In my work as a family physician in inner city Toronto, I witness how living in poverty harms a patient’s health. More important than my own observations are the words of people with lived experience, such as Mike Creek, who has described poverty as corrosive and more difficult to beat than cancer.
First, poverty means being unable to pay for basic items — the necessary ingredients for our bodies to function — including adequate food, safe housing, clothes and medications for health conditions. Second, poverty means constantly worrying. Will there be enough for rent, for transit, for school supplies for the kids? And it means constantly making tough decisions about what to pay for amongst a number of competing demands. Should I pay for my medications, or save that money for rent, and take my medications only part of the time? This constant calculus is stressful, and we now understand that such stress is likely toxic to our minds and bodies. This is particularly the case for children who grow up in poverty, whose brains are still developing. Third, poverty can be incredibly socially isolating. Often people cannot engage in activities such as meeting friends and relatives for a meal or a movie, and hence lose the supports and contacts that we all rely on. These processes work together to result in worse health.
Despite our universal health care system and other social safety nets, the health of Canadians living in poverty is significantly worse than those better off. In Toronto, a recent report found that men in the lowest income group are 50% more likely to die prematurely than those in the highest income group. In Hamilton, the Code Red project found a staggering 21-year difference in life expectancy between the wealthiest and poorest parts of the city. Statistics Canada has reported that if every Canadian were to experience the mortality rates of the wealthiest 20%, there would be 40,000 fewer deaths per year. Not surprisingly, living in poverty can increase the chance that someone will require many more health services, leading to higher health care costs. And household food insecurity — which is tightly linked to a family’s income — is also a predictor of health care use and costs.
All of this has led health providers to join in action against poverty. This has included educating ourselves about the poverty-health link and developing tools for use in clinical practice. At St. Michael’s Hospital, providers in our family health team may screen patients, asking if they have difficulty making ends meet at the end of the month. We have hired staff to specifically help patients with their income security. This can mean identifying benefits and grants that a patient is entitled to, helping to file taxes, working through a budget, and addressing financial literacy. We are rigorously evaluating the impact of this and other initiatives to address the social determinants of health.
Despite the innovative nature of such work, we recognize its limits. Far more powerful would be a basic income guarantee (BIG) that would ensure everyone was lifted out of poverty. This is an idea that is being explored in Finland, The Netherlands and here in Canada. Ontario’s public health units and almost 200 of Ontario’s physicians have written to the provincial government, urging its leaders to support a landmark trial of basic income.
Eliminating senior’s poverty seemed utopian before Old Age Security and the Guaranteed Income Supplement were introduced. And in the last decade, the number of children living in poverty has been reduced through federal and provincial benefits. Working age adults are the missing link. A basic income could dramatically reduce poverty in Canadian families, as well as improve health and reduce health services costs. This is a discussion that has rapidly moved from the fringe to the mainstream. Let’s build on this momentum.
Andrew Pinto is a family physician, public health specialist, and scientist at St. Michael’s Hospital in Toronto. He is active on twitter @AndrewDPinto.