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The cultural hegemony of chronic disease association discourse in Canada

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Abstract

In this paper, we explore how corporate domination of two major disease associations in Canada, Heart and Stroke Canada (HSC) and Diabetes Canada (DC), as manifested in membership of their boards of directors may be acting with biomedical complicity to create hegemonic discourse on the nature of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). This is problematic as the activities that derive from this discourse thwart public policy action to address the primary causes and means of managing chronic disease: Canadians’ living and working conditions. Through critical analysis of the membership of HSC and DC boards of directors, we link their corporate and biomedical backgrounds with the limiting of chronic disease association messaging to narrow discredited behavioural approaches. We also draw attention to other means by which the corporate sector is able to shape disease association discourse on the causes and means of managing chronic disease. To rectify this, we call for membership of these boards to include those knowledgeable with broader understandings of health and those most likely to suffer CVD and T2DM: the poor, excluded, and marginalised. Since we recognise these associations will not voluntarily undertake these actions, we present means to force this shift.

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Notes

  1. Our most consistent effort was making available the exhaustive analysis of the social determinants of CVD in two reports (Raphael 2001, 2002) and two overviews of the SDoH and CVD and T2DM relationship (Raphael et al. 2003; Raphael and Farrell 2002). More recently, we provided details of an extensive study of the SDoH of the incidence and management of T2DM (Dinca-Panaitescua et al. 2011; Dinca-Panaitescua et al. 2012; Pilkington et al. 2010; Raphael et al. 2012).

  2. Material deprivation and adversity during childhood and adulthood make independent contributions to the incidence—and management—of these diseases (Davey Smith et al. 2002, 2001). In addition, the SDoH of chronic disease of early child development, adult employment security and working conditions, food and housing insecurity, cluster, a result of public policies that inequitably distribute economic and social resources (Shaw et al. 1999).

  3. Search terms included (Heart and Stroke Canada) and (social determinants) as well as numerous singular SDoH such as poverty, income, working conditions, early child development.

  4. http://www.heartandstroke.ca/articles/at-the-heart-of-the-indigenous-health-crisis.

  5. http://www.heartandstroke.ca/-/media/pdf-files/canada/2017-position-statements/accessto-affordablehealthy-nutritiousfoods-ps-eng.ashx?la=en.

  6. https://www.heartandstroke.ca/-/media/pdf-files/canada/2017-heart-month/heartandstroke-reportonhealth2017.ashx.

  7. http://www.heartandstroke.ca/what-we-do/partners.

  8. http://www.diabetes.ca/about-cda/donor-recognition.

  9. The first author had the recent experience of meeting with HSC staff who assured him they were aware of the SDoH and CVD literature and were working hard to include it in HSC activities. He commented he had been told the same 12 years prior at a previous meeting with HSC staff.

  10. Ideally, we would confirm these hypotheses by carrying out interviews with HSC and DC staff members and examining Board minutes for evidence these board members from the corporate sector actively resist broader discourses concerning the sources and means of managing chronic disease. We believe the same reasons that lead to HSC and DC discourse—staff perception of board resistance to broader discourses and fears of jeopardy of employment—preclude our being allowed to carry out such an examination. Indeed, we were denied the opportunity to post our presentation from the conference at which this material was initially presented “[B]ecause of claims within that have been interpreted as libel”.

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Authors and Affiliations

  1. School of Health Policy and Management, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada

    Dennis Raphael, Claudia Chaufan, Morouj Bakhsh & Jessica Bindra

  2. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada

    Toba Bryant

  3. Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada

    Allan Puran

  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Daniel Saliba

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  1. Dennis Raphael
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Correspondence to Dennis Raphael.

Appendix: Board of Directors of HSC and DC

Appendix: Board of Directors of HSC and DC

Heart and Stroke Canada

Chair: Andrew W. W. Cockwell (Toronto)

Andrew Cockwell is a managing partner for Ursataur Capital Management. Prior to this role he was a partner with ReichmannHauer Capital Partners, a Canadian middle market private equity firm.


