Recently Ontario Health Minister Deb Matthews made a speech to the Toronto Board of Trade in which she introduced changes to the province’s health care system. Hmmm – interesting choice of audiences. The Ontario government is preparing for an upcoming provincial budget. It is widely expected to contain drastic spending cuts as recommended by economist Don Drummond, who was hired to write a report on how to cut provincial costs and increase revenues. A recent Toronto Star article claims Drummond does this work for love, not money, and I suppose it’s easy to love one’s work when you’re earning $1500 a day. I may be going out on a limb here, but I’m guessing increased corporate taxation may not be the bedrock of his recommendations, although apparently significant cuts in the name of “austerity” and a major overhaul of the health care system will be.
Although we have yet to see the contents of Mr. Drummond’s report, slated for release February 15th, we already know what will work. I feel like the kid in class with her hand thrust into the air: “Ms Matthews – pick me! Pick me! I know this one….!” Yes – if Deb Matthews and the Ontario government want to reduce health care spending, all they have to do is – reduce poverty – the single most important modifiable factor determining whether someone is healthy or not.
Not long ago the Ontario government released a so-called “Poverty Reduction Plan” promising to reduce poverty for 25% of poor Ontario children by the end of 2013. Its limited focus on child poverty would be laughable were it not so sad. The McGuinty government would have us believe that “focusing on children” (or more accurately, one in four poor children) will break the cycle of poverty. Increasing the Ontario Child Benefit from $50 to just over $100 monthly per child (spread out over four years) will undoubtedly buy more macaroni and cheese, but break the cycle? Please. No amount of wishful thinking will get that notion airborne.
And while the plan’s after-school programs and parenting centres are not necessarily bad ideas, they are insufficient, and worse, reminiscent of the bad old days. In 1917, the Ontario Board of Health created Infant Welfare Centres and the Rural Child Welfare Project, which employed public health nurses to educate low income and immigrant women on parenting. Based on the fallacious notion that the health of poor children was related to their parents’ ignorance and not their poverty, it did not work then and frankly no amount of education and moral support now will erase the fact that families all across Ontario are struggling to afford the twin luxuries of housing and food. Further, the provincial plan is contingent on two unlikely puzzle pieces falling into place: a strong economy and a federal government coming willingly to the table to pony up significant dollar amounts.
Low income people have short life expectancies, higher rates of costly chronic diseases such as diabetes, and poorer access to health care. Serious about reducing health system costs? Increase social assistance rates (which in real terms have fallen 55% since 1995) and the minimum wage, which will reduce poverty, which will reduce illness, which will reduce health care costs. As income inequity increases, which it will after massive cuts to social spending, so do illness rates and health care costs.
Austerity is code used by wealthy people to avoid higher taxes and get the rest of us to bear the pain so they can keep making money. Don’t fall for it.
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It’s interesting how health care has evolved to largely take care of the results of poor decision making. We don’t need more research to figure out how to treat our diseases; we do need research to figure out how to help people to make good decisions and how to force governments and corporations to stop making bad decsions so easy.
Yes the poverty coefficient is huge and successive governments at all levels have made large platitudinous comments about “fixing” it – and yet, nothing gets done. Partly because of reluctance to increase taxes but also because to really do so means impinging on people’s freedoms – the freedoms to make choices, to have choices etc.
All of this aside, health care spending is out of control and it is out of control because so much of what we do is futile. The failure to treat the poverty problem is separate from the broken health care system. We need action to address both. Just as a for instance if 2 B dollars was sav ed in health care, and half of it was turned to really fight poverty – what would that do?
at first i thought your comments were referring to a health care system largely tasked with caring for preventable illnesses caused by the “bad decisions” of governments to keep people impoverished – which is true – and perhaps impinging on the freedom of corporations to avoid taxes! but as i read further i began to think you might be actually suggesting something different – whose poor decisions are you referring to?
