Op-Ed: How poverty is killing us


By Ted Bruce

At the PHABC Conference this year Dr. John Millar PHABC’s Vice President outlined in a key note address some of the key issues related to poverty and health. He and Laurel Rothman recently summarized this view in an essay in iPolitics. They use an expression that is becoming more common as we gain ever more evidence of the devastating impact of poverty in Canada: poverty is killing us. This expression may seem to some to be overly charged or even shaming of governments. But the essay clearly demonstrates this is not overstating the case against poverty. I suspect the language will get even stronger the longer governments fail to address the key issue of growing income disparity and its very real consequences to our Canadian society.

Read the iPolitics article (December 11, 2014): http://www.ipolitics.ca/2013/12/11/how-poverty-is-killing-us/

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 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.

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

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.

Is the Media Doing Its Job?

By Ted Bruce

Those of us in the public health community often complain about the media failing to highlight key public health issues. We beat ourselves up about not framing issues in terms that will get attention or “traction” with the public and decision-makers. You may have noted lately some pretty fine coverage of the impact of inequality and poverty on health. The recent Globe and Mail series on inequality and the front page article in the November 21 issue of the Vancouver Sun on food deprivation in school children represent very mainstream media efforts that clearly set out the need to address the social determinants of health.

To some extent this coverage represents just how bad the situation is becoming in an environment where governments essentially abandon their role to invest in the well-being of communities and are obsessed with reducing taxes. But the good news is that it also represents a story about the persistence of public health in raising awareness. If we consider the type of coverage on poverty that we are seeing in the media, there seems to be some significant attention to the need for action to address poverty and the broader social determinants of health. But the political elite still seems stuck in what many say is a completely discredited idea of “trickledown” economics and they sell this message to the public.

Similarly, while the media is getting better at highlighting the issue of the health impacts of poverty, they fall down on what should be done about it. Generally they highlight a charitable model for solving this broad social problem. The Vancouver Sun article is tied in with the idea of people adopting-a-school to help out. While charity is important in our society, it has never been and will never be a solution to socially constructed poverty and inequality. In attempting to critique the shortcomings of the charitable model for poverty reduction, the Public Health Association of BC was part of a campaign to encourage the CBC to host a “right to food day” as a balance to the very extensive effort they make to their food bank donation campaign at Christmas. The rationale for this was very clearly articulated in a piece by Graham Riches in the Vancouver Sun. Was the CBC interested? No.

Ted Profile

So the mission is not yet complete. Good on the media when they deliver thoughtful and passionate stories about public health.  Now it is time to turn our attention to the myths about why action is not affordable and hold our political leaders to account.

– Ted Bruce is the past-President of the PHABC

Where do we go from here? Reflections on the Welfare Food Challenge

By Marjorie MacDonald

I have not been blogging for the past three days because I have been so busy with work deadlines and preparations for the PHABC Conference, rapidly approaching. Although I have not been blogging, during that time, I thought continuously about the food challenge, what it means for me, and where I go from here. Even the fact that I was too busy to blog was an indicator of my privileged position with a well paying job. I might complain about how busy I am, but the opportunity to be busy with work that I enjoy, that provides me with satisfaction, a sense of accomplishment and a conviction that I am making a contribution to society is a privilege that comes from a fortunate configuration of circumstances that so many do not have access to. 

Over the past three days, I found myself wondering – has this been a useful thing for me to do? And where do I take it from here? Clearly, the entire thing has been an artificial exercise. Poverty and food security are not issues I will have to deal with and now that the food challenge is over, I can go right back to eating what I want to eat without worry about the cost, the nutritional value, or the availability of food. So did this do anyone any good at all? Can I sustain the sensitivity I have developed this week to food security issues in a way that I can contribute to finding a solution? Will my efforts and those of the other participants in the challenge result in government “raising the rates?” Sadly, I am not optimistic. So much more needs to be done.

Many of my colleagues tell me that even though they did not participate in the challenge themselves, their conversations with me about it raised their consciousness about food security, poverty, their own relationship to food, and to a recognition of their own privilege.  All well and good, and it is a start, but it isn’t enough.   Some tell me they are prompted to contribute more to charity. Many seem to think that this might be part of the solution. But how useful is one person’s charity and what can it accomplish? Frankly, not much.  A charity response to the huge food security issues we have in this province will be a drop in the bucket that does nothing for the entire population of those affected and it does not solve the problem.  So what can we do to address the crisis of poverty in the province?

