Abstract
Data touching on the increasing level of economic inequality and its impacts are becoming more available in Canada. Warnings have been issued concerning the critical consequences of the increasing rates of economic inequality, which are basically being raised within various sectors of social development. The primary information is that increased economic inequality results to the creation of poverty, a condition that is not acceptable within Canada. The impact of economic inequality to both health and poverty among Canadians is well known to most professionals dealing with public health. However, responses on public health are limited when it comes to delivering of ameliorative programs to help people who live in poverty. Some provincial and federal health associations contain important documentations including a document acknowledging that economic inequality is detrimental to human health.
Despite this, important discussions on the the extent to which economic inequality play a major role in creating poverty, and its effects on community structures which support health, the root causes of increasing levels of inequality, have been ignored and their effects to public health. Reasons for, and evidence of, resistance to deal with such important issues and potential measures for addressing such economic inequality and its effects on health have been presented in this discussion. The role of the government in helping to fight economic policy has been considered and appropriate policies recommended.
Introduction
There is a traditional concern in Canada with regard to health inequalities. However, discussions on public health, link to poverty and economic inequalities which have been and still continue to be a ranging debate for decades (Yalnizyan, 2003: 115). The data documented on the recent rapid increases of economic inequality have increased the focus of the public and the government on these issues. Social development organizations have been credited for highlighting the issues of increased economic inequalities and poverty within Canada. Use of progressive policy institutes which work through the support of labor unions, have also been efficient in highlighting inequality issues.
Studies have shown that, progressive policy institutes and social development organizations have been so active while compared with the role of public health institutions. The municipality of Canada has a tradition of being active in offering of community social services. The municipality under Canadian government has recently been active in the identification of key elements of the available social infrastructures to support health in Canada. Despite these efforts, there have been limited impacts on the public health practice and research going on in Canada.
limited action by the public towards health detriments such as poverty and economic inequality is worrying, given the tradition of Canada which advocates for strong promotion on health. In fact, many government statements and documents include concepts on health detriments. Yet, most professional activities and discourse on public health remain focused, when programs are delivered to individuals with low incomes identified as the most vulnerable group to face poor health outcomes. While Canada has a potential to include public health discourse in resolving economic inequality in the creation of poverty and various sources of the prevalent economic inequality, there still exists structural barriers and potential attitudinal to moving in the right directions (Tesh, 2003: 234-235).
This paper looks into the current state of public knowledge on economic inequality and levels of poverty within Canada, and their major impacts upon the health of people in Canada in terms of different discourses. The state of government and public health involvement in resolving these issues is considered through analyzing selected public and governmental health association studies and documents of public health practice.
Some illustrations are presented showing how health inequalities increase are caused by the way in which public and government health addresses structural issues. The paper also give an argument suggesting the importance of active government involvement in dealing with economic inequality, through implementation of policies and programs to deal with critical economic inequalities in Canada.
Economic Inequality, Poverty, and Health in Canada
Much of the available information in Canada relating to poverty and economic inequality is collected and also reported by the Canadian statistics on the ongoing debate (Glyn, 2004: 98). The conceptual form of analysis focus on the publication of the findings and this is mainly the responsibility of the social development organizations like the Canadian Institute for children, Canadian Social Development, the National Council of Welfare among others.
The key contribution recently done on the debate on economic inequality was the publication and research of the Growing Gap. The report highlighted the growing concern on the increase in the inequality gap between the poor and the rich people within Canada. These findings were reported by the Toronto-based Centre for Social Justice. Additional contributions are made through publication and development of social measures on social health by both the Canadian Center for Policy Alternatives and Statistics Canada. The CCPA recently made a publication bringing together work on the poverty and economic inequality, determinants of health, and findings of social health decrease in Canada. From another approach, journalist Stanford (2006: 56-57) played an important role in the publication of government policy making process and on the creation of poverty and economic inequality policy.
Discussions on public health, poverty, and economic inequality, have been taking place basically within promotion documents on health issues, a variety of publications have been issued by the Canadian Public Health Association, research and concept analysis, provincial health associations, and reports from different researchers from Universities in Canada. There are however anxious disjunctions between ideas given by the public health practice generally, and the government statements. Some of the available disagreements are directly related to reluctance to participation in the making of health and social health policies. This may also help to influence the neo-conservative and neo-liberal ideologies on political life in Canada.
