What makes people sick? Infectious agents like bacteria and viruses and personal factors like smoking, eating poorly and living a sedentary lifestyle.
But none of these compares to the way that poverty makes us sick. Prescribing medications and lifestyle changes for our patients who suffer from income deficiency isn’t enough; we need to start prescribing healthy incomes.
Decades of studies have shown that health care accounts for less than 25% of health outcomes. The upstream factors that affect health — such as income, education, employment, housing, and food security — have a far greater impact on whether we will be ill or well. Of these, income has the most powerful influence, as it shapes access to the other health determinants. Low-income Canadians are more likely to die earlier and suffer from more illnesses than Canadians with higher incomes, regardless of age, sex, race or place of residence.
No wonder doctors and policy-makers are beginning to line up behind the notion of a basic income guarantee.
Basic income is an approach to poverty reduction that is much simpler and more streamlined than existing programs. Every year, Canadians file taxes. With basic income, if their incomes fall below a certain level, they get topped up to an amount sufficient to meet basic needs. Basic income is a smart alternative to costly social assistance programs, helping overcome the “welfare wall” that traps too many people in the cycle of poverty.
Earlier this month, 194 physicians in Ontario signed a letter calling for a basic income pilot program. Delivered to Minister of Health Eric Hoskins (also a physician), the letter outlines how poverty leads to higher rates of heart disease, depression, diabetes and scores of other illnesses.
In the same month, a new report has brought forth the most official look at basic income in Canada in a generation. The Government of Saskatchewan Advisory Group on Poverty Reduction, which included community members and high-level public servants, reviewed the evidence and consulted key groups that work with people experiencing poverty.
Their recommendations included the ambitious goal of reducing poverty in Saskatchewan by 50% by the end of 2020. To reach such a goal requires putting in place a policy with the power to do so, and the group came to the consensus that a Basic Income pilot project would be an effective and achievable means of doing so.
Recommendations included the ambitious goal of reducing poverty in Saskatchewan by 50% by the end of 2020. To reach such a goal requires putting in place a policy with the power to do so, and the group came to the consensus that a basic income pilot project would be an effective and achievable means of doing so.
A growing body of evidence shows that allowing poverty to continue is far more expensive than investing to help improve people’s economic wellbeing. Currently $3.8 billion dollars — 5% of GDP — is lost from the Saskatchewan economy each year due to increased health and social costs and decreased economic opportunities. In Ontario, this cost of poverty has been calculated to be upwards of $30 billion per year.
Where more extensive basic income pilots have been tried, both internationally and in Canada, the results have been impressive. The Mincome experiment in Dauphin, Manitoba in the 1970s resulted in higher school completion rates, and a reduction in hospitalization of 8.5% largely due to fewer accidents, injuries and mental health admissions. According to the Canadian Institute for Health Information, Canadians spent $63.6 billion on hospital services in 2014, meaning a decrease of 8.5% would result in savings of $5.4 billion. This is just one of the many areas where the return on social investment saves public funds, improving the lives of Canadians in the bargain.
Some policy changes happen slowly, with incremental movements in public opinion. But every once in a while, an idea that had seemed outside the realm of possibility quite suddenly gathers momentum. The concept of basic income is on a course from the margins to the mainstream. If political leaders have the health of Canadians as their first priority, they’ll turn advice into action and implement basic income.
Danielle Martin is a family physician and Senior Fellow at the Women’s College Hospital Institute for Health System Solutions and Virtual Care.
Ryan Meili is a family physician, founder of Upstream: Institute for A Healthy Society and an advisor with the Evidence Network.
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