As public health professionals, we know that making significant change requires a broader, structural response. We need to change the social, environmental, and political structures that promote and sustain poverty in BC. It seems a tall order in a province that refuses to join all (but one) of the other Canadian provinces in developing a poverty reduction plan. We do have a voice and we understand the importance of advocacy. Many of us have connections in high places.  We can use our voices and our connections. We just need to get ourselves up from our comfortable living and working situations and do something, anything. However, a coordinated, collective response is likely to be more powerful than a response from one of us working alone.  Join a group that is working toward poverty reduction or food security. Talk to your MLAs.  Once again, I encourage all of you to do this.

As PHABC goes through a process to revise and update its strategic plan, we have the opportunity to do something concrete, visible, and productive to address these important issues.  Let us know what else you think we can do as an organization. Post a response to this blog, or contact us directly. We want to hear your ideas about what we, as individuals, and as an organization can do.  In many ways, we are the converted. How do we move beyond the “usual suspects”? That is where I sometimes struggle, so your ideas on that are welcome.

Marjorie MacDonald is the President of the Public Health Association of British Columbia

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


Ethical healthcare in British Columbia

By Ted Bruce

I read with interest the article in The Tyee by Christine Boyle and Seth Klein entitled Imagining a Moral Economy for British Columbia.

The article laid out the rationale and the potential for us to re-think economic development and base our decisions about the economy on a set of moral principles. The principles they articulate include ecological justice, equality and shared good.  The article resonated with me in part because of the work PHABC has been doing to bring attention to the Corporate Determinants of Health: see the recent commentary in the Canadian Journal of Public Health by PHABC’s Dr. John Millar.

But it also reminded me of the need for a moral foundation for the health care system.

PHABC has called for greater investment within the health care system on upstream prevention and health promotion. Similar to the “moral economy”, a health promoting system would be based on a strong set of ethical principles – those articulated by public health. The core principles of public health concern themselves with questions of equity, social justice and the distribution of health and risk. Public health recognizes that health is situated within the social, political, and economic environment and if the health care system is to be effective it must attend to the relationship between these aspects of society and the individual. In short, improvements in the health of the population and the reduction in health inequities – ostensibly the goals of the health care system – depend upon addressing poverty, racism and inequality.

In fact the current approach to health care, with its focus on treating sick individuals, is nearing collapse under the weight of an unlimited demand for more service and an attempt to respond to this demand primarily by improving efficiency of services geared to these already ill individuals. Many would say that addressing the social determinants of health is not the job of the health care system. But there is an important and under developed role for health care to focus on health promoting factors – to keep people healthy, to address health inequities through targeted programming and to show leadership to encourage and facilitate inter-sectoral actions to address the social determinants of health such as poverty.

It is time we redesigned our health care system based on the ethics or moral foundation underlying public health.

– Ted Bruce is the past-President of the PHABC.

Healthy Corporate Citizen Award

Corporations are an ever increasing part of our lives not just through the products and services they produce and provide, market and sell but through their involvement in shaping society through their increasing dominance in the social, political and economic life of our communities. Corporations affect our health in both direct and indirect ways.

In order to raise awareness of the role of the corporate sector in public health and in the potential for corporations to provide leadership in improving health, PHABC has created a Healthy Corporate Citizen Award.

The award is intended for a corporation, financial institution or producer/worker cooperative in British Columbia that demonstrates a broad and comprehensive commitment to promoting health through a range of policies, products/services and practices. The award is not intended to reward a specific policy, product/service or practice but rather is intended to recognize a broad commitment to addressing the determinants of health (e.g., housing and food security) that can be influenced by corporate activities (e.g., paying a living wage) and to avoid contributing to dangerous or unhealthy policies, products/services and practices (e.g., marketing unhealthy food).

PHABC members or organizations that wish to self-nominate must submit a general statement of nomination of no more than 500 words. In addition, the nominator must comment on the performance of the nominated organization in regard to specific criteria.

If you are interested in making a nomination pleasecontact PHABC (staff@phabc.org) to get more information on the criteria for the award.