Trevor Hancock: Poverty serious detriment to public health

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I was pleased to see the B.C. Ministry of Health use the powers of the provincial health officer to designate opioid drug overdose deaths a public-health emergency. But this is not the only, nor is it the largest, such emergency.

Of the likely candidates for designation as a public-health emergency, none seem as important as poverty, especially in B.C.

B.C. remains the only province that does not have a poverty-reduction plan. Yet the B.C. Poverty Reduction Coalition notes that 9.9 per cent of the province’s population lives in poverty — and that it is more than 13 per cent, if we use a measure of poverty that reflects the actual cost of living.

Disgracefully, the poverty rate rises to more than 20 per cent among children, according to First Call’s 2015 B.C. Child Poverty Report Card. Child poverty is never the fault of the child, and yet it handicaps many children for the rest of their lives, at great social and economic cost to us all.

For working people, B.C.’s low minimum wage and high cost of living compound the problem.

In a report released last week, the Canadian Centre for Policy Alternatives notes that at $10.45 an hour, B.C. has the lowest minimum wage in Canada. The report states:

“A minimum-wage worker with no dependents working full-time earns less than the poverty line both before and after tax.”

And while the government has announced increases to the minimum wage, the report notes “workers in B.C. will continue to earn less than the poverty line even if they work full-year, full-time.” It seems that the B.C. government is not interested in helping or supporting those living in poverty to get out of poverty.

Meanwhile, the province’s social assistance rates remain low. The Public Health Association of B.C. noted in April: “The B.C. provincial budget tabled on Feb. 16, 2016, marked the first time in nine years that there was any increase to the disability benefits of people with disabilities. Those on welfare have not received an increase since 2007.”

As the association notes, B.C.’s rates “are among the lowest rates in the country, in one of our most expensive provinces.”

This indifference to poverty comes at a cost, both in human and economic terms. At the national level, a 2015 report from the Canadian Institute for Health Information found “there has been minimal progress in reducing the health gap between lower- and higher-income Canadians over the past decade.

“For the majority of indicators, this gap has persisted or widened over time.”

In B.C., a 2013 report from the Health Officers Council reported that average life expectancy in 2006-10 in the Local Health Areas with the highest socio-economic status was 4.7 years higher than in the lowest scoring LHAs. Moreover, the gap between rich and poor LHAs had actually increased by 1.1 years between 2002-06 and 2006-10.

A recent report from the Public Health Agency of Canada examined the direct economic burden of socio-economic inequalities in health. The agency looked only at acute-care in-patient hospitalizations, prescription medications and physician consultations, which together represent only a quarter of all health-care expenditures.

While cautioning that we can’t necessarily conclude that having a lower income causes poorer health, or that reducing income differences will reduce differences in health-care costs, the report nonetheless states: “Socio-economic health inequalities cost the health-care system an estimated $6.2 billion annually,” or more than 14 per cent of total annual expenditures.

Personal experience and common sense, as well as a great deal of evidence, tell us that poverty results in poorer health. There is little doubt that inequalities in income translate to inequalities in health, which translate into additional health-care costs. It is time the B.C. government recognized that if opioid overdose deaths are an emergency, poverty is a far greater and more long-lasting emergency.

We need a concerted plan to reduce poverty and the health inequalities and economic impacts that result. Among other things, this plan needs to include a fair minimum wage, so people who work full time are not left in poverty, a level of social assistance that respects human dignity and a solid commitment to ensure that no child in B.C. grows up in poverty.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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