Linking health and low incomes – Opinion/editorial – Linking health and low incomes
August 31, 2008

In Sweden, the risk of a woman dying in pregnancy and childbirth is one in 17,400. In Afghanistan, the odds are one in eight.

This huge discrepancy is the result not of the health-care system but of the environment where people are born, live, grow, work and age. That is the conclusion of a landmark report on the social determinants of health presented to the World Health Organization (WHO) by a blue-ribbon panel of international experts this week.

The report details the slope linking income and health: The poor are worse off than the less deprived, who in turn are worse off than those with average incomes. This “social gradient” is seen everywhere, including the most well-off countries like Canada.

“Social injustice is killing people on a grand scale,” says the WHO report. “The toxic combination of bad policies, economics and politics is in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible.”

In fact, the report continues, there is little point in trying to prevent or treat illness without treating the underlying causes: poor housing, inadequate education and a lack of human rights.

The report points to Nordic countries that have followed policies that encourage equal benefits, full employment, gender equality and low levels of social exclusion as outstanding examples to follow.

And the report calls on all countries to close the growing chasm between rich and poor within a generation.

Canada does not escape this study unscathed, as the panel’s 19 members included former federal health minister Monique Begin, now a professor of management at the University of Ottawa.

Begin notes that Canada likes to brag that for seven years in a row it has been voted the best country in the world in which to live, but she asks: “Do all Canadians share equally in that great quality of life? No they don’t. The truth is that our country is so wealthy that it manages to mask the reality of food banks in our cities, of unacceptable housing, of young Inuit adults’ very high suicide rates.”

Changing this environment in any country requires “unprecedented leadership,” the report says.

One of its strongest recommendations is that all countries provide early childhood development programs and education for their youngest citizens. Those are programs that are sadly lacking in this country.

“Investing in early childhood development provides one of the best ways to reduce health inequities,” says the report. Such programs reduce the risk of later obesity, malnutrition, mental health problems, heart disease and criminality.

The report also calls on all countries to tackle the inequitable distribution of power, money and resources and to make “fair employment and decent work” a central goal of policy-making.

There are lessons here for Canada. This report should be required reading for all our politicians and policy-makers.

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