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How to vaccinate against poverty

Being poor can be deadly and the Canadian Medical Association has ideas for a cure


 

Matt Hamilton/The Daily Citizen

This winter and spring I served as moderator of a traveling road show assembled by the Canadian Medical Association (CMA) in conjunction with Maclean’s. At each town hall meeting across the country teams of local and national experts were assembled to discuss a deceptively simple question: What makes us sick?

It wasn’t really a discussion of germs or viruses or tobacco use. It was an exploration of what has come to be known as the “social determinants of health”—things like insecurity in income, housing or food; lack of education or adequate childcare; teen births, racial discrimination, among others. They may not seem to be purely health issues, but individually, or in lethal combinations, they can and do kill Canadians before their time.

It was a search for bold thinking and fresh ideas, which they found in abundance from the hundreds of audience members who turned out, and from the extraordinary collection of expert panelists on stage—health care workers, social advocates, Aboriginal leaders–who live with the realities every day.

On Tuesday, July 30, the CMA released its report in Ottawa along with a sweeping series of recommendations—from housing and food-security programs to a pilot study of a guaranteed annual income. The ideas are sure to cause discomfit to some of Canada’s political leaders.

“I have to say it was a fascinating, but at times also disheartening, national discussion,” said CMA president Anna Reid, an emergency-room doctor at the Stanton Territorial Hospital in Yellowknife. “In a nutshell, we heard that the biggest barrier to good health is poverty. I do believe that many Canadians do not realize how many of our fellow citizens live in poverty, and how difficult it is for those living in poverty to be healthy.”

By some estimates, 20 per cent of the $200 billion spent annually on Canadian health care can be attributed to socio-economic disparities. The things people don’t have—money, primarily—are what kill them or degrade the quality of their lives. The Hamilton town hall meeting, for example, heard of two city neighbourhoods, one rich, one poor, where the difference in average life expectancy was 21 years.

There are vaccines for diseases like measles, mumps and polio. But how do you vaccinate against poverty? That, in essence, is what the CMA set out to explore in its cross-country consultations and in online discussions on its website.

If the CMA consultation causes a little unease for the ruling class, that can’t hurt. Canada, by any measure, is a middling performer among wealthy countries when it comes to health outcomes or alleviating the damage of social and economic inequality. That was clear, too, in the spirited comments, and heart-wrenching stories shared by audience members at every stop. And by the evident frustration of many of our panelists, who see the problems first hand, and who are all too often thwarted by a system that finances and administers health in isolation from all the thing that make us healthy: education, housing and employment, to name just three.

“The perceived abandonment of responsibility for health care by the current [federal] government was seen as a serious blow to ensuring accountability of how health care is delivered,” the CMA report found.

Among its recommendations was that “a health impact assessment” be part of any cabinet discussions of new policies or programs cuts.

But the reality is that no one level of government can “fix” social and health inequality. Society is us, and the best solutions the consultations heard were usually those that worked across the spectrum, community-based programs that drew from the resources of neighbourhood organizations, and from all levels of government. “There is no one sector responsible for making this happen,” Reid said. “It has to be a joint effort, involving health-care providers, governments, patients and Canadians from all backgrounds and Canadians from all walks of life.”

It means knocking down the silos and bureaucratic fiefdoms that cause one policy in one department to work in isolation, when it really does take a village.

One troubling example raised by Aboriginal panelists and audience members during the Winnipeg town hall were the overlapping and sometimes conflicting federal and provincial services for health, education, housing and other social services for on-reserve and urban status and non-status Indians and Metis people. Chronic education underfunding was denying post-secondary education to a huge cohort of young people, at huge economic and social cost.

There are promising developments. One is New Brunswick’s Economic and Social Inclusion Corporation, a non-partisan Crown corporation with the grand aim of reducing poverty and improving social outcomes. Its 22-member board includes relevant provincial cabinet ministers, an opposition member, business, municipal and social leaders from urban and rural areas and a rotating co-chairmanship that includes a person living in poverty. This spring it played a key role in inspiring changes to the delivery of social services. It is exploring ways to deliver a prescription drug plan to the 70,000 families in the province with no drug coverage at all.

The report’s focus on issues of poverty, housing and education are part of the CMA’s multi-year commitment to advocate for a health-care system that is better focused on patient outcomes, while remaining financially sustainable. It’s a tall order.

“Some people may think that, in looking beyond health care, physicians are treading off their usual path. We’re not really,” Reid said in Winnipeg this winter before a town hall meeting focusing largely on Aboriginal health, social and economic issues. “There is nothing more frustrating than diagnosing a health problem and prescribing treatment for a patient in the knowledge that the cause of the illness will persist.”