An exception to this notion is however demonstrated by specifically well presented reports on social inequalities with regard to health, by the the Director for Public Health in the Island of Montreal. Despite all these efforts, Canada has not been able to come up with a report fully concentrating in health importance or equivalent in scope to the Health Divide, Acheson and British Black reports. The Canadian National Forum for health has made a series of reports recently focusing on health, referred to as Health Action Building on Legacy. This report contains important trance and adequate evidence of poverty and low income levels as one of the major determinants of health, but such findings are mostly diffused in various papers.
Poverty and Economic Inequality Increases in Canada
Statistics on Canadian low income rates are mainly based on community and family identity and size on people living under strained conditions. Those cut offs have been used to identify used in the identification of people people living in poverty. Poverty levels in Canada had gone up by 1996, by 18% and the level of child poverty had reached the peak of 17 years at the rate of 21%. The issue of child poverty has been of policy concern, with a rate of 1.5 million children in Canada living in poverty. The recent statistics in Canada from the census carried out in 1996 have shown that child poverty rates at the provincial levels were low in Prince Edward Island with a rate of 18.5%, and were high in Minetoba with the rate of 26.3%. The wealthiest province in Canada from the findings of personal gross product had an rise in child poverty from the rate of 12% in the year 1989 to 26% in 996. A publication of these increases has clearly been made by the Canadian record of newspaper, the Toronto Mail and Globe, which have been showing various reports on child poverty increase.
As levels of economic inequality increase, poverty levels also increase. A study on the income rates at Luxembourg show that the current association between the rate of economic inequality in any nation when measured through the use of child poverty and Gini index 16 in western industrialized nations were positive, strong and reliable. The increasing gap shows that by 1996, poverty levels had increased in Canada from the ratio of 22:1 in 1973, with the richest and the poorest having a gap of 10% to 10% (Glyn, 2004).
From a report presented in 1980s, it has been shown that income levels for most Canadians had decreased. The average report for earnings between men in 1995 was $ 31. Income levels decreased from 1990 to 1995 by 6% among wife and husband families and went down by 8% among single parent families. Yet, people who are well off in Canada continued becoming wealthier. The potential health related effects on inequality in Canadian economic status were checked by the existence of strong social programs. From 1993 however, there has been weakening of social programs and after taxes gap, which has begun growing.
Canadian Discourses on Economic Inequality, Poverty and Health
Various discourses have been used to show analysis on the economic inequality, health and poverty relationships. There are four ways through which Canada has framed these issues. The first discourse focuses on lifestyle, where great emphasis is placed on the behavior of those Canadians who are not well off. According to Stanford (2006: 102), this is the main approach used in public health with regard to health inequalities in Canada. This can work out if the departments of public health can develop programs and staff positions for physical activities, tobacco use, and other addictions, prevention of violence, sexual health, nutrition, among others.
The second form of public health discourse mainly focus on poverty, where the psychological and material focus deprivations affecting the poor people are considered. A focus on poverty may be associated through development of programs directed to reducing the consequences of poverty, as well as in identifying the root causes, and acting on the structural causes of increased poverty.
Discourse at the third stage focus on health gradient and socio-economic factors which differ in well being and health that exists among people of different status in education, social class and income. In this discourse, there is a consideration on the important role played by public policy in promoting and sustaining economic inequality. The Association of Canadian Health has been at the forefront in advocating for identification of economic and social conditions, which affect human health. In their practice, statements for health impacts and health promotions of economic and social conditions, and their implications on various public policies are put together. From the previous developments in health promotion and population health, there is a comprehensive and articulate statement of the known facts about factors which determine health at the societal level, and economic inequalities. Surprisingly, many documents available from the government clearly consider economic resources distribution as determinants of health.
The fourth consideration on inequality discourses focus on the relationship between health and economic inequalities and looks at how economic inequality and health problems among the poor people have been, and how the unequal distribution of resources across the Canadian population can have adverse effects on health of the population and the entire community. Economic inequality is also shown to be the cause of societal adverse effects and mainly injure health through a system which decreases social cohesion or weakening of community infrastructure. In considering these important issues, one cannot avoid asking where the Canadian health practices and health policies fail.
