Social Policy in Ontario

Poverty is making Canadians sick, says a report released Tuesday by the Canadian Medical Association.

The report, based on public consultations at six “town halls” in cities across the country last winter and spring, said factors such as poor housing, lack of access to healthy food and early childhood programs all affect health.

“We heard that the biggest barrier to good health is poverty,” says CMA president Dr. Anna Reid, a Yellowknife emergency room physician who says federal, provincial and territorial governments must give top priority to developing a plan to eliminate poverty.

“It really hit me in a visceral way when we did those town halls,” said Reid.

Malnourished people become ill. People who can only afford junk food or don’t have access to healthy food because there isn’t a supermarket nearby can develop diabetes. People who live in mouldy, substandard housing can get asthma medications, but it won’t make the asthma go away. Social isolation has mental health consequences, including increased suicide rates.

“The cost of inaction is higher than acting,” said Reid at a press conference Tuesday to launch the report.

About half of all health care outcomes are linked to “social determinants” such as income, housing, education, disability, gender and race. In comparison, a quarter of health outcomes can be attributed to the health care system, which includes access to health care and waiting times. Only 15 per cent of outcomes are linked to biology and genetics and 10 per cent to environmental factors such as air quality.

Canadians want sincere, legitimate action, said Reid, who is making tackling poverty the focus of her mandate as CMA president.

“This report does not point fingers,” she said. “Canada is a prosperous country and can do better.”

Among the report’s 12 recommendations was evaluating a guaranteed annual income approach to alleviating poverty through a major pilot project funded by the federal government.

Another recommendation was a national food security program to ensure access to safe and nutritious food for all Canadians, no matter where they live or how much they earn.

The report also drew attention to the issue of child poverty. The Conference Board of Canada gave Canada a rank of “C” when it comes to child poverty and placed it 15th out of 17 peer countries. Only Italy and the United States have a lower ranking.

About one in seven Canadian children live in poverty and the rate has been on the increase since the mid-90s.

It’s not an issue that can be ignored because poverty hinders the ability to sustain economic growth, the OECD has warned.

“If we could eliminate child poverty, we could go a long way to improving health,” says Reid.

Fred Phelps, executive director of the Canadian Association of Social Workers, said addressing the social determinants of health will tackle health care costs. It will take measures like a long-term commitment to affordable housing, he said.

“The roadmap exists,” he said.

“It’s the political will that’s lacking.”

Jeff Morrison, president of Ottawa’s Centretown Community Health Centre, says the centre offers services that address inequalities, including showers for people who live in inadequate housing, phone and email for those who don’t have their own access, and a door-todoor bus service for seniors and disabled people who have trouble going to a supermarket. Still, with intensification, housing costs have increased and the population base served by the centre is growing. The health centre’s biggest challenge is acquiring space to offer services, said Morrison.

Drawing attention to the role poverty plays in health outcomes is part of the role of the CMA, said Reid. About one in five health care dollars is spent addressing problems related to poverty, according to the Public Health Agency of Canada.

Doctors can help address poverty by being aware of the effect poverty has on their patients’ health, she said. The CMA is developing a tool kit that helps physicians take medical histories that take this into account. They can also get involved in a leadership role.

“We represent over 78,000 physicians. We actually have a fair amount of political leverage,” said Reid.

“It behooves us to start looking at these things.”