After its consultations, the CMA recommends that:

  • the federal, provincial and territorial governments give top priority to developing a plan to eliminate poverty;
  • the federal government finance a guaranteed annual income pilot program, possibly similar to an experiment in Dauphin, Man., in the 1970s that offered promising returns in health, education and social outcomes;
  • there be a greater emphasis on secure housing for people with chronic conditions and affordable housing programs for low- and middle-income Canadians;
  • investments be increased in early childhood development;
  • comprehensive prescription drug plan be created “to ensure that al Canadians have access to medically necessary drug therapies”;
  • there be greater investment in Aboriginal health and education, and fostering of Aboriginal health care providers.

If it all sounds rather utopian, it’s not. Many of these ideas are in place in countries in Europe, which are delivering vastly better outcomes in key indicators including lower rates of infant mortality, chronic disease and chronic poverty, and better longevity and education outcomes.

“It’s a question of compassion and our duty as physicians to bring these issues forward,” said Reid. “For society, it’s also a question of costs, a way to ensuring that we can continue to afford our health-care system.”


 

How to vaccinate against poverty

  1. Well you know we’re not going to do anything that might cost money.

  2. The LICO-defined poverty rate is at the lowest percentage of the population in several decades.

    • There should be no poverty in an advanced 21st century society

      • With the LICO definition of poverty, it is impossible to eliminate poverty, since it is a relative definition.

        For example, if every single person in the country earned a dollar a year, the LICO definition of poverty would tell you that there is no poverty.

        Whereas if the average income were $100,000 per year, and 10% of the people earned $30,000 there would be a 10% poverty rate, using the LICO definition of poverty.

        I expect the reason the LICO poverty rates in Canada have been coming down is because the salary of the average male worker has stagnated, and because of social transfers, more poorer people are catching up relatively speaking,

        although in absolute terms things could actually be getting worse.

        But progressives have trumped the LICO definition as the gold standard, when it was trending in favour of the poverty industry, so it would ruin 30 years of their “whining” if they started talking about absolute poverty measures rather than relative poverty measures.

        So by the measure progressives have always preferred and trumpeted, poverty rates (i.e. LICO rates) under Harper have been going down, even with the Great Recession.

        How about them apples! -).

        • Well, I think most adults are aware of what poverty is…LICO or not

          So whether you’re trying to compare poverty today to what constituted poverty 50 years ago….we have poverty….or whether you’re trying to make a hero out of Harper for partisan purposes……we have poverty……and it has to go.

        • There are other measures of poverty still in evidence. Intergenerational poverty (lack of social mobility), worse health outcomes for those with lower income, etc. Surely we can agree that these are things that deserve our attention.

          • It’s not poverty, though, that is a cause.

        • Sour apples, rotten and worm filled!

        • So then let us reduce the income gap. I think a minimum and maximum wage, which are linked, would do well. If the maximum wage increases, so does the minimum. We would do well to learn from the Scandinavian countries where the higher and lower earners are separated by a factor of 4.

      • Except that some people are lazy and can’t be bothered; I worked in Social Services and saw that for myself. So why should they be pandered to?

        • Agreed. They have something like 400,000 homes in the UK where they are literally knocking on doors every morning to get people up and out for school and work or at least work searches.

          And they have people with 10 kids, by different partners, living in council housing and collecting bennies.

          There has to be a cultural change there….so that people don’t get bennies unless they are in job training….and it’s mandatory to go to school. The Tory govt is capping kids at 2 for benefits.

          The thing is, if you don’t stop it….400,000 becomes 800, 000 and more in short order….and the crime and health problems damage the whole country.

          People need education/training….and the only people on bennies should be those who simply can’t function.

          • Tell that to someone like me, whom lost his job due to slowdown in the retail industry, I’ve been looking for 2 months with no calls and i’m not some punk ass crack head with no experience. I’m more qualified than most of the idiots with Degrees and Certifications who get hired over me…

            I goto welfare to get some money for food and rent… Im given $20 in food stamps and told to bad this is all you get, I got denied assistance because i couldn’t prove 2 full years of work at w/e their set earning rates are. I have developed an Ulcer because of the stress… Oh yea i moved from my hometown to goto University which didn’t help jack shit since i got screwed over on my loans and couldn’t go back after my first year…

            Its called dealing with the drug addicts dreggs who get on assistance because they are to useless to get a job. The government makes it easy for them to get assistance so they can lead people like you on to think that way.