Canadian Governments’ Focus on Health Inequalities
Canada has been known for its active participation in promotion of health theory and practice. This section reviews various documents prepared by the federal government concerning the issue of inequalities on health. The document prepared by the government in 1974 entitled as the New Perspective on the Health of Canadians addresses important issues on health concept. Factors influencing the incidence of death and sickness in Canada were based on human biology, health care organization and lifestyle. Though the document has been criticized for over-emphasizing individual’s importance on lifestyle choices. However, the document has been significant in the identification of health determinants, rather than concentrating on systems of health care (Mitchell, 2006: 164-172).
These documents have given recommendations relating to economic and social issues which have been designed to help those who are less privileged by improving their lifestyle. In doing this, the government has realized that health, education, economic circumstances, provision of facilities for health care, and developed pre-natal care are important factors to be considered while fighting to limit levels of infant mortality. The Canadian government also acknowledge that most Canadians are still economically deprived, resulting to lack of insufficient and adequate housing.
The archived document in 1986 on a Framework For Health Promotion made an identification on the need to reduce inequities among the high and low income groups among the three major challenges which have been identified. The first challenge which the government face is the need to reduce inequalities in health, between the high income earners and the low income earners in Canada. It was identified that those people with low levels of income have more health problems while compared to people who are well off. It has also been recognized that most single parent families are mainly affected by poverty while compared to families with both parents in Canada (Stanford, 2006: 135-137).
The number of children in Canada affected by poverty is more than one million. A significant mode of improving health conditions was through coordinating public policies on health, and determinants of health potentially having a relation with income differences. Policies with a direct bearing on needs of health, need to be properly co-ordinated. The list presented in the government document is long, and among other things, it includes employment, income security, housing, education, agriculture, business, justice, transportation and technology.
The current statement by the federal government on population health promotion shows that the most recent development concern consequences of economic inequality on human health. The document entitled Population Health Promotion is a model that integrates health promotion and health problems. This document is written to the effect that health challenges among poor people is not determined by the amount of richness an individual person has, but by the way in which such wealth is distributed among various groups of people. In the same way, the social status of individuals affect human health by making a determination of the degree that people possess over situations in life, and hence their capability to take specific actions. Concern with social status and income are a major determinant of health, and are shown in the government document on Taking Action on Population Health. This paper has the main intention of promoting health programs by involving health workers at the branch levels.
The latest statement made by the government on health statistics touched on the health of Canadians. The commission of this report was done by the Provincial, Federal and Territorial Advisory Committee on population health, to enable people access detailed and comprehensive statistical overview of Canadians health status and the main factors which determine health status. The report was made with the main aim of helping program planners and policy makers to make an identification of issues of priority and to be able to measure progress in the entire population health. This report continues intellectual commitment on the part of the government to the role of major health determinants on social and individual well being (Raphael, 2005).
A big section of this report concentrated on the economic and social environment. The report states that in the case of stress, violence, unemployment and poverty, the effect of health is a direct one, such an effect is normally negative and shocking to the wealth of a country that is highly regarded as Canada. This document also focused on people with low income in Canada, much of the data has been made on the economic inequality, poverty levels and family income and was publicized through social development organizations.
Limitation of Government Policies
In the consideration of health determinant, there is need to consider both behavioral and social determinants. The government in doing this has failed because it has come up with documents which are complicated in their presentation of health issues and economic inequalities. The action of the government in most instances work at a cross purpose, while attempting to address these issues.
The current government at the provincial level elected in 1995 did put in place poor policies that enhanced the level of economic inequality within Canada, health problems and poverty. This policy froze the construction of houses and ended rent controls. In addition, the policy caused a 22% cut off in the payment of welfare, together with income tax cuts. On the issue of tax reductions, research studies found that the rich people benefited from this scheme by $15, 586 while the poor majority had a benefit of only $12, 231. These policies have caused a reduction in expenditure invested in the development of social infrastructure.
Current Public Health Practice in Canada
From two studies conducted to consider the role played by the public health sector in dealing with health inequalities generally, and poverty in particular, the first study looked into emphases of public health, while the other focused on provincial, federal regional projects on health, especially those dealing with poverty within Canada. The third study carried out focused on the way in which Canadian, public health workers and others have been responding to health inequalities.
