The Politics of Health

by Diana Daghofer

Barack Obama, Pope Francis, the International Monetary Fund (IMF) and organizations like Oxfam and the World Health Organization are all saying it: Inequality is the greatest concern of our time. So what’s it going to take for our governments to act?

Dr. Gary Bloch, a family physician in Toronto and a founding member of Health Providers Against Poverty, is outspoken about his frustration, recognizing that there is so little he can do for patients whose chief ailment is a lack of income. As he puts it (in a Globe & Mail op-ed) , “That we set our minimum wage to benefit companies’ bottom lines, and not to ensure low-wage workers are able to stay healthy, and to afford the basics of food, shelter, clothing and other necessities, is both a tragedy and a public health travesty.”

Inequality does not serve anyone except the extremely wealthy. Public health advocates have pointed out the health implications of the income gap for decades. It is getting worse, and now, many other influential voices are joining the chorus:

• A recent Oxfam report says the world’s 84 richest individuals have as much wealth as the half the world’s population, the 3.5 billion poor.
• The IMF is concerned about world stability, pointing out that inequality within countries, “fuels resentment, protest and instability,” as evidenced by riots in Brazil and Turkey, countries that have experience significant economic growth of late.
• The key message from the World Economic Forum’s (WEF) annual “Global Risks 2014” report is that rising inequality is “the top global risk.”
• Pope Francis urged participants at the WEF annual conference in Davos, Switzerland in January to work towards a “better distribution of wealth, the creation of sources of employment and an integral promotion of the poor which goes beyond a simple welfare mentality.”
• President Barack Obama focused on inequality in his State of the Union message, saying, “no one who works full time should ever have to raise a family in poverty.” The President committed to raise the federal minimum wage to $10.10 per hour, and called upon private businesses to follow suit.

But while the media is making much of the economic and political concerns caused by growing inequality, are corporations or governments changing their practices? News reports out of Davos say that the conference agenda didn’t do much to alter participants’ conversations outside of WEF14 meeting rooms.

In the past 30 years, corporate and individual taxes, especially for high-income earners and large corporations, have decreased substantively in Canada. Combining federal and provincial rates, corporate taxes declined by half between 1970 and 2012 (from over 50% to 25%).[1]  In British Columbia, top income earners saw their taxes decrease from 82.4% in 1970 to 43% by 2010.

Our current federal and provincial governments don’t seem in the least bit inclined to increase corporate and personal taxes, even among the very rich. As Gary Bloch says, “Our governments can continue to legislate poverty and ill health, or they can build legislative bridges to a healthier life for everyone.”

So, how is it that we keep voting in governments that put corporate interests above those of citizens? According to Oxfam, the concentration of wealth is no accident: “Wealthy elites have co-opted political power to rig the rules of the economic game, undermining democracy…”

Given the undeniable evidence, how do we make the dramatic changes needed to take control of wealth out of the hands of a tiny minority and back to the majority?

Diana Daghofer is a PHABC Board Member and a public health consultant living in Rossland, British Columbia.

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[1] Arne Ruckert and Ronald Labonté, The global financial crisis and health equity: Early experiences from Canada

Globalization and Health 2014, 10:2 doi:10.1186/1744-8603-10-2

Local Actions for Reducing Health Inequalities

By Jalil Safaei 

The Social Determinants of Health (SDOH) discourse is getting more practical for improving the health of populations and reducing health inequalities. Following the WHO Commission on SDOH Report in 2008 (Closing the Gap in a Generation), which emphasized acting on SDOH, a recent significant report published by the British Academy for Humanities and Social Sciences titled – “If You Could Do One Thing …” Nine local actions to reduce health inequalities – identifies nine local actions that could be implemented at the local level to improve the community health and reduce health inequalities in the community.

The report consists of nine chapters, each devoted to a specific local action for reducing health inequality. The actions correspond to and address various social determinants of health and health inequality. They include:

1. Implementing a living wage
2. Increasing early childhood education
3. Implementing 20 mph speed limits for cars in residential areas, by shops and   schools
4. Tackling health-related ‘worklessness’: a ‘health first’ approach
5. Building ‘age-friendly’ communities and cities
6. Using participatory budgeting to improve mental capital
7. Improving the employment conditions of public sector workers
8. Increasing the scope of adult and further education
9. Evaluating policies for evidence of cost effectiveness

Written by prominent scholars from various social sciences, the report is a welcome and timely interdisciplinary document for guiding local actions to reduce health inequalities in the communities where people are born, live, work and age. The report provides evidential support to some of the initiatives suggested by our local public health advocates in British Columbia.