            I also can’t afford my medication to deal with the Ulcer because here in Canada we don’t have any prescription medication coverage. People like you should be ashamed of yourselves and I hope your way of thinking festers and dies because its disgusting.

            What you said is like saying that fat people eat McDonald’s therefor everyone who eats McDonald’s is fat

          • Work Camps…. Send them to Work Camps, They would be free to leave but would get cutoff

          • ‘I’m more qualified than most of the idiots with Degrees and Certifications who get hired over me…’

            There’s yer problem. Big mouth, no education

            PS…and ulcers don’t come from stress.

          • “i’m not some punk ass crack head with no experience…”

            “I’m more qualified than most of the idiots with Degrees…”

            ..”.which didn’t help jack shit since i got screwed over on my loans…”

            I can;’t imagine why someone with your charming disposition would have trouble finding employment in the retail sector. Dealing with people.appears to be your strength. Truly puzzling.

          • Go see your physician. He/she can likely get you samples for your medications.

        • Some people think that people like you who are public servants are lazy and entitled – do you like that generalization?

    • Regardless–there is still poverty. There’s more to be done.

      • Poverty, actual poverty, is almost inexistent in Canada.

        Even welfarites get food, clothing, shelter, TV, refrigeration, thermostatic heating, running water both cold and hot, flush toilets, and a host of other luxuries only dreamed of among most of the world’s population.

        • So you’re not aware of the situation on many native reserves, or even the effect noted in the article, where a poor neighbourhood showed a 21 year differential in life expectancy? Until such differences are small, and there is a high degree of social mobility (ie, low intergenerational poverty/low income), there’s room to improve on poverty.

          • On reserves there is limited mobility, but that’s due to ‘first nations’ culture and not poverty as such. And there are a lot of prosperous folk on reserves.

            The difference in life expectancy is likely due to poor choices, which leads to both less prosperity and poorer health.

            As long as people have the freedom to make poor choices, some people will do just that.

          • There have been different articles in Macleans online that have revealed some interesting things about conditions on FN reserves in Canada. One discussed the conditions on reserves in Alberta where many bands are very financially well off and yet the living conditions on the reserves continue to be quite appalling. It isn’t necessarily a matter of simply money but often financial management and the lack of basic skills.
            Certainly there is also a strong correlation between socio-economic status, level of education and life choices with regard to making healthier decisions. It isn’t that good food is always so much more expensive than junk food (ie: rolled oats aren’t more money than sugary cereal) but you have to know how important it is to make the better choices.

  3. Just consider the price of energy in Canada.
    We are an energy-rich, wealthy country. Those who own it, raise it – so the rest of us stay at the bottom.
    Maybe not the best example.Poverty is man made, and will stay with us till Doomsday.

    • Well that’s a great attitude…..just quit trying eh? Might as well go back to the caves.

  4. Sounds to me that if you quit trying in this country, you get rewarded more than people who work for a living. Why should I stay employed in a job I don’t like, when, if these programs are implemented, my family and I will be cared for completely? Sheesh.

    • Sounds like you’ve never tried to live on welfare.

      With something like a minimum income, you still have an incentive to strive/work if you want to improve your lot in life. A minimum income, pretty much by definition, can’t deliver a standard of living all that close to average/median. So if you’re satisfied living on $12k per year, maybe laying about on minimum income is for you.

  5. Making proof of the use of a long term passive birth control method (NorPlant, IUD, Implanon, etc) a prerequisite for receiving various sorts of social assistance would be an excellent step towards stopping the ‘cycle of poverty’ at its most vulnerable point.

    Of course the respective social services department would cover the cost of the necessary as a social investment with almost immediate returns.

    • There’s probably less draconian measures that could be taken. Poor people are likely to take advantage of birth control methods when provided.

      • Hardly ‘draconian’.

        And no, there are welfare mothers whose plan is to use the cash flow they get from farrowing to sustain their leisure lifestyle.

        • Ignorant statements.

    • No.

  6. People who put themselves into poverty are probably not going to make good choices in the rest of their life either, including those that impinge on health.

    So it’s quite possible that poverty is not the cause in a cause-and-effect, but just another effect.

    • No. Definitely proven not to be the case in numerous studies.

      • What, people who make bad choices in their lives are ‘proven’ not to end up with bad outcomes?

        Get serious.

