rabble blogs are the personal pages of some of Canada's most insightful progressive activists and commentators. All opinions belong to the writer; however, writers are expected to adhere to our guidelines. We welcome new bloggers -- contact us for details.

Addressing health inequalities requires looking beyond individual responsibility

Please chip in to support rabble's election 2019 coverage. Support rabble.ca today for as little as $1 per month!

A new report by the Canadian Medical Association provides a timely reminder that money buys better health, even in a country with a universal public health-care system. A poll commissioned by the CMA found a large and increasing gap between the health status of Canadians in lower income groups (household income less than $30,000) and their wealthier counterparts (household income over $60,000).

The fact that income affects health is hardly a surprise. A large body of research has shown that both globally and in Canada, income (and socioeconomic status more broadly) is closely related to virtually all health outcomes that one can think of, from life expectancy to mental health. Health experts have coined the term "social determinants of health" to draw attention to the factors outside the health-care system that affect health, and income is identified as one of the key social determinants of health.

And yet, despite all the research advances that we've made in understanding health and what makes people healthy, so much of the discussion is still focused on individual responsibility and lifestyle choices.

In my 10-minute conversation about the CMA report with Bill Good on his CKNW show Monday morning, the questions of poor people smoking and eating fast food came up more than once. But aren't the poor bringing this ill health on themselves through their own "wrong" lifestyle choices, both Bill Good and a caller asked?

It's easy to blame the poor for their misfortune and it gets us "off the hook." If the poor make bad choices, then we don't have to feel bad for them getting sick or do anything about the large health disparities that exist in our country. It's just not our problem that they have double the rates of diabetes and heart disease and tend to die younger than us, wealthier Canadians.

But in reality, lifestyle choices are a relatively small factor in shaping health outcomes, much less important than our living and working conditions. In fact, living and working conditions often constrain our choices to a very large extent. The health research is very clear (p. ix):

"Chronic disease can no longer be explained only as an outcome based on engaging in the 'wrong' health behaviours. There is a need to look beyond individual responsibility to understand the ways in which the social environment shapes the decisions we make and the behaviours we engage in."

In other words, the income-related health inequalities the CMA report documents represent unfair and avoidable ill health, and it causes enormous human suffering, costs years of the life of our fellow citizens. As one of the Canadian members of the World Health Organization Commission on Social Determinants of Health, Monique Bégin points out:

The truth is that Canada -- the ninth richest country in the world -- is so wealthy that it manages to mask the reality of poverty, social exclusion and discrimination, the erosion of employment quality, its adverse mental health outcomes, and youth suicides. While one of the world's biggest spenders in health care, we have one of the worst records in providing an effective social safety net. What good does it do to treat people's illnesses, to then send them back to the conditions that made them sick?

This is a national embarrassment and we all have a responsibility to ensure that every Canadian has the opportunity to lead a healthy life.

The large body of recent health research shows that if we want to improve health among lower-income Canadians, then poverty reduction should become our No. 1 health priority. Solutions focused on individual lifestyle choices and "healthy living" are not only incredibly patronizing to lower-income Canadians, they are also bound to be ineffective.

If you're concerned that poverty reduction is expensive, consider how much we already spend to treat preventable and avoidable income-related illness today. In a recent CCPA report, I estimate the extra costs of providing health services to the poorest 20 per cent to be $1.2 billion in B.C. alone and $9.1 billion in Canada, or 6.7 per cent of the total costs of our health-care system.

As Andre Picard concludes in an old Globe and Mail article:

The most powerful drug we have -- money -- is pretty plentiful in Canada. But it is not being prescribed to everyone who would benefit.

This article was first posted on the Progressive Economics Forum.

Thank you for reading this story…

More people are reading rabble.ca than ever and unlike many news organizations, we have never put up a paywall – at rabble we’ve always believed in making our reporting and analysis free to all, while striving to make it sustainable as well. Media isn’t free to produce. rabble’s total budget is likely less than what big corporate media spend on photocopying (we kid you not!) and we do not have any major foundation, sponsor or angel investor. Our main supporters are people and organizations -- like you. This is why we need your help. You are what keep us sustainable.

rabble.ca has staked its existence on you. We live or die on community support -- your support! We get hundreds of thousands of visitors and we believe in them. We believe in you. We believe people will put in what they can for the greater good. We call that sustainable.

So what is the easy answer for us? Depend on a community of visitors who care passionately about media that amplifies the voices of people struggling for change and justice. It really is that simple. When the people who visit rabble care enough to contribute a bit then it works for everyone.

And so we’re asking you if you could make a donation, right now, to help us carry forward on our mission. Make a donation today.

Comments

We welcome your comments! rabble.ca embraces a pro-human rights, pro-feminist, anti-racist, queer-positive, anti-imperialist and pro-labour stance, and encourages discussions which develop progressive thought. Our full comment policy can be found here. Learn more about Disqus on rabble.ca and your privacy here. Please keep in mind:

Do

  • Tell the truth and avoid rumours.
  • Add context and background.
  • Report typos and logical fallacies.
  • Be respectful.
  • Respect copyright - link to articles.
  • Stay focused. Bring in-depth commentary to our discussion forum, babble.

Don't

  • Use oppressive/offensive language.
  • Libel or defame.
  • Bully or troll.
  • Post spam.
  • Engage trolls. Flag suspect activity instead.