Past chair: Rod McKay, FCA (Calgary)

Rod McKay is chair of the board of Tourism Calgary and member of the board of the Calgary Sports Tourism Authority. He is a fellow of the Chartered Accountants of Alberta. He serves on the board and audit committee of Fidelity Capital Structure Corporation and the board of the Institute of Corporate Directors—Calgary.


Directors

Penny Ballem, MSc, MD, FRCP,FCAHS (Vancouver)

For the last 7 years, Dr. Penny Ballem served as the city manager of the City of Vancouver. During her tenure, Vancouver experienced a remarkable rise in its global brand built on the success of the 2010 Olympic and Paralympic Games and the City’s innovative policy agenda in the area of sustainability, its comprehensive healthy city strategy, and its innovation economy.


Denis Berthiaume, FCIA, FSA (Montreal)

Denis Berthiaume has been the president and chief operating officer of Desjardins Insurance since 2011 and also senior executive vice president and general manager, Wealth Management and Life and Health Insurance, of Desjardins Group.


Andrew Claerhout, ICD.D (Toronto)

Andrew Claerhout leads Teachers’ Infrastructure & Natural Resources Group. He is responsible for delivering long-term, predictable value and hedges against inflation by making direct investments in infrastructure on a global basis.


Barry Cracower, MBA, ICD.D, (Toronto)

With an extensive career in marketing and sales in the retail sector, Barry Cracower brings business, entrepreneurial, and consulting experience to Heart & Stroke. Founder and former president of Rexall Drug Stores, Barry is currently an active member of several for-profit (public and private) and not-for-profit boards, including Zast Foods, Dominion Citrus, The Baycrest Health Centre, and as chair of DAREarts Foundation.


Thomas Feasby, MD (Calgary)

Dr. Thomas Feasby is a professor of neurology and was the dean of the faculty of medicine at the University of Calgary from 2007 to 2012. Prior to that, he was an associate dean of the faculty of medicine at the University of Alberta and vice-president academic at Capital Health in Edmonton.


David Butler-Jones, MD, MHSc (Ottawa)

Dr. David Butler-Jones was Canada’s first chief public health officer from 2004 to 2014. He headed the Public Health Agency of Canada which provides leadership on the government’s efforts to protect and promote the health and safety of Canadians. A researcher in a broad range of public health issues, he is a professor in the faculty of medicine at the University of Manitoba as well as a clinical professor with the department of community health and epidemiology at the University of Saskatchewan’s College of Medicine.


John Kelleher (Toronto)

John Kelleher is a partner and in-house CEO/CXO in McKinsey’s turnaround unit that focuses on providing elite leadership talent to drive large-scale turnarounds. John is an experienced turnaround CEO & private equity executive who has driven multiple successful turnarounds across a range of industries. His specialty is corporate finance, financial modelling, private equity/mergers and acquisitions, and accounting.


Zaylin Lalji (Vancouver)

Zaylin Lalji brings to the Heart & Stroke board extensive experience in business and the public sector as well as an active commitment to numerous philanthropic causes in Canada and abroad.


Thomas Marrie, MD (Halifax)

Dr. Thomas Marrie served as 12th dean of medicine at Dalhousie University from 2009 to 2015. Prior to his appointment he was the dean of the University of Alberta’s faculty of medicine and dentistry. Thomas had a 22-year career at Dalhousie, where he worked as a professor, researcher, and clinician and founded the division of infectious diseases.


Glenn Sauntry, B.Eng, MBA (Toronto)

A graduate of McGill University, Glenn is vice chair of BMO Capital Markets. Prior to his current position, he was a head of Bank of Montreal’s Canadian Corporate and Investment Banking Group. Glen has been at BMO or its successors for the last 22 years. Prior to that, he spent 10 years at Scotiabank.


Rebecca Schalm, PhD, ICD.D (North Vancouver)

Dr. Rebecca Schalm is founder & CEO of Strategic Talent Advisors Inc. She provides boards, management teams, and human resource executives with expert advice and innovative succession, development, and talent management solutions. She has assisted organisations for over 20 years in building talent capability that enables business strategy.


