Imagine two children, born on the same day, at the same hospital, to different parents. One family is rich, the other is poor. Experts say one of those kids will grow up to be healthier than the other.
Which one do you think it is?
We all know that we could be healthier if we ate better food, quit smoking and exercised more. But there’s another idea that’s perhaps just as important or even more important in influencing our health. Doctors, health advocates and researchers have been saying for some time now that social and economic factors have a huge impact on health outcomes.
Experts have identified a number of social factors that influence health. What is your income? What kind of house do you live in? Where do you work? What is your education? Do you have access to healthy food and recreation programs? All of these factors affect not only your physical, but also your mental, health.
There is overwhelming evidence that shows people with lower incomes die earlier and have higher rates of chronic diseases or conditions. In 2013, the Canadian Medical Association (CMA) held a series of town-hall meetings on the issue of what makes us sick. Their conclusion was simple: poverty kills. In the report that followed, CMA President Dr. Anna Reid had this to say about the importance of the social determinants of health: “If a patient comes to a doctor with asthma, we can prescribe medication. But if that patient goes back to a home where there’s mould inside the walls and the air is unhealthy, all the medication in the world won’t make that person better. If a patient has diabetes, we can prescribe medication, and the physician or another health care provider can explain to that person the importance of a healthy diet. But if that patient can’t afford fresh fruits or vegetables, or if there isn’t a proper supermarket in the community where these foods can even be found, that diabetes is going to be much more of a challenge.”
A new report by Health Quality Ontario also found that the poorer people are, the more likely they are to suffer from multiple chronic conditions and to be overdue for screening tests. The report shows half of the people living in the poorest urban neighbourhoods in Ontario are overdue for colorectal cancer screening, compared to just over one-third of the people in the richest urban neighbourhoods.
The stress of being poor also has mental health repercussions. The recent spate of suicide attempts in Attawapiskat highlights the need to pay closer attention to the social determinants of mental health, as well. Attawapiskat First Nation community leaders declared a state of emergency after 11 people tried to take their own lives in one day earlier this month. In the past seven months, more than 100 of the 2000 people that live in the remote northern Ontario community have attempted suicide. The youngest was 11. The oldest was 71.
The regional chief has blamed the crisis on the social determinants of First Nation health. Ontario Regional Chief Isadore Day says the Indian Act created third-world social conditions that have led to health and suicide emergencies. Chief Day says there “must be a combined and coordinated effort from all levels on all aspects of First Nation health in order to repair this broken system.” Day also says: “The cycle of poverty, poor health, suicides, violence will continue for another generation if determinants of health are not addressed immediately.”
The Chiefs of Ontario have presented the federal government with a framework on how to fix this broken system. Their recommendations include implementing mental health and addiction services. They’re also calling for a plan to eliminate poverty through investments in housing, healthy affordable food, infrastructure, and education and training.
Federal health minister Jane Philpott doesn’t think there is a need for a national suicide prevention strategy, but she does believe in the importance of the social determinants of health. At a conference in Ottawa in early April, Philpott said “when people have access to high quality of education, when they have access to jobs, when they have money in their pockets, when they have hope – that’s when we are going to be able to make progress.”
The Ontario government has shown some interest in addressing the correlation between income disparities and health disparities.
In 2008, the province rolled out a plan to reduce poverty. The strategy yielded some progress early on. The poverty rate dropped to 15.1 per cent in 2011, but by 2013 it was back up to 15.6 per cent – almost as high as it was initially in 2008. In 2014, the province committed to a new five-year poverty reduction strategy. In 2015, it also made a commitment to end homelessness in Ontario within 10 years.
Earlier this year, the Ontario budget pledged free tuition for students from low-income families. The government said it was combining existing programs to create an Ontario Student Grant. Starting in September 2017, the grant will pay for “average” college or university tuition for students from families earning incomes of $50,000 or less. The Canadian Federation of Students has welcomed the idea. But there has been some criticism on how the system will work. Students will still be on the hook for possible travel and living expenses. In addition, those who want to pursue programs with higher-than- average tuition fees, such as engineering, will have to apply to another program to cover the extra cost.
While these may be steps in the right direction, we could do so much better. Every action our government takes now to tackle inequality could make a real difference in the health of generations to come.
We need to keep advocating for public policies that do more to address inequities. And we need to make sure governments follow through on their promises. Single mothers are among those that persistently struggle to get by on low incomes. Pushing the government to eliminate the gender wage gap and implement a higher minimum wage could help pull many families out of poverty.
We have a responsibility to take action now, so that one day it can be the birthright of all children to enjoy a long and healthy life.