Jalil Safaei is a PHABC Board member and Associate Professor at the University of Northern British Columbia.

The Power of Myths

By John Millar

For those of us involved in advocacy and lobbying to reduce health and socioeconomic inequities, it is not unusual to be met with a couple of common responses:

• There is no real poverty
• Inequities are inevitable – they have always been with us and they are actually needed to motivate people to work and invest
• We shouldn’t tax the rich because they are the job creators and the engines of economic growth

THESE ARE ALL MYTHS

There are several reasons these myths persist:

• To many wealthy people living in affluent neighbourhoods (or gated communities), there is little visible evidence of poverty and little or no contact with poor people
• As a consequence, there is an ‘empathy gap’: the well-off simply don’t care. See Daniel Goleman – Rich People Just Care Less
• Concerns that increasing taxes on the wealthy will reduce job creation and economic growth
• There has been a successful misinformation campaign conducted by conservative think tanks funded by corporations and wealthy donors to convince the public that an agenda of lower taxes, smaller government and fewer public investments in social programs and infrastructure is necessary for economic growth; and through ‘trickle down’, poverty will be solved

This banned Ted Talk by billionaire Nick Hanauer helps to dispel some of these myths:

Why Austerity Kills

By Dr. John Millar

In a recent book ‘The Body Economic – Why Austerity Kills. Recessions, budget battles, and the politics  of life and death’, David Stuckler and Sanjay Basu review the evidence from a worldwide natural experiment in political economic approaches to dealing with recessions: ‘austerity’ vs. ‘stimulus’ (http://thebodyeconomic.com/).

The Body Economic by Stuckler and Basu

The austerity approach aims to reduce government debt and deficit by cutting government expenditures (healthcare, education, housing, unemployment) and privatizing as many services and businesses as possible. The stimulus approach is more tolerant of debt and deficit and maintains government investments in social services such as healthcare, education and unemployment. The most drastic austerity approach was applied in Russia in the 90s driven by a concern that once the Soviet Union collapsed, a rapid transition to capitalism was needed to prevent a return to communist political control. The approach advocated by economists such as Jeffrey Sachs and Milton Friedman was called ‘Shock Therapy’: massive rapid privatization and deep cuts to government healthcare and other services. The result was widespread unemployment and poverty and 10 million deaths (life expectancy dropped by 7 years). The deaths were mostly working age men due to suicide and alcoholism. The health of the population has still not recovered. Shock Therapy was successful in establishing capitalism but in a highly inequitable form: wealth concentrated in the hands of a few, an oligarchy.

Other countries from the Soviet bloc such as Poland and Belarus took a more gradualist approach as recommended by Joseph Stiglitz: slower privatization and the maintenance of essential social programs such as healthcare and education. This avoided a deterioration of population health and a quicker economic recovery.

Visit: http://thebodyeconomic.com/

In Southeast Asia in the late 90s, an austerity regime imposed by the IMF on Thailand resulted in widespread poverty, unemployment and hunger followed by a rise in HIV, suicide and infant mortality. By contrast Malaysia took a stimulus approach resulting in few negative health effects and a more rapid economic recovery.

When a severe recession hit Iceland in 2008, demands by the IMF for austerity were democratically resisted. So instead of austerity, healthcare spending was increased, a job-matching program was funded and debt relief provided by government for small businesses to sustain employment levels. As a consequence population health improved, homelessness was avoided and the economy made a good recovery (although many off-shore investors were left with considerable financial losses). And Iceland remains healthy and the happiest of all nations.

In Greece, Italy and the UK various forms of austerity have had serious health impacts including HIV epidemics, increased suicide rates and widespread hunger. And their economies have been slow to recover. By contrast, Sweden has invested in employment programs and maintained social programs thus preserving good population health and the economy.

The authors have three recommendations for dealing with recessions:

1. “First do no harm”: ensure that government policies are reviewed for their health impacts.
2. Help people return to work.
3. Maintain social programs such as prevention and healthcare.

The evidence that emerges from this vast natural experiment in economics and population health is that an ‘austerity’ approach (smaller government, cutting taxes, balanced budgets, cutting social programs, privatizing and relying on economic growth and ‘trickle down’) has a damaging effect on population health and results in slower economic growth. In recessions, more government investment in important social programs such as healthcare, housing, education and skills training, jobs and unemployment services stimulates the economy, preserves the health of the population, reduces poverty and homelessness and results in a more rapid and equitable economic recovery.