Alison Twiner (Vancouver)

Alison Twiner is group director of global marketing solutions at Facebook Canada where, since 2010, she has worked with the team responsible for building strategic marketing relationships and delivering business solutions for Canada’s largest marketers and agencies. Prior to Facebook, Alison held a similar role building the business of Google Canada.


Source: Abstracted from Heart and Stroke Canada (2017). Our board of directors. Toronto: Author. Retrieved from http://www.heartandstroke.ca/what-we-do/leadership.

Diabetes Canada

Jim Newton, Chair

Jim Newton is a certified chartered accountant at KPMG, Toronto specialising in IT, and financial audit. Newton also currently chairs the CDA board committee for 2015–2016 year.


Catherine Potechin, Secretary

Potechin is an enterprising global executive with forte in strategic leadership and expertise in general management, sales, marketing, and team leadership across various industries including Pharmaceuticals, Medical/Health care, Nutritional CPG, Ergonomics and Antimicrobial Ingredient Brand Chemical.


Suzanne Deuel, Past Chair

Ms. Deuel served as Senior Vice President of Operational Risk, Insurance Management, and Risk Management at the Toronto-Dominion Bank. She has been Interim Chair of the Board of Directors at Canadian Diabetes Association since February 8, 2013 and serves as its Director.


Directors

Michelle Corcoran

Michelle is practicing as a Certified Diabetes Educator (CDE)/certified insulin pump trainer at the Upper River Valley Hospital in Waterville, NB. She has been involved in local and national volunteer executive committees including New Brunswick Provincial advocacy and CDA National Advocacy Council.


Dawn Gallant

Mrs. Gallant is a registered nurse in Mount Pearl, Newfoundland, and Labrador. She has years of experience working with diabetic patients. Ever since she and her daughter were diagnosed with diabetes, she has been fervently volunteering for CDA for more than 15 years now.


Maureen Kotopski

Maureen Kotopski is a Consultant for Paradigm Quest Inc., a leading Canadian mortgage underwriting and servicing business process outsourcing company. As the first Business Process Outsourcing (BPO) Company dedicated to mortgages in Canada, Paradigm continues to evolve, exceeding lender expectations.


Ram Krishna

Ram Krishna is the Director of Business Operations at Sunram Systems which specialises in providing IT solutions for project management and business analysis. He has been an active board member of the CDA since 2010 and National Diabetes Trustee Corp since 2015.


Jim Porter

Chief Operating Officer at Atlantic Lottery Corporation with degrees in Engineering and an MBA in Science & Technology. Previously, Chief Information Officer for Tyrne Enterprises Inc.

Tyrne Enterprises Inc., an accredited provider of World Lottery Association Security Control Standard.


Diana Provenzano

Diana Provenzano is a self-employed charted accountant who provides tax and accounting services to a broad spectrum of clients ranging from non-profit organisations to multinational companies. She is an expert in disability tax credit/savings plans and gives tips on how to maximise tax return.


Ronald Sigal

Dr. Ron Sigal is a Professor of Medicine, Cardiac Sciences, Kinesiology and Community Health Sciences, Division of Endocrinology and Metabolism at the University of Calgary. He is also a Health Senior Scholar with the Alberta Heritage Foundation for Medical Research.


Jay Silverberg

Dr. Silverberg is an Endocrinologist and Affiliate Scientist, Evaluative Clinical Sciences, Schulich Heart Research Program, based at Sunnybrook Heart Research Institute.


Ellen Stensholt

Mrs. Stensholt was an eminent lawyer for the Canadian federal government and bore witness to many of the trade agreements Canada has signed.


Stan Struthers

Stan Struthers is a Manitoba politician, and a former member of the Legislative Assembly of Manitoba for the New Democratic Party


Michael Swartz

Michael Swartz is an independent financial analyst who worked in world of banks and money.


Source: Information obtained through Google™ searches of names obtained from Diabetes Canada (2017). Board of directors. Toronto: Author. Retrieved from http://www.diabetes.ca/about/leadership-teams/board-of-directors.

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Raphael, D., Chaufan, C., Bryant, T. et al. The cultural hegemony of chronic disease association discourse in Canada. Soc Theory Health 17, 172–191 (2019). https://doi.org/10.1057/s41285-018-0072-7

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