In 1998, the Director of the Montreal Public Health Department published
his first annual report entitled Social
Inequalities in Health . The report's conclusions were clear: the
social and economic environment of low-income neighbourhoods had an
extremely negative impact on the population's health, including infant
mortality, lung cancer, fertility rates, psychological distress, and
The Public Health Department had already implemented a number of programmes
to alleviate the impact of poverty on infants, street youth, the elderly,
etc. Although well-designed, these programmes had no impact on the economic
environment, a major health determinant. An upstream action was essential
but the components of an effective strategy had not been identified.
No progress could be made without additional information, and research
and development were deemed essential. However, the research questions
were diverse and revolved around local financing, fiscal issues, and
urban planning. None of the researchers with expertise in these fields
worked at the Public Health Department and public health professionals
often did not know them. Moreover, the researchers were not necessarily
aware of the possible connections between their work and public health.
For example, researchers studying by chance the relationship between
water fees and environment protection found out incidentally that poor
people would reduce their water consumption for personal hygiene if
water fees were based on utilisation. It was not possible to recruit
these professionals as their backgrounds were extremely varied and the
Public Health Department was unable to meet their need to share knowledge
with peers. However, effective collaborations with public health professionals
could be envisaged to design research projects.
Consequently, a proposal was made to establish a body that would bring
together Montréal university researchers and the Public Health
Department, to promote and support public health interventions targeting
poverty. OMISS, or the Observatoire montréalais des inégalités
sociales et de la santé, is this organisation. OMISS would also
provide a link between researchers and decision makers.