To quote Stuckler and Basu: “Ultimately austerity has failed …because it is an economic ideology…that stems from a belief that small government and free markets are always better than state intervention. It is… a convenient belief among politicians taken advantage of by those who have a vested interest in shrinking the role of the state, in privatizing social welfare programs for personal gain. It does great harm…punishing the vulnerable”.

The lesson for Canada and BC is that, while economic growth and job creation are important elements of economic recovery there must also be public investments in social support programs. This will lead to a more rapid economic recovery, shared prosperity and improved population health.

Dr. John Millar

– John Millar is a Clinical Professor Emeritus , University of British Columbia School of Population and Public Health, and Vice President of the PHABC.

Welfare Food Challenge Days 3 and 4

By Marjorie MacDonald

I did not get the opportunity to blog this weekend because I have been sick. The only good thing about that was that I wasn’t hungry, which made it a bit easier to cope. On Friday, however (Day 3), I thought a lot about how challenging it is to eat a healthy diet on such a low income. Although I have been able to include some fruits and vegetables, the most nutritious foods are out of my price range. There is no way to eat “organic” and if you want to eat meat, forget about buying meat that comes from animals not raised with hormones and antibiotics – you pay a premium for that.  Meat, in fact, is a luxury that would be pretty difficult to afford on a daily basis.  If you have any kind of health problem, it actually does become impossible to eat appropriately. Cheaper foods are often calorie dense, with low fibre and nutrients. Anyone living in poverty with a chronic condition, like diabetes, is going to be at very high risk for adverse health consequences. No wonder the illness and death rates are so high among the poor.

On Saturday afternoon, I dragged myself out of my sick bed to make some bean soup for dinner, thinking it would be a good nutritious meal that I could eat for several days. Variety on $26.00 a week? Forget it. My soup included mixed beans, water, two Oxo cubes, onions and carrots, and on preliminary tasting, was quite delicious. The Oxo cubes I used were pretty high in salt content so not so great for my high blood pressure, but did contribute to the good taste. Being sick, I laid down to rest while waiting for it to cook. This was a big mistake because I promptly fell asleep, waking up to the odor of something burning. OMG – it was the soup! And yes, it was badly scorched. I managed to scoop off the top layer of the soup and put it into another pot. It was heartbreaking to have to throw out about half the soup.  What was left tasted scorched. There was no longer enough to last for 3 or 4 days, but I could still get about 2 meals out of it. This kind of an event for those who are not poor might be annoying and frustrating, but for a person living in poverty, this would be a disaster that could mean hunger for the rest of the week.  For me, I can look forward to Wednesday when this food challenge will end, but there is no end in sight for those living on social assistance.

– Learn more about Rasie the Rates’ Welfare Food Challenge and how you can get involved in raising public awareness about the inadequacy of welfare rates and the costs of poverty in British Columbia.

BC Poverty Reduction Coalition: http://bcpovertyreduction.ca/

Welfare Food Challenge: http://welfarefoodchallenge.org/

Marjorie’s Welfare Food Challenge – Day 2

By Marjorie MacDonald

Keen to stay on track today, I started the day with a shopping trip – choosing the grocery store that I know is generally cheaper (but the vegetables are not as nice) than the others. I bought some mixed beans and oxo cubes to make soup, a small bag of black beans, a small bag of brown rice, a bag of mottled apples on the discount shelf, two onions, a bunch of spinach, a small bag of skim milk powder, a loaf of whole wheat bread (the cheap kind), a dozen eggs (not free range, free run, or Omega 3) and the most inexpensive small bag of ground coffee I could find. I wistfully passed over the fair trade coffee beans I might otherwise purchase. As I walked to the checkout, I saw a bunch of bananas on sale and got very excited that I had just enough money left to buy them.

If I had children to feed I would likely not have purchased coffee at all – it would be an unjustifiable expense. The sacrifices necessary of parents on welfare are a stark reality when there is only $26.00 in your pocket. It also immediately became clear to me that people on welfare do not have the opportunity to take advantage of the benefits of bulk purchasing to get the better prices.  Small bags of beans and rice cost more per unit than large bags that will feed more mouths and last longer, but buying the large bag uses up too much of the food allowance. I can see this becoming a vicious cycle and never allowing one to get even just a wee bit ahead.  You have to have money to save money!