My comment was deliberately ambiguos – and the following statement carried it further. Any decision is a bad one if it affects how well our health system performs or how generally ill the population is from the perspective of preventable disease. So, poor decisons in the form of not focusing on population heatlh, allowing technology to drive the direction (and expense), of health care, of social policy that forces people into bad decisons about their own health because of poverty, to social engineering that makes walking obsolete, and yes, down to and including whether or I choose not to exercise, eat in a healthy way, drink, smoke, etc.
Not addressing the poverty issue is one of those “bad decisions” – because it forces people into choices that they might otherwise not make. It isn’t an excuse for the rest of us though. How much preventable disease would be prevented if we maintained a normal body weight, exercised regularly, didn’t consume trans fats, drank only in moderation, didn’t smoke and didn’t consume salt like we do?
So much of what we do addresses “western diseases”.
The thrust of the article is focusing on those who are in poverty (and arguably kept due to ridiculous welfare rates that don’t allow you to get out of poverty) and I think we all agree that in such a situation, ‘personal choice’ is hardly a factor given the limitations of one’s income as well as social planning that prevent eating healthy or exercising.
To Mark’s other point about ‘the rest of us’ making bad decisions – First of all, it is worth recalling that physicians, in Canada, are part of the 1% in terms of income and the link between income and health is not just shown at the bottom but is a gradient so that at every income level, increasing income is linked to increasing health. This has also been linked to one’s control over life, ‘class’ in society, status etc. So we cannot operate on the assumption that it is simply the very poor that have issues related to health that stem from income. Let’s not forget that there is a large expanse of people in between those living in poverty and physicians living with significant wealth and privilege in our society and the effects these have at various levels.
I absolutely think that much morbidity and mortality and its associated cost can be prevented through appropriate lifestyle changes, however, this makes then an argument for significant investment in public health. This means we have to look seriously at subsidizing healthier food choices, taxing unhealthy ones (not just cigarettes, but sugar-sweetened beverages etc), ramping up ad campaigns, workshops, educational endeavours to promote these messages, and finally, and this is the tough one, dealing with the food industry as is appropriate. At the end of the day, public health budgets do not in any way compare to the massive marketing budgets of the food industry which day in and day out promotes unhealthy food choices which we attempt to counter with a drop in the bucket. These steps, along with addressing poverty, are all part of reducing our healthcare costs.
Great article, Kathy, we are definitely aligned with our thoughts. While I applaud the fact that Ontario and several other provinces have formalized poverty reduction strategies, most do not go far enough, and poverty is not something any single level of government or any one sector can tackle alone. Poverty is everybody’s business and I hope your post encourages others to continue to learn more about the root causes of illness and the costs we all bear by paying for the outcomes of poverty rather than investing upstream in preventing poverty. Big need to advocate for systemic change. There have been three recent federal reports on addressing poverty which all have a common underlying theme – the need for a coordinated and comprehensive national strategy, with targets, timelines, measurements, to address poverty across Canada. The reports can be accessed here:
In From the Margins Senate Report: http://www.parl.gc.ca/Content/SEN/Committee/402/citi/rep/rep02dec09-e.pdf
Federal Poverty Reduction Plan (HUMA) House of Commons Report: http://www.parl.gc.ca/HousePublications/Publication.aspx?DocId=4770921&Language=E&Mode=1&Parl=40&Ses=3
The Dollars and Sense of Solving Poverty Report from the National Council of Welfare: http://www.ncw.gc.ca/
Lori – it’s interesting that you reference 3 federal reports on poverty, while the canadian government remains one of few western nations not to have a national housing strategy – shameful.
Its quite disheartening to see just how irrational the drive for austerity is when one takes account of the significant role that poverty plays in the health equation. I wouldn’t go as far as code, but it does seem almost certain to me that the wealthier members of society simply fail to empathize with the daily realities of the poor. A prerequisite for austerity is at least some measure of affluence – you can’t give up something, temporarily or otherwise, if you don’t have it in the first place. What is austerity for some is outright deprivation for others.
