A version of this commentary appeared in JSource and Community News Commons
Over three million Canadians struggle to make ends meet — and what may surprise many is the devastating influence poor income, education and occupation can have on our health. Research shows the old adage, the “wealthier are healthier,” holds true, as the World Health Organization (WHO) has declared poverty the single largest determinant of health.
According to WHO, social and economic conditions and their effects on people’s lives determine their risk of illness, the actions they are able to take in order to prevent themselves from becoming ill and treating illness when it does occur. We know that poverty can affect our health in a variety of ways. Income provides the prerequisites for health — including housing, food, clothing, education, safety and the ability to participate in society in a meaningful way.
Low income limits an individual’s opportunity to achieve their full health potential because it limits choices. This is why, in order to capture the true multi-dimensional and dynamic nature of poverty, it is more accurately recognized as social and economic exclusion — meaning the lack of economic resources required for dignified participation in society (not only what is necessary for physical well-being but also psychological and social well-being). This can include everything from the ability to afford safe housing, choose healthy food options, and find inexpensive childcare, to the ability to access social support networks, learn beneficial coping mechanisms and build strong relationships.
Here’s what journos need to know:
1. In Canada, there is no official measure of poverty. The way in which we measure and conceptualize poverty has implications for the types, characteristics and success of policies developed to reduce poverty and its effect on health. Statistics Canada does not define poverty nor does it estimate the number of families in poverty in Canada. Instead, they publish statistics on the number of Canadians living in low-income, using a variety of measurements including the Low-Income Measurement (LIM); the Low-Income Cut-Offs (LICOs); and the Market Basket Measure (MBM).
Also of note, following the federal government’s cancellation of the mandatory long-form census in favour of a voluntary national household survey, the methodology has changed in such a way that long-term comparisons of income trends over time have been made difficult, because the National Household Survey is now likely to under-represent those living in low income.
2. There is a social gradient in health. Substantial and robust evidence confirms a direct link between socioeconomic status and health status — meaning people in the lowest socioeconomic group carry the greatest burden of illness. Research demonstrates that there is a social gradient in health that runs from top to bottom of the socioeconomic spectrum. What this means is if you were to look at, for example, cardiovascular disease mortality according to income group in Canada, mortality is highest among those in the poorest income group and, as income increases, mortality rate decreases. The same can be found for conditions such as cancer, diabetes, and mental illness.
3. Poverty in childhood is associated with a number of health conditions in adulthood. More than one in seven Canadian children live in poverty ― this places Canada 15 out of 17 similar developed countries. Children who live in poverty are more likely to have low birth weights, asthma, type 2 diabetes, poorer oral health and suffer from malnutrition. But also children who grow up in poverty are, as adults, more likely to experience addictions, mental health difficulties, physical disabilities and premature death. Children who experience poverty are also less likely to graduate from high school and more likely to live in poverty as adults.
4. People living in poverty face more barriers to access and care. It has been found that Canadians experiencing low-income are more likely to report that they have not received needed health care in the past 12 months. Also, Canadians in the lowest income groups are 50% less likely than those in the highest income group to see a specialist or get care in the evenings or on the weekends, and 40% more likely to wait more than five days for a doctor’s appointment. Individuals in low income are also twice as likely as those in the highest income group to visit the emergency department for treatment.
Research shows that compliance with medical treatment also tends to be lower among individuals living in poverty which can lead to pain, missed appointments, and increased use of family practices services. Researchers have reported that Canadians in the lowest income groups are three times less likely to fill prescriptions and 60% less able to get needed tests because of costs.
5. There is a profound two-way relationship between poverty and health. What this means is people with limited access to income are often more socially isolated, experience more stress, have poorer mental and physical health and fewer opportunities for early childhood development and post-secondary education. They also often have inadequate housing, more exposure to environmental pollution and are unable to access healthy foods.
In the reverse, it has been found that chronic conditions, especially those that limit a person’s ability to maintain viable stable employment, can contribute to a downwards spiral into poverty. This is especially true for Canadians living with severe mental health or addictions issues — but also individuals who are living with physically debilitating conditions — who often find that the Canadian patchwork quilt of social benefits, including various sorts of disability insurance, public-sector payments for individuals living with a disability and related pension payments do not, even in combination, provide an adequate living wage. Studies show that many more people who live in poverty experience poor health than the reverse.
Carolyn Shimmin is a Knowledge Translation Coordinator with EvidenceNetwork.ca and the George and Fay Yee Centre for Healthcare Innovation.