A version of this commentary appeared in the Toronto Star, the Huffington Post and Ottawa Life
With a federal election on the horizon, certain high level policy topics are bound to make the headlines beyond the personalities of the political leaders: the economy, energy prices, jobs prospects even climate change. But what seems surprisingly absent from the political hustings so far has been a fulsome discussion of the health of everyday Canadians, and how we can improve it.
Health for many pundits is all about healthcare. And while healthcare deserves its place in the political spotlight, what should be a central concern for Canadian voters is the human and economic costs of poverty on health. These costs aren’t just personal — affecting those unfortunate many beneath the poverty line — but affect our economy and our communities as a whole. Fail to address poverty, and you fail to address health. Fail to address both, and your discussions about the economy or jobs or markets (which rely on healthy Canadians and healthy communities) are not really complete.
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 income provides the prerequisites for health — including housing, food, clothing, education and safety. Low income limits an individual’s opportunity to achieve their full health potential (i.e., physical, psychological and social well-being) because it limits choices. This includes the ability to access safe housing, choose healthy food options, find inexpensive childcare, access social support networks, learn beneficial coping mechanisms and build strong relationships.
Here’s what everyone needs to know:
1. In Canada, there is no official measure of poverty. The way in which we measure and define poverty has implications for 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).
Following the federal government’s cancellation of the mandatory long-form census in favour of a voluntary National Household Survey, long-term comparisons of income trends over time have been made difficult because the voluntary 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. This social gradient in health runs from top to bottom of the socioeconomic spectrum. 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, and being at the bottom of this list is not where we want to be. 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, 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. 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. 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. Studies show the former — people living in poverty experiencing poor health — occurs more frequently than poor health causing poverty.
Our podcasts on the link between poverty and health:
An interview with Dr. Paul Goering, Dr. Gary Bloch, Dr. Ryan Meili and Dr. John Millar
Ending Homelessness in Canada is Possible
Carolyn Shimmin is a Knowledge Translation Coordinator with EvidenceNetwork.ca and the George and Fay Yee Centre for Healthcare Innovation.