Poverty makes Ontario sick TheStar.com - Opinion - Poverty makes Ontario sick
Economic inequality translates into limited access to health-care for province's poor
August 05, 2008
Dr. Gary Bloch
Dr. Itamar Tamari
Jane D. is a 57-year-old Toronto woman with diabetes and high blood pressure.
She lives on social assistance benefits of $570 a month and has few social supports. She struggles to eat healthy food and she hasn't been able to quit smoking.
Earlier this year, she noticed some chest pain but missed two cardiac stress tests because she was looking for an apartment.
Jane's family doctor is frustrated when Jane doesn't comply with her advice but she is also frustrated with a society that keeps her patient poor.
Jane's family doctor is right to be concerned about poverty's impact on Jane's health. Poor women in Ontario are four times as likely to develop diabetes as high-income women. They also are more likely to suffer from high blood pressure, heart disease and depression.
Infant mortality rates are 60 per cent higher in poorer Ontario neighbourhoods and growing up in poverty too often leaves lifetime scars. Children in low-income households experience a higher risk of health problems throughout their lifespans, independent of their later socioeconomic status.
Even when people have enough to meet their basic needs, being lower on the pecking order still means you're more likely to get sick. A recent British study showed that men at the lowest level of the civil service had death rates four times higher than senior administrators.
Almost all Canadians have health insurance and poor Canadians are more likely to get needed health care than poor Americans. But despite 40 years of medicare, the poor still do not have equal access to services and most certainly do not have equal access to health. Even though Ontarians living in low-income areas are much more likely to have heart attacks, they are 25 per cent less likely to have an angiogram – and they wait 40 per cent longer for these tests.
Jane's family doctor is concerned that poverty is getting worse in Toronto and Ontario while it is moderating in other parts of the country. Ontario's child poverty rate is now 10 per cent higher than the rest of Canada and nearly half of all of Canada's poor children live in this province.
In its 2007 report, the Ontario Health Quality Council highlighted three approaches the health system could take to alleviate health inequalities related to societal inequality:
Improve access by having clinics open on evenings and weekends while improving physical design to accommodate disabilities and using outreach to engage those least likely to use the system.
Improve patient relations by providing culturally competent care and assistance to overcome social and economic barriers to care.
Co-operate with other sectors to improve overall population health.
Toronto's Access Alliance Multicultural Community Health Centre's award-winning Peer Outreach Worker program has hired more than 100 women from refugee and immigrant communities to teach parenting skills and facilitate maternal and child health-care services to more than 10,000 women and their families. The Toronto Client Access to Integrated Services and Information project improves the health care of the chronically homeless by electronically linking client data between different agencies.
However, ultimately the health-care system needs other sectors to take the lead to eradicate poverty. Northern European countries have child poverty rates of 3 per cent compared with Ontario's 13 per cent. In 2002, when Quebec introduced its poverty action plan, its childhood poverty rate was 18 per cent higher than Ontario's. Just three years later, the Quebec rate was 24 per cent lower.
Campaign 2000, the national coalition to eliminate child poverty, has a four-point plan for poverty reduction:
Ensure that adults working at least 30 hours per week earn enough to sustain themselves and their families.
Ensure that disability benefits provide a guaranteed and adequate income.
Provide transitional support when adults are not able to be employed. Among other things, this means changing eligibility criteria for Employment Insurance, which currently bars 80 per cent of unemployed Torontonians from receiving benefits.
Easing the financial burdens of working families with a national housing strategy as well as medicare coverage for drugs, home care and basic dental care.
Finally, certain groups such as native people and immigrants require special strategies for poverty reduction.
Comprehensive poverty reduction will require more public spending. Because of tax and program cuts, since 1993 the provincial government's budget expenditures have fallen from 19 per cent of gross domestic product to 16 per cent. Despite the health levy implemented during the government's first term, the Liberals have by and large left the Harris tax cuts in place.
In the 2008 budget, the government announced a broad series of welcome initiatives, including a low-income children's dental program and new social housing. However, the $100 million allotted for social housing pales beside the overall $732 million cutback in Ontario social housing since 2001.
If Ontario is serious about reducing poverty and its health consequences, then we need to revisit our 15-year love affair with lower taxes.
Earlier this year, Premier Dalton McGuinty appointed Youth Services Minister Deb Matthews to chair a cabinet committee on poverty reduction and the government has committed to developing a poverty-reduction strategy that will contain specific indicators and targets by the end of 2008.
As physicians who witness poverty's toll on a daily basis, we are thrilled with the government's commitment to poverty reduction and look forward to meeting with the minister to outline our concerns and recommendations.
Jane D. and her family doctor shouldn't have to wait any longer for help.
Dr. Michael Rachlis, Dr. Gary Bloch and Dr. Itamar Tamari, are members of the Ontario Physicians Poverty Working Group.