  7. You can’t treat poverty. Just sayin’ monkeys

  8. The biggest challenge in vaccinating against poverty is the tendency to mistake markers of economic success for factors needed for economic success. Poor people have worse health outcomes. Are those outcomes due to the fact that they’re poor, or because the same factors that make them poor also make them sick? Smoking, drinking, poor nutrition are examples. Poor nutrition can occur because of lack of income, but it doesn’t explain a propensity to spend money on junk food instead of healthy food choices (a bag of potato chips can cost the same as a pound of carrots, for example.) Smoking and drinking are small, relatively cheap pleasures in an otherwise deprived life. On the other hand, all of the above can also result from issues with education, impulse control, and making good choices. We mistake effects for causes all the time – how else to explain the fixation with universal university education? Answer: people with bachelor’s degrees have historically earned more. The assumption is that they earn more because of the bachelor’s degree, rather than the bachelor’s degree being a marker of talent in an era when degrees were relatively scarce.

    • Indeed, correlation cannot determine causation.

  9. “… perceived abandonment of responsibility for health care by the current [federal] government…”

    Health care is, constitutionally, a responsibility of the provincial governments.

    You would castigate the federal government for following both the intent and the letter of the Constitution?

    • Roads are a provincial responsibility too, but they’re built and maintained partially through federal funding. There’s a shortage there too, as our infrastructure is allowed to fall apart. That’s why we pay for transportation ministries at both levels of government. The same goes for public health care, but it is still near the top of Harper’s not so hidden agenda to make Canada unrecognizable.

      The barely hidden agenda is to unravel Canada’s signature public
      health care model in favour of an aggregate of more expensive, more
      fragmented, and less universal corporate models.
      Just as the Harper government corrupted the environmental file (in
      the name of “streamlining”), by drastically removing federal oversight
      and involvement (vacating jurisdiction), so too is it “vacating
      jurisdiction” of health care.
      The agenda is being achieved by starving the provinces of required
      funding. Once the 2014 Health Accord is expired, the Harper government
      will reduce its Canada Health Transfers (CHT’s), — monies transferred
      from the federal government to the provinces – by$36 billion, up to the end of 2024.
      The void of insufficient funding will be filled by corporate health care.
      Once this is achieved, Canadians’ access to health care will be
      restricted, user fees will increase, insurance coverage will cost more,
      and patient fatalities will rise in number.
      Here are some numbers.
      According to the Canadian Institute for Health Information, public
      health care costs less than $180 per month per Canadian, while a private
      insurer in the U.S. charges three times that amount for comparable
      service.
      Even worse, according to a study by Dr. P.J. Devereaux, and published
      in the Canadian Medical Association Journal, if we switch to for-profit
      hospitals, over 2,000 more Canadians will die needlessly each year.
      What are the drivers behind this agenda which is contrary to the wishes of about 86 per cent of Canadians?

      http://rabble.ca/news/2013/08/harpers-barely-hidden-agenda-to-undermine-public-health-care-canada

  10. “Finding ways to deliver a prescription drug plan” to impoverished people is not going to eliminate poverty or impoverished lifestyles or improve anyone’s overall health. In fact, prescription drugs are a leading cause of iatrogenic disease, emergency hospital admissions and death.
    This sounds like a smokescreen to simply push more drugs, except now with public funding.
    The word “vaccinate” is derived from the Latin word “vacca” which means cow.
    The pharma companies certainly need another Cash Cow from their pals at the CMA… Not.

    • The benefit though, of a national pharmacare program, is that it can cover primarily medications shown to have benefit and to be cost-effective and help to control the prescribing of expensive new me-too drugs marketed by the companies that have uncertain risks and benefits. We can get more appropriate medications to more people who do need them at less cost to all of us. @illgotgains

  11. So, the bottom line is, heave Steve ASAP to improve health care and poverty.

  12. Instead of more government subsidies which encourage wastes, inefficiencies and higher prices, we should teach low income people how to operate hydroponics farm to give them access to healthy fruits and vegetable. Poor people are typically obese because they cannot afford a healthy diet which causes diabetes, high blood pressure and heart attract. In other words, we must show them how to ‘fish’ instead of giving them the ‘fish’.

  13. So can I live anywhere I want and get a guaranteed income form other peoples money?

    Maybe part of the problem is cultural belligerence. Move, jet a real job, build self esteem and contribute. Sure beats self pity and whining.

    Mind you, rather the money go to the underclass of Canada than the criminal bankers, bailout corrupt and union greedy. And is better than Libya bombs, defective F35s and the massive amount of equalization for dysfunctional governments we have.

    Maybe the reporters should look at say, blind disabled in poverty, or other disabled or discarded vet. At least with these people they have little choice.

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