Your income has a greater impact on your health than lifestyle choices

TheRecord.com – opinion/columns
Oct 19, 2013.    By Cameron Dearlove

If you’re worried about taxes, if you’re worried about the costs of health and social spending, this is for you.

As government treasuries continue to get squeezed with declining revenues and increasing costs, and middle-class families struggle with greater financial pressures and a tough labour market, people fret more over taxes.

The knee-jerk response to these pressures is to cut spending and put off investments in health care and social programs. But the data is in: the best way to control health and social spending is not through cuts, but by tackling inequality, fighting poverty, and investing in healthy communities for our children.

The study of the social determinants of health provides us with the best opportunity for reining in long-term health costs. The social determinants are the economic and social conditions that determine the health of individuals and communities. Research has shown that economic and social conditions are more important factors in determining health than individual and family behaviour.

Put simply, your income has a greater impact on your health than lifestyle choices. One oft-cited study revealed an astonishing 21-year life expectancy gap between two Hamilton neighbourhoods — one affluent, one with entrenched poverty. That poorer neighbourhood’s life expectancy of 65.5 years isn’t close to Canada’s average. If it were a country, it would rank 165th in the world.

We find equally striking numbers when looking beyond communities to the health costs of individuals experiencing poverty. A study in Vancouver determined that the costs to the health system of one homeless individual accessing emergency services can reach $55,000 a year, a figure well beyond what it would have cost to house this person.

Supportive housing projects, like SHOW in Waterloo, have been shown to save public funds by keeping residents housed and healthy. Study after study shows our ticket to sustainability in health care lies in reducing inequality and eliminating poverty.

The connection between income and health costs is clear, but for a fuller picture we should apply the social determinants more broadly.

Let’s consider, for example, the social determinants of crime. Our prison population is made up disproportionately of people experiencing poverty.

One Toronto Star study revealed that 70 per cent of offenders arrived in prison with an unstable job history. An Elizabeth Fry Society report revealed that 80 per cent of incarcerated women were in for poverty-related crimes.

According to Senator Hugh Segal, it costs $144,000 to house a federal inmate for a year, but only $12,000-$20,000 to bring a person out of poverty, leading to savings across the spectrum.

What about the social determinants of childhood development and education? Poverty can actually leave a mark on a child’s brain development. A Berkeley study identified differences in prefrontal cortex development based on a child’s socioeconomic background, a part of the brain responsible for problem solving and creativity.

Studies across age groups show that the stressful reality of poverty takes up so much mental energy that it can negatively impact an individual’s pursuit of education.

In Ontario, kids coming from low-income families are far more likely to be taking applied math over academic math than students from higher-income families. Another Ontario study found nearly half the students who left high school without graduating lived in low-income families.

Many people and organizations in our community work to mitigate the impacts of poverty on kids, such as Nutrition for Learning, an organization that organizes breakfast programs in local schools. They do amazing and necessary work, but no amount of food can fully remove the impact poverty can have on a child.

The good news for taxpayers is that investing in our children is actually good for the economy. James Heckman, a Nobel Laureate in Economics, found that every dollar invested in early child education saves between $4 and $17 in future social costs.

All of this is not to say that poverty inevitably leads to poor health, lower educational outcomes, or crime for an individual. It does mean that from a systemic view, poverty carries serious consequences for individuals and communities.

People like to believe that our individual efforts and decisions determine our fates, but the social determinants expose the naiveté of this view. Pulling oneself up from one’s bootstraps isn’t impossible. But systemically, the dice are loaded.

It’s time we put to rest the assumption that cuts to social and health spending save money. Let’s judge spending decisions instead on the social determinants of everything.

Cameron Dearlove is a community developer who lives in Kitchener.

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