Yesterday, I was consumed with sorting out the details of how I was going to engage in this challenge, so I did not have much time to confront and consider the meaning of this experience or why I was actually doing this.  Today, with the details taken care of, I had time to think about all of this and to confront some of the emotions that were just below the surface yesterday. I was reminded of something I had not thought about in many years – my own childhood growing up in a family of 8 children. We did not often go hungry, but the cost of food was an issue for my parents, at least when I was quite young (later their financial situation improved greatly). But then, we drank powdered milk, ate primarily hamburger for meat (or fish sticks on Friday), sometimes had a “bologna roast,” and rarely had fresh vegetables.

There was almost never enough for seconds, but when there was, the first one to finish got the seconds, so I learned to eat fast and that unhealthy habit remains with me today.  My mother had to intervene to make sure that everyone had a turn for seconds over the course of a week. What dawned on me suddenly yesterday was something I had never realized or considered as a child. You will probably wonder about my intelligence level that I didn’t realize what was going on, but my mother sometimes said – when we told her to sit down and eat was – “No, you go ahead, I’m not hungry. I ate something awhile ago.” And we would jump in and eat her share.  She was sacrificing her food so that we would have more and I was completely oblivious to this. Of course, I forgot all about it when I got older and we became more financially secure. She never discussed this with us even as adults.

Join Dr. Marjorie MacDonald, from October 16th – 23rd, as she spends a week on the Welfare Food Challenge.

But I know that this is a common experience for those living in poverty.  No one should have to sacrifice their own food and health to feed their children.  Please do your part and lobby your MLA to “Raise the Rates”.  While you are lobbying your MLA, also encourage them to support a poverty reduction plan.  To get started, visit the Poverty Reduction Coalition’s ‘Meet your MLA and Ask Them’ online resource.

Marjorie’s Welfare Food Challenge – Day 1

By Marjorie MacDonald

Because I had forgotten to sign up for the challenge in advance I did not do any real preparation. This was a huge mistake.  I had not looked to see whether there were any guidelines for participants before starting. Thus, I struggled through the first day trying to figure out what I was allowed to do. I had a lot of questions like:

1. Could I eat the food I already had in the house? I thought – probably not, but what else was I going to do since I was not prepared?   However, I was pretty sure my organic steel cut oats might be a bit too expensive.  Some cheaper no-name oats out of the bulk bin would likely be a safer choice. Put that on the shopping list.
2. Was I allowed to put food I had purchased (e.g. stale bagels I bought on sale) into the freezer to keep them from getting any staler? Someone living on welfare in a SRO would not likely have a freezer.  Hmmm. Check with Ted on that one.
3. Could I eat food that I had been given? For breakfast I did toast a stale bagel, no butter. I used some homemade jam that someone gave me. I had a vague feeling that was probably not OK, but hey, it was free wasn’t it? Note to self – find out if someone has written any guidelines for this.  I felt Ok about using my toaster (versus the freezer) because my husband bought it for $2.00 at a thrift store about 10 years ago. I had considered putting a skiff of cream cheese on the bagel (surely that small amount wouldn’t cost much?). I discovered, however, a bit of mold on the cream cheese.  Big dilemma. Should I just scrape off the mold and keep using it because I couldn’t afford to throw it out, or use my public health knowledge about food safety and get rid of it. I’m pretty sure that if I was living on welfare I knew what the answer would be – scrape it off! I got rid of it.
4. How the heck was I going to manage without my coffee? I knew for sure that my gourmet beans freshly ground in my coffee grinder would be a bit out of my price range this week. But, there was no way I could face a day on $3.50 cents worth of food without my caffeine. I had one cup. Guilt trip – cheating already on my first meal of the day!

These were just some of the many questions that I obsessed about all day.  It took me quite awhile in the morning to calculate the cost of everything for my lunch, which consisted of a hardboiled egg (about 40 cents), some carrot sticks (about 10 cents – bag of carrots $2.99, with 30 carrots, so one carrot about 10 cents), cucumber slices (10 cents), and an apple (about $1.00).  That is pretty healthy I thought!  Oh oh, probably costs too much and I’ll be going over my limit. Dinner was pasta (purchased at Costco – yikes, that is probably not ok – I wouldn’t have a membership if I was on welfare) with a bit of canned tomatoes on top and lots of pepper. Note to self – protein is going to be an issue. I definitely need to find the rules for this venture and do a proper shopping trip.

Postscript. I did look for the guidelines last night and discovered that I had broken most of the rules on the first day. No charity. No food already in your house.  Ok, I guess that means a trip to the grocery store this morning – to start fresh today on Day 2.  I promise myself I won’t cheat today.

