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I must commend Health Minister Bou­dreau for recognizing the need to ad­dress issues of population health in New Brunswick (Daily Gleaner, June 2015). This province has some of the highest rates of chronic disease in Canada, high rates of obesity, and high rates of smoking (see Statistics Canada). Over­all, New Brunswick does not fare well in health as compared to the rest of Canada. Part of this is history (it takes a long time for generational change to occur), part is demographic (we are aging faster and youth are leaving), but a large part is structural (social de­terminants).

Briefly, the social determinants of health are those factors influence the overall health of populations, as op­ posed to individuals. These factors include: income; education; social sup­port networks (community); working conditions; social environments; built and natural environments; personal health practices; healthy child de­velopment; gender; and culture. Much has been written on these determin­ants, and many public servants with­in the government of New Brunswick are keenly aware of how addressing determinants “upstream” can improve the health of the population much more than individual behaviour­al changes.

In his recent comments, Minister Boudreau makes a start in addressing social determinants, by noting that poverty, education, and social support play a role in health. He also recogniz­ es that a”comprehensive approach” is required. However, at the same time he places the blame on the individ­ual for “sitting in front of our iPads” and provides solutions such as encouraging us to be “drinking a lot of water.” These small choices are not aspects that the gov­ernment can or should address, and do more to demonize people for relax­ing with technology or choosing a coffee over a glass of water.

A comprehensive strategy by government would begin with a horizon­tal consistency across policies which would require a whole new approach to governing. For example, when fu­el prices begin to rise there are inevit­able calls for a rebate program, How­ever, subsidizing vehicular travel works directly against efforts to get people out of their cars more, to make shorter and fewer trips.

Our communities are designed around the vehicle with streetscapes oriented to allow for the efficient movement of cars. What about making our communities denser; making pedestrians the focus of our communities? This can happen in places large and small (see N.B,’s own Hassan Arif for some ideas).

Eduction is another area where there is a lack of policy consistency. School days are shorter in New Brunswick and students have fewer in-class days than in other provinces (especial­ly after snow days). At the same time, the introduction of new standardized testing requires teachers to spend more time teaching to the test rather than allowing for free-play and physic­al activity time. Children are thus more sedentary throughout the day, have more trouble paying attention in class, our readiness for university is lower, and so on. These are all parts of the social determinants of health.

There are many people in New Brunswick who know a lot about this topic, publish on this topic, and suggest policies on this topic. Min­ister Boudreau can look at great or­ganizations such as the New Bruns­wick Health Research Foundation or the New Brunswick Social Policy Re­search Network that work within the Province and host many dedicated and knowledgeable researchers. We don’t need to “come together” anymore to discuss ideas, many ideas are already here and already have evidence. We need some real policies based on evi­dence that are implemented with the health of people in mind.

• Published in the Daily Gleaner (Fredericton), September 11, 2015