations can come about.

The arts and humanities can direct attention to the health-threatening effects of adverse living and working conditions and the political and economic systems that spawn them. Most of these efforts aim to improve healthcare by promoting empathy and sensitivity among health professionals towards patients and improving clinical skills. However, less effort is devoted towards improving living and working conditions-the structural and social determinants of health-that cause illness and make managing illness difficult. Using the arts and humanities to suggest how society could be changed to promote health is even less common, especially in regard to our economic system of capitalism. In this paper, we consider how the acerbic art of Georg Grosz, which critiqued the political, economic and social life of Weimar-period Germany, may find renewed relevance to the contemporary scene in Canada and other nations under the thrall of neoliberal approaches to governance. We suggest that Grosz's art can be a rich stimulus for promoting social justice and health equity through reflection and discussion, research, and then action to direct attention to how living and working conditions threaten health and how the economic and political systems that create these health-threatening conditions can be reformed or replaced. These activities can take place in classrooms, as part of professional development activities, or form the basis of research studies and advocacy efforts. Evidence of the usefulness of this approach obtained through discussions with undergraduate health studies students is presented.

Background: While consensus exists that the sources of health inequalities are social inequalities brought on by the experience of qualitatively different living and working conditions, means of addressing these conditions continue to be the subject of dispute. Whether to emphasis education or income as a social determinant of health is one such example of differing views on the sources of these inequalities and the means of addressing them. These different emphases are often justified through the narrow examination of the magnitude of statistical relationships between educational attainment and income with health outcomes.Purpose: We offer a broader view, seeing these differing emphases as indicative of contrasting views of the nature of society and means of responding to these inequalities with emphasis on education representing a liberal reformist view of the issue while an emphasis on income representing a materialist structuralist view.Research design and study sample: We examine, the validity of this hypothesis through an analysis of content of five representative publications that consider educational attainment as a social determinant of health and five that do so for income.Analysis and results: We find that the emphasis on education as a social determinant of health focuses on the attributes of the individual and is generally accepting of the structures and processes of the existing economic and political order. In contrast, an emphasis on income - when placed within a materialist analysis - views existing systems as inequitably distributing income and other resources thereby requiring their reform or transformation.Conclusion: Considering evidence of deteriorating living and working conditions for many in Canada and elsewhere, we see the latter emphasis as more useful for understanding and addressing these disturbing developments.

Bertolt Brecht's 1938 poem 'A Worker's Speech to a Doctor' has been used by health educators to direct attention to the health-threatening effects of adverse living and working conditions. However, to date there has not been a systematic analysis of these evocations and their goals (eg, develop clinical skills through promotion of empathy, encourage action to improve living and working conditions, and/or calls for broad societal mobilisation for systemic reform or even replacement). Of particular concern and relevance is the context in which this poem is mentioned, how it was applied, and whether it is presented in fragments or its entirety, thereby leaving intact Brecht's critique of the capitalist economic system and its role in creating illness as well as the Doctor's complicity in this same system. This investigation revealed that while most of the 56 instances found in books, book chapters, journal articles, presentations, and blogs did draw attention to how living and working conditions shape health and in many cases their public policy antecedents, most did not include the entire poem, leaving out Brecht's critique and blunting his message. We suggest 'A Worker's Speech' and other Brecht's poems as a rich source for reflection, discussion, and action to promote health by health and social services workers, researchers, community activists, and the public.

Jane Philpott's Health for All is the most recent contribution to policy discourse related to health care and social determinants of health. Unfortunately, the volume is sadly lacking in critical analysis of the current economic and political environment in which health policy is being made.

The growing polycrisis in Canada and elsewhere associated with deteriorating living and working conditions have increased calls for a post-capitalist socialist economy. Among the means of accomplishing this goal is the late Erik Olin Wright’s argument for eroding capitalism by developing alternative economic structures and processes that enable equality and fairness, democracy and freedom, and community and solidarity in a post-capitalist society. In this article, we consider how one of the means cited by Wright for eroding capitalist structures, credit unions, can contribute to this goal. Credit unions are non-profit and member-owned financial institutions that in addition to offering all the services of for-profit banks, usually at lower costs to clients, provide an alternative public ownership model to capitalist finance and privately owned food production and distribution, housing, transportation, and telecommunications. We also propose that in addition to providing a model of collective ownership credit unions can – in collaboration with other social movements – take on a broad advocacy role calling for public policy that more equitably distributes economic and social resources to the population.

Background: Despite a robust literature on the importance of promoting health equity, actual progress in doing so is flagging and this is especially the case in Anglo-Saxon liberal welfare states such as Canada, the USA, and the United Kingdom. Purpose: In this paper we place these developments within the context of the political economy concepts of capital accumulation -- or profit making -- and social reproduction -- or the ongoing functioning of society. Research Design: We carefully reviewed the current state of theorization and research into the political economy of health to identify the main themes and findings in this literature in relation to the polycrisis of living and working conditions in Canada, the USA, and United Kingdom.Analysis: We drew upon critical materialist political economy thought to show how the growing contradictions between profit making and societal functioning in capitalist economies - and this especially so in liberal welfare states -- threaten both the quality and equitable distribution of the living and working conditions that shape health - the social determinants of health - and the organization and delivery of health care. Results: While there is increasing application of political economy approaches to understanding the adverse effects of capitalism, almost all of these are limited to critiquing capitalism without envisioning a post-capitalist society. Various ways of addressing these contradictions are provided that include 1) redistribution, social spending by governments, and managing the market economy within existing economic and political structures; 2) movement towards social democratic or conservative models of governance common to the Nordic and Continental nations respectively; or 3) building a post-capitalist socialist future.Conclusion: While we offer three paths forward towards achieving health equity, we conclude that the last path, building a post-capitalist socialist future, offers the most useful means of promoting health equity in both the short and long-term.