I don’t hold an egalitarian view of wealth redistribution as an end in itself, but if we’re serious about improving health and well-being as legitimate ends, then across the board austerity is exactly the wrong thing to do. To talk of improving our health care system and improving health generally without taking wealth redistribution (read: better taxation) as a serious option is just that much hot air. The grand question here that most shirk from is this: How do we balance the right of individuals to their private property (income) and their (private) pursuits for happiness and the good life with the collective good of social welfare? Although we do not, as our neighbours to the South, have the right to property and pursuit of happiness written explicitly into our constitution, it would be intellectually dishonest to deny that the average Canadian has no comparable interest in keeping his money in his pocket and an interest in spending it the way he sees fit. At the same time we do have, running deeply through our social consciousness, a commitment to humanitarian concern for the well-being of our fellow citizens – this was among the major moral drivers for the establishment of Medicare in Canada in the first place. And today we see these come into a very real and very jarring conflict with each other. Now more than ever we need to have a committed and open discussion about this and its sad to see that one side (austerity and economics) has taken such a dominant hold in the minds of our policy makers.
A significant point regarding poverty is the fact that chronically ill seniors, the demographic that puts some of the biggest strains on our health care system, are increasingly finding themselves outliving their means, further aggravating the cycle.
I totally agree with the content of Kathy’s and Dmitiri’s articles! Preventive maintenance is a prudent choice to make vis-a-vis health care and wellness. Making wise investment in the medical and dental health and welfare of our children NOW would save enormous amounts of money for the government in the future. When we consider that poverty costs Ontario up to 38 billion dollars annually, it makes good fiscal sense to take steps to eradicate poverty and child poverty as much as we can. To this end, I personally urge the Government of Ontario to:
*index social assistance rates (OW and ODSP) to inflation, insuring that the buying power of the most vunerable at least stays the same in years to come;
*introduce a Housing Benefit for ON for low income tenants so that more money is available to them for essentials like food, education and transportation;
*institute a $100.00 per month healthy and nutritious food allowance for all recipients of OW and ODSP;
*increase Ontario’s minimum wage from $10.25 to $11.00 an hour to insure that all Ontarians with full time employment live above the poverty line;
*legislate a system of fair and progressive taxation.
No one in this province should have to choose between paying the rent or feeding the children! All citizens deserve to be treated with equality, fairness and dignity!
There’s a paradox operating here that, in my 44 yrs of nursing, has always been here. That paradox is that we talk about a health care’ system which, for most of us, is not accessed until we become unhealthy’! Then there are the silos’ in which our current system attempts to function, eg, MOHLTC, Min of Community and Social Services, and between which is very little communication. Seems to me that the overarching model needs to be based on a determinants of health model’ that looks at more than just lack of physical health. Your previous correspondents have mentioned prevention and wellness promotion. Yea for them! What about the social and economic determinants that influence how we stay healthy? What consideration is/has been given to them?As a nurse I’ve been through more cycles of cuts/layoffs and new programming/hiring, than I can count. To what end? Here we are again. If we keep on doing what we’ve always done, we’ll always get what we always got. Time for some politicians who have a broader visual’ capability than the current bunch seems to have.
Interesting position Dimitri poverty does seem to have a major impact on the healthcare. I just one comment and that is profit profit and more profits. The rich are getting richer and the poor are getting poorer. Poverty has been institutionalized and would bankrupt the economy to eradicate it, Furthermore poverty fulfills several functions within our society. First it provides allot of revenue treating people who live in poverty.I can only imagine how many jobs are a result of treating people living in poverty. Poverty including the working poor do jobs for minimum wage that others wouldn’t do and on and on. I’m not suggesting the government not do something I’m suggesting it’s in the best interest of the big tax payers ( the middle class) to increase both the absolute and relative impacts of poverty and then and only then will peoples health improve. Moreover the total cost of healthcare would decrease. This scenario would encourage the taxpayer to put pressure on governments to do something about the pending poverty crisis. Once the taxpayer understands that improving the health of those living in poverty would leave money in their pockets as a result of lower healthcare costs then it becomes an issue for the them. I guess the real issue here is education the public is not aware of how important the institution of poverty is and the impact it has on their bottom line.