Good public policy can mitigate health woes

Canada.com – saskatoonstarphoenix/news/forum
Thursday, February 10, 2011.   Mark Lemstra, Special to The StarPheonix

My last four columns have described the impact of income on health.

Some find it difficult to believe that income is not only the greatest predictor of health outcomes, but one of the largest predictors of risk behaviour as well.

Although most people understand the impact of poverty on health, it is harder to conceptualize how mid-income people have much worse health outcomes and engage in more risk behaviours than do residents with high incomes.

The reality is that higher income not only is associated with greater social status but a higher degree of control over one’s life and the ability to participate more fully in society. In this regard income is not the end point, but a means to an end to improve our quality of life.

The psychological experience of income inequality affects not only our mental health but our physical health, as well.

Let’s take a step back to demonstrate that income predicts mental health problems and then provide some explanation as to how. A literature review published in the American Journal of Epidemiology found that lower income adults were 81 per cent more likely to experience major depression, compared to adults with higher income. Another literature review published by the Saskatoon Health Region in the Canadian Journal of Public Health found that lower income adolescents were 149 per cent more likely to suffer from depression than were higher income adolescents.

The theory as to why lower income residents are more likely to experience mental health problems is called social causation. This line of thought suggests that mental health problems are more likely to result when people are offered differential access to resources such as quality education, and rewards such as good jobs with decent pay and benefits.

Some see nothing wrong with this. Those who believe in functionalism point out that in order for society to progress, we must distribute resources and rewards unequally. This ties in with philosophy that promotes the survival of the fittest.

Others have a completely opposite opinion. Conflict theorists would suggest that those in positions of power intentionally restrict access to resources and rewards in order to maintain their advantage in society.

All that said, these macro social theories do little to explain how income has a direct impact on mental health. For that, we need micro social theory.

Increased stress is the most widely described explanation for higher rates of mental disorder within lower income groups. Not only do these groups have more stresses such as insecurity in income, housing and food insecurity, and exposure to violence and so on, but they also have fewer resources to deal with these challenges.

For those who believe that you can medically treat someone with depression when the original cause is income inequality, it is ironic that we then restrict access to mental health treatment resources by cost, location of services, entrance requirements, and so on. The mismatch between the life experience of people and their reduced capacity to cope with the challenges creates psychological distress.

To appreciate this, all we have to do is think what it would be like to live in a neighbourhood with high rates of violence, crime, poverty and unemployment.

Regrettably, it is even worse for children, who have no choice in their parents. The conditions that children live in aren’t of their choosing, and extend past the home.

The income of parents influences what neighbourhood the children live in, what school they attend, and what levels of support they will receive. As such, material deprivation is even more harmful for children than it is for adults.

If you recall the literature reviews I mentioned, lower income children have more mental health problems in comparison to other children (149 per cent higher). The other problem with deprivation in children is that these are their formative years. Is it really that hard to conceptualize why children would do poorly in school and have no aspirations of attending university when they have much more serious problems at home?

This is not to suggest that higher income guarantees good health or that lower income assures someone of poor health. It only means that, on average, higher income people will enjoy better health than will middle income people, who will enjoy better health than do low income residents.

The good news is that if bad public policy can create these problems, good public policy can reduce them substantially.

However, to get to that point, we will need to conclude that social inequalities in health outcomes are not only preventable, they are inexcusable as well.

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