The Welfare Food Challenge

By Marjorie MacDonald

Last year about this time, I was at a research team meeting in Richmond that included several academic researchers from various BC universities and representatives from each of the six health authorities. We were discussing the future of our Core Public Health Functions Research Initiative and how we were going to ‘re-vision and re-brand’ it. We also talked about the need to develop a new five year research agenda to build on the cross cutting themes of our current research agenda. One of those themes is “health equity.” Over our discussions, we were enjoying breakfast, coffee with fruit and muffins, and a delicious lunch – all funded by CIHR research grants – that is, by the taxpayers of Canada. I noticed that Ted Bruce was not really eating or drinking the coffee and then at lunch I asked him why he wasn’t eating. He told me that he was doing the welfare food challenge that only allowed him to spend $26 dollars a week on food. I was impressed with his fortitude in the face of such abundance. I wasn’t sure I would be able to resist eating when the food was laid out so beautifully in front of me. It did inspire me, however, and I contemplated doing the same thing the next time the challenge came around. Fortunately, it seemed ages away!

This year, I got the notice about the food challenge when I was reading Stats Canada’s recently released report on the income of Canadians and was surprised to find that I was actually in the top 10% of Canadians in terms of income. Who knew? I never considered myself rich, although I am well aware of my privilege! At least I didn’t make it into the top 1%. Having been raised Catholic, I’m pretty good at guilt, so this realization prompted me out of my cocoon and I resolved to do more than I had been to address the issue of poverty.

The food challenge seemed a good place to start but I was so busy writing another CIHR grant that I forgot to sign up right away.  Ironically, in the proposal, I was citing the poverty statistics in BC – for example, that BC has the highest poverty rate in Canada and that BC’s child poverty rate is tied with Manitoba for being the worst. To add to my discomfort, I know that poverty is a major contributor to the health inequities that I am researching. As President of PHABC, which is a member of the BC Poverty Reduction Coalition (co-chaired by Ted Bruce, past president of PHABC and blogger extrordinaire), I knew that it was time to ‘put my money where my mouth is’ (excuse the pun) and sign up for the challenge. I encourage all PHABC members to do the same. Here is the link – it is not too late – the challenge starts today.  http://welfarefoodchallenge.org/

I will be blogging about my experiences in Health Voices so stay tuned!

Marjorie MacDonald is the President, Public Health Association of BC

 

Income Inequality “No Big Deal” according to Economists

By Diana Daghofer

In North America, the Occupy movement cast the spotlight on an issue that has been the focus of grave concern around the world – income inequality. So the media flurry that came with the release of Statistics Canada’s latest report on the Income of Canadians (September 11, 2013) was no surprise. CBC’s Kelowna-based Daybreak South (September 12, 2013) and the CBC national show, The 180 (September 13, 2013), are two examples that featured leading economists, both of whom were completely uninformed of the health, social and even the economic costs of income inequality.

The numbers simply confirm what we all know – the rich are getting richer, leaving the rest of us behind. At an average of $381,000 each, the richest 1% of Canadians earn more than ten times the average Canadian income. More than the numbers, though, it is the response from leading economists that is troubling for the future of our country.

Take, for example, the response to Daybreak South host, Chris Walker’s, excellent question “Why does it matter that there is a gap?”  His guest, UBC Okanagan economics professor Ross Hickey, was pretty nonchalant: “Things have been going better for most of us. The gap matters because people care about it. Extreme wealth bothers people.” The good professor proceeded to talk about the value these wealthy few bring to our nation: “There is no reason to try to trip these people up, because a lot of what they are doing is fuelling the economy and providing jobs for those at the low end of the income distribution.”

On CBC’s The 180, guest Terence Corcoran, editor of the Financial Post, echoed those sentiments, actually saying, “Inequality is not a bad thing. It is inevitable…in any political system.” When asked whether he thought anything should be done about growing income inequality in Canada, he said, “What’s the point? What are we trying to accomplish?” Well, I would ask him, “How about saving lives?”

No reason to reduce the gap?