Street-connected young people (SCYP) in Tanzania face intersecting challenges, including economic vulnerability, social marginalisation and limited access to supportive networks. This study examines the impact of the Youth Association (YA) model, implemented by Railway Children Africa, and does so through the lens of the relational well-being approach, which emphasises the interplay of material, relational and subjective dimensions of well-being, as well as personal, societal and environmental drivers of well-being. Using a mixed methods design, this study tracked 116 SCYP in Mwanza and Dar es Salaam, Tanzania, through four stages of the YA model. Quantitative data revealed gains: 71% transitioned into stable housing, 84% reported increased pride and self-worth and 58% initiated income-generating projects. Qualitative insights provided deeper context, capturing participants’ reflections on how peer networks and leadership opportunities, and vocational training fostered self-confidence, economic independence and community integration. Participants’ recommendations included expanding educational opportunities, enhancing health services and addressing logistical barriers to increase the model’s accessibility and impact. This study demonstrates the transformative potential of relationally driven interventions for vulnerable young people. By leveraging existing networks and prioritising relational support, the YA model offers an effective pathway for SCYP to transition from precarity to stability. The findings underscore the importance of participatory approaches and call for further research into the invisible networks of care supporting SCYP, ensuring that future interventions are responsive to their lived experiences and evolving needs.

This chapter provides an overview of important concepts from the political economy literature and their relevance for understanding the problem of food insecurity in Canada and the UK. It provides various definitions of politics and related concepts and explains why politics is key to understanding both the presence of food insecurity and the means of responding to it. The sources of food insecurity are not to be found within individual failings but rather in the nature of the economics and politics of a society. The chapter also introduces the concept of discourses and how various discourses exist concerning the sources of food insecurity and the appropriate means of responding to it. In Canada and the UK, food insecurity is usually seen as an unfortunate by-product of modern society with the most appropriate response being charitable food distribution that does little to solve the problem. Finally, the view is presented that food insecurity is only one component of a range of problematic approaches to public policy that require the transformation of the economic system towards one that equitably distributes economic and social resources, including food, thereby eradicating food insecurity and a host of other problems.

This chapter documents the growth and proliferation of a variety of charitable non-governmental responses to the problems of food insecurity in Canada and the UK. This has been associated with an exponential growth of food banks, food diversion schemes, and other community-based activities such as community gardens and kitchens, children’s feeding programmes, and food distribution to families plans. Each will be defined and examples in Canada and the UK provided. The history of these charitable efforts is documented, as is the role played by labour unions, churches, and other well-meaning advocates. It is shown that all these responses are problematic as they fail to address the economic and political causes of food insecurity. Particular details are provided of further failures associated with charitable responses to food insecurity such as the experience of stigma and degradation by users of food banks and promulgation of the belief that food insecurity is being addressed. The role that the corporate sector plays in creating food insecurity is considered and placed alongside their involvement with these charitable efforts.

The past two decades have seen increasing mentions of health equity and the importance of addressing the social determinants of health in USA public health statements. Yet, there is little uptake of these concepts into USA public policy. We see this, in part, as being due to the unwillingness of the USA public health community – including its network of Masters of Public Health Programs – to address the fundamental cause of health inequities: the United States’ capitalist economic system which skews the distribution of the social determinants of health in favour of the wealthy and powerful. We illustrate this reluctance by examining how the Bloomberg School of Public Health of Johns Hopkins University conceptualises the promotion of health equity through its International Declaration of Health Rights. Nothing in the Declaration considers how the economic system threatens health yet it is presented as a model for public health education. We review its shortcomings and show how revision to it is unlikely since the School is endowed by its namesake billionaire Michael Bloomberg who has denounced any attempts at redistributing wealth and income in the service of public health. Evidence of how public health messaging is already shaped by powerful economic interests embedded within the United States’ capitalist system substantiates concerns that have been raised about such branding and its effects on public health discourse and action.

It has been recognized since antiquity that the organization of society and how it distributes resources are the primary determinants of health. Yet most definitions of health in the academic and practice literatures limit their focus to the individual's experience of health and functional abilities, neglecting the structures and processes of societies in which the individual is embedded. We draw upon developments in the critical health communication and critical materialist political economy of health literatures to provide a definition of health that directs attention to the role that economic and political systems play in either equitably or inequitably distributing the resources necessary for health. Since these distributions interact with the individual's unique biological and psychological dispositions and situations to produce health, it is important to identify their sources and means of making their distributions more equitable. Because it is through communication that humans interpret society, themselves, and others, a concise definition of health that draws attention to these societal features and their roles on a day-to-day basis in promoting or threatening health is essential.

The adverse effects of climate change are already apparent with action required to forestall a full blown climate catastrophe. Despite findings that social democratic welfare states – Denmark, Finland, Norway and Sweden – more proactively respond to climate change through environmental policies that complement public policies promoting economic and social security, even these eco-social welfare state environmental policies are unlikely to avert a climate catastrophe. To avert a catastrophe will require gaining public control over energy policy and countering the power and influence of fossil-extracting industries. In theory, this could be accomplished through existing policy instruments. In reality, it may require establishment of a post-capitalist eco-socialist state, the outlines of which remain uncertain even among leading eco-socialist scholars. To effect either of these paths will require public awareness and support for such action. To that end, we identify public discourses of climate change which reflect these two ways forward as well as four other means of responding to climate change: (1) individual responsibility; (2) local action; (3) technocratic solution; (4) public policy advocacy; (5) balancing power in society; and (6) establishing a post-capitalist society. Despite the latter two discourses being the most likely to support effective action, they are the most marginalized.