Toronto Star

We need to talk about poverty and health

- CAROLYN SHIMMIN Carolyn Shimmin is a Knowledge Translatio­n Coordinato­r with EvidenceNe­twork.ca and the George and Fay Yee Centre for Healthcare Innovation in Winnipeg.

With a federal election on the horizon, we’re starting to see policy topics creeping, as they so rarely do, into the headlines: the economy, energy prices, jobs, even climate change. But what seems surprising­ly absent from the political conversati­on so far is any discussion of an issue that is traditiona­lly top-of-mind for Canadians: our health, and how we can improve it.

Health for many pundits is all about health care. And while health care deserves its place in the political spotlight, it’s also essential that voters understand a too-often ignored, inextricab­ly linked issue: 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 incomplete.

More than 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 adage, the “wealthier are healthier,” holds true, as the World Health Organizati­on has declared poverty the single largest determinan­t of health.

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 (physical, psychologi­cal and social) because it limits choices. This includes the ability to access safe housing, choose healthy food options, find inexpensiv­e child care, 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, it publishes statistics on the number of Canadians living in lowincome, using a variety of measuremen­ts.

Following the federal government’s cancellati­on of the mandatory long-form census, 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 direct link between socioecono­mic status and health status. Robust evidence shows that 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 15th 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 with a lower 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 per cent less likely than those in the highest income group to see a specialist, and 40 per cent more likely to wait more than five days for a doctor’s appointmen­t. They are also twice as likely as higher-income Canadians 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 per cent less able to get needed tests because of costs.

5. There is a profound two-way relationsh­ip between poverty and health. 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.

As we approach the October election, Canadians ought to remember that poverty, health and the economy are inextricab­ly linked issues. We ignore those links at our peril.

Low income limits an individual’s opportunit­y to achieve their full health potential

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