Public health practitioners, and many beyond our circle, know that the social determinants of health – with income leading the way – are the prime predictors of disease and illness. Living conditions out-trump the effect of any behavioural risk factors, including diet, exercise and even tobacco use.[i]

Here are some of the effects of income inequality on health, comparing those living in neighbourhoods with the lowest 20% average income in Canada to those in the wealthiest 20% average income:

• Infant mortality is a very sensitive indicator of societal health, and Canada is a healthy place, right? So it would likely surprise most Canadians that 40% more babies die in their first year of life in our poorest neighbourhoods (7.1 of 1000 live births) than our richest (5.0 of 1000 live births).[ii]
• Suicide rates in the lowest income neighbourhoods are almost twice as high as in the wealthiest neighbourhoods.[iii]
• Men in Canada’s wealthiest neighbourhoods live, on average, almost 4.5 years longer than those living in our poorest neighbourhoods.¹
• People in our poorest neighbourhoods are almost one and a half time more likely to have a chronic disease than those in the wealthiest neighbourhoods, and almost twice as likely to be hospitalized for them.²

Literally hundreds of research reports show us that health inequities in Canada are widespread and affect us at every stage of life.

Does Wealth = Health?

It is true that, at every step up the income ladder, people are healthier, overall. The economists pointed out that the incomes of the poor are increasing. So, does more wealth mean better health? Not necessarily. It is actually the gap between the rich and poor that is the best indication of health, or the lack thereof. Countries with the smallest gap between rich and poor are those that report the best health of their populations.² Of course, those countries take an active role in distributing resources more equally among their populations, and tend to invest more in their social infrastructure.¹ In other words, income inequality – leaving people in poverty – is a choice that governments (and those that vote them in) make.

The Financial Impact

Leaving lives lost for a moment, more illness clearly increases healthcare costs. In 2010, the cost of ‘avoidable’ and ‘excess’ hospitalizations was over $400 million.³ And it hits us at the other end of the economic scale, too.  When people are sick, they can’t contribute to the workforce and other economic productivity.

So, while Messrs. Hickey and Corcoran could be excused for not recognizing the health impact of the income gap, they should understand its economic impact. In 2011, the International Monetary Fund identified “the increase in inequality (as) the most serious challenge for the world.”[iv]

Researchers, policymakers, the Canadian Medical Association and countless public health practitioners have expressed deep concern about the health, social and economic consequences of the increasing gap between rich and poor in Canada, and around the world. I applaud the media’s efforts to cover the issue, but the next time they interview economists about income inequality, I would ask them to include a public health professional who can bring to light the many evidence-based solution to this problem. Many people believe that poverty is inevitable. It’s time we show them that it is a choice our governments, with voter support, have made.

Diana Daghofer is a public health consultant living in Rossland, British Columbia and a member of the Public Health Association of British Columbia

References and Further Reading

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[i] Raphael D, Social Determinants of Health: Canadian Perspectives, 2nd edition, Toronto, ON, Canadian Scholars Press, 2008

[ii] Raphael D (2010), Health Equity in Canada. Social Alternatives Vol. 29 No. 2, 2010

[iii] Canadian Medical Association (2013), Submission on Motion 315 (Income Inequality), Submitted to the House of

Commons Standing Committee on Finance, April 25, 2013 [cited September 12, 2013]. Available from: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Submissions/2013/Income-inequality-Brief_en.pdf

[iv] Philip Aldrick, “Davos WEF 2011: Wealth Inequality is the “Most Serious Challenge for the World,” The Telegraph, January 26, 2011.

Need We Say More

By Ted Bruce

Need we say more? Apparently yes. The evidence on the impact of low income on health such as that described by Dr. Patricia O’Campo just keeps piling up.

When many people working full time cannot get out of poverty. When many people working full time cannot get out of poverty. And when we ignore studies showing that acting on critical social determinants of health such as quality child care makes economic sense for our society, it is clear there is something very wrong. The need to invest in poverty reduction is an elephant on top of the table not under it. Fortunately, we know from other public health efforts that the evidence eventually does lead to action. Just consider the 12 great achievements in public health as recently documented by the Canadian Public Health ssociation: http://www.cpha.ca/en/programs/history/achievements.aspx.

It can be frustrating to see a lack of action, but that is all the more reason for public health practitioners to speak out about the evidence. Thank you Dr. O’Campo.

Ted Bruce is the Past President of the PHABC

Further reading:

Social policy is health policy. Vancouver Sun Opinion: Poverty linked to multiple health problems in new mothers, study finds | Patricia O’Campo |  August 28 2013

BC’s welfare recipients need immediate relief | Seth Klein, Lorraine Copas, Adrienne Montani | April 24 2012

2012 Child Poverty Report Card | First Call: BC Child and Youth Advocacy Coalition | November 2012

15 by 15: A Comprehensive Policy Framework for Early Human Capital Investment in BC | Human Early Learning Partnership | August 2009