A Bitter Pill to Swallow: Poverty as a Social Determinant of Health
You probably don’t need a peer review study to tell you that poverty has a significant negative impact on health.
The connection between health and poverty is so clear that the World Health Organization has declared poverty to be the single largest determinant of health. And while Canada has historically held reputation as a world leader in healthcare for the most marginalized people, we have begun to lag behind other industrialized countries in poverty and health.
A UNICEF Canada report released last year that showed that out of 35 rich nations, Canada was in 26th place for child well-being. Specific geographical areas of the country suffer more than others; for example, the infant mortality rate in Nunavut, is 21.4 (for every 1,000 live births), while the Canadian average is 4.8.
The implications of poverty on Canada’s population are far-reaching – poverty has the effect of even shortening people’s lives. Researchers in Hamilton, Ontario, have found that men in the wealthiest 20% of neighbourhoods in Canada live on average more than four years longer than men in the poorest 20% of neighbourhoods. Homelessness exacerbates this risk to life at an enormous degree. While the life expectancy for the average Canadian is 77 to 82 years, for a homeless person, it is only 34 to 47.
Poverty’s implications for health don’t stop there. Recent international studies have shown us the enormity of the scope of the issue.
Take a Cornell University study which followed participants over the course of 15 years. The study found that impoverished children had increased feelings of helplessness, more chronic physiological stress, and more deficits in short-term spatial memory than kids from middle-income backgrounds. The study’s conclusions are twofold: early intervention is the most effective way to address these issues and increasing a poor family’s income is the best way to reduce childhood exposure to poverty.
A report released in the United Kingdom last week highlighted increasing infant mortality rates in the country alongside increasing income inequality. According to the study, children living in the most deprived areas of the country are much more likely to be in poor health, be overweight or obese, suffer from asthma, have poorly managed diabetes, experience mental health problems, and die early.
A number of other recent studies have demonstrated the impact of the scarcity and the effect of living with the daily stresses of poverty on the brain. Featured in a Pacific Standard article, a former nursing-home aide living in low-income named Sirrea Monroe described how chaotic this balance can be:
“It’s always just, ‘Who do I have to pay today? Can I slide this gas bill three or four days? Can the rent wait ’til next week?’ With the lights, the phone, food, and maintenance on the car, I’m always scraping and moving stuff around. And then my daughter just grew two inches and she needs new pants, so it’s always something. Always.”
Canada is the only industrialized country with public healthcare which does not have national pharmacare, which only exacerbates the relationship of economic instability and poor health. In fact, 1 in 10 Canadians cannot afford to fill their medical prescriptions.
The lack of access to pharmacare and other components of healthcare do not just have a human cost, but a financial one. A recent Canadian Federation of Nurses Unions report estimates that in 2017, Canada will waste $7.3 billion (that’s $14,000 a day!) through the lack of national pharmacare and the high costs of prescription drugs compared to other countries. Additional estimates place the cost of poverty on the Canadian healthcare system to be $7.6 billion. Studies have also shown that $1 invested in the early years of a child’s life can save up to $9 in future spending in the healthcare system.
The reality of poverty in Canada – and the growing impact on our health, both for individual well-being and collectively for our economic benefit– is too significant to ignore. It’s a bitter pill to swallow, but without taking large systemic change to the way we address poverty in Canada, our health will only get worse.
We have solutions to both poor health and poverty in Canadian communities, but short-term, band aid solutions are not the answer. The answer seems as obvious as the question, but it requires a big step forward pushed by political will.
We need to change the way we legislate, budget, and govern on poverty. We need systems change where our laws, policies and programs explicitly recognize that we have a legal human rights obligation to take action to end poverty in this country. By actively addressing poverty through these avenues, Canada can re-establish its reputation as a world leader on health and human rights.
Laura Neidhart is the Development and Communications Coordinator for Canada Without Poverty.