Health Practices at the Provincial Ministries
From a survey carried out in six provinces dealing with public health practice, the practice was found to be consistent within these provinces in Canada. The possible core strategies and content areas were control of communicable disease, and health protection, population health and health promotion, direct services among other roles. This showed that most provinces lacked evidence of any mandated programs which were explicitly focused on health, addressing the major health determinants, or making use of multiple strategies (Stewart, 2006:9-10). Though most provinces had the main concern of dealing with the control of communicable and health protection, this did not result in the implementation of mandated programs. As a result, most on these commitments did not work out well to yield the desired results.
Informants at the provincial levels have said that the reasons for these failures have been experienced due to lack of focus on public health and lack of political commitment, as well as the failure to do proper allocation of resources on health issues. Informants claim that issues of public health have been overshadowed by putting more focus on acute and care services which were expected to last in the long term.
While looking at the regional health projects and the federal, provincial concerns on poverty, two territories and ten provinces were used to do this study. Four projects initiated by the federal government addressed issues of nutrition education, post natal support education, and parental education. The other focus was concentrated in addressing and attending issues of poverty planning, such as antipoverty strategy and strategic plans. Other projects were focused in the reduction of health barriers and economic burden, such as provision of housing, clothing, food coupons, extended health benefits and dental care among others (Labonte, 2005: 244).
Strategies put in place to address these issues were either political in nature, community or organizational. The ministry of health supported these projects either through involving political strategies or through making of policies to be used by other organizations. Political strategies included the lobbying of the government concerning social assistance, minimum wage, educating politicians and affordable housing
This study shows that the Canadian government greatly participate in a variety of initiatives which address poverty. Though these initiatives play a vital role, they have not done much to alter the political and socio economic conditions which contribute to poverty as experienced by most Canadians. Until these significant structural conditions are altered, there will be limited improvements in the Canadian health problems.
Why the Government Should Get involved in Solving Problems of Economic Inequality
Studies have established that, though the Canadian government has been actively involved in solving economic and health inequalities, it has not been able to achieve these goals due to lack of good strategies. Public health organization and other organizations involved in these activities have put in policies which work at a cross purpose, hence unable to accomplish their mission. There is need for the government to do proper research and come up with appropriate programs and policies to tackle economic inequality, health problems and poverty.
From the above discussion, it is clear that the Canadian government has a policy which considers social status and personal income, as well as issues of economic inequality, and various determinants of health. The government should come in to emphasize on equality in social status and income distribution. Studies have shown that, most people suffer from income inequality and health problems not because of the difference in earnings, but due to unequal distribution of resources. The government should therefore implement new policies to ensure that wealth is distributed equally to all people. In this aspect, equality may mean that the poor should be given special treatment to help bridge the big gap between the rich and the poor (Gadd, 2003: 244-246).
There is need for the government to focus on health determinants. This will help to ensure that the root causes of health problems and income inequality are tackled, to avoid such future problems. From the list of potential health determinants which are available from the government list, the Canadian government can put in place policies and programs to face such challenges and to ensure that poverty is eradicated within the country.
It is important that the government should implement the available infrastructures and policies to reduce unequal income distribution between the rich and the poor. The center for policy alternative should ensure that the federal governments put in place alternative budgets in favor of the poor people.
Conclusion and Recommendations
From the above discussion, it is clear that economic inequality consequently result to health problems and poverty within Canada. The Canadian government has been on the forefront in promoting participation in health campaigns and in the implementation of programs and policies to fight economic inequality, poor health and poverty. Despite these efforts, little has been achieved in reducing the gap between the rich and the poor in Canada. The government should conduct a proper researcher to establish the best policies and programs to deal with these issues.
It is also suggested that people who are concerned with poverty and economic inequalities effects upon health are supposed to do good training, and also educate others about the root causes of economic inequality (Williamson and Reutter 2005: 166-167).
The Canadian government should ensure that any activity carried out by the Federation government with regard to life indicators on human health should be directly linked to the established evidence regarding the main role of infrastructures at the society level in supporting health. Lobbying and advocacy activities should be carried out to ensure that the public is made aware of the importance of infrastructure and showing the need to avoid policies which increase economic inequality, because they weaken social infrastructures and increase poor health and poverty.
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