Poverty is shortening Canadians' lives, according to a new report by the Canadian Medical Association. Among other recommendations, it called for a "health impact assessment" as part of the Cabinet decision-making process.

The report, titled Health Care in Canada: What Makes Us Sick?, is based on a series of "town hall meetings" held across the country this past winter and spring.

"In every phase of the consultation," the report's executive summary states, "four main social determinants of health were identified by participants: income; housing; nutrition and food security; early childhood development." Among the themes summarized by Dr. Anna Reid, CMA President:

• Poverty is the most important issue and must be addressed.

• Poverty can cause multiple morbidities and even influence early childhood neurologic development.

• Mental health issues remain "the elephant in the room" and underlie many of the social determinants of health.

• Governments need to be pressured to take action, but there is a clear role for citizens, physicians and communities to help deal with the problems.

• Canadian society has suffered from a lack of imagination, will and leadership to address social inequities.

• The guaranteed annual income is a compelling concept and can have a positive impact on health outcomes.

• Structural racism keep Aboriginal people in poverty; this must be addressed to improve health outcomes for those communities.

The report cited "Code Red," a collaborative study by the Hamilton Spectator and McMaster University, which found "staggering disparities" based on Hamilton residents' income and education: "For instance, the expectancy ranged from 86.3 years -- 5 years longer than the Canadian average -- in a rich neighbourhood to just 65.5 years in a poor neighbourhood, a gap of 21 years. ... Similar variations in health outcomes were referenced at the town hall meetings in Calgary, Winnipeg, and Montréal."

Among the dozen recommendations made in the report:

Recommendation 1: That the federal, provincial and territorial governments give top priority to developing an action plan to eliminate poverty in Canada.

Recommendation 2: That the guaranteed annual income approach to alleviating poverty be evaluated and tested through a major pilot project funded by the federal government.

Recommendation 8: That the federal government recognize the importance of the social and economic determinants of health to the health of Canadians and the demands on the health care system.

Recommendation 9: That the federal government require a health impact assessment as part of Cabinet decision-making process.

Recommendation 12: That educational initiatives in crosscultural awareness of Aboriginal health issues be developed for the Canadian population, particularly for health care providers.����

Crawford Kilian is a contributing editor of The Tyee.