Poor income, poor health

Here’s a question for you. Which of the following increases your risk of developing heart disease, diabetes, cancer or respiratory illnesses the most?

a) a sedentary lifestyle
b) a poor diet
c) smoking
d) poverty

If you answered any of the first three (a, b or c), you’ll be surprised to learn that none of these factors alone cause poor health more than living in poverty can.

Yesterday, the Toronto Star published an article written by Stephen Lewis and Linda Silas (the President of the Canadian Federation of Nurses Unions), in which they discuss the significant impact of inequality on health outcomes in Canada.

As the authors note, there are many reasons for us in Canada to celebrate our public health care system and its provision of universal care regardless of income. However, if we are to truly foster health equity in our society, we must address poverty and growing income inequality.

What causes poor health? It is well known that personal behavior such as smoking, eating poorly and not exercising enough can all increase the risk of developing chronic illnesses later in life. However, these activities are most often viewed as individual choices, removed from the environmental and social context in which the individual lives.

However, if you are living in poverty, a lack of a nutritious food and leisure time for exercising is often not a matter of choice, but a matter of insufficient income. While it’s true that people with high incomes do not always make healthy lifestyle choices, their income does provide them with the option of doing so if they choose. Not so for many who live below the poverty line.

Numerous studies have demonstrated the impact of poverty on health. In his book Poverty and Policy in Canada: Implications for Health and Quality of Life, Dennis Raphael notes that, “Canadians living within the poorest 20 per cent of urban neighbourhoods die earlier from a wide range of diseases that include cardiovascular disease, cancer, diabetes and respiratory diseases…than other Canadians” (Raphael, 209).

An inability to afford fresh, nutritious food, coupled with the stress created by poverty and social exclusion, can have a lasting impact on physical and mental health.

As Lewis and Silas point out very well, achieving health equity begins long before people are at the point of entering a hospital; it begins with ensuring they have an income sufficient to meet their basic needs.

Poverty reduction strategies can therefore also be public health strategies. Reducing poverty can improve health, reduce incidence of disease and illness, and enable people to lead more engaging and productive lives.

Inequality, and the poor health outcomes that result from poverty, are costs that are shared by everyone in society through an increased use of public services, including health care. Therefore, we all can benefit from poverty reduction.

I have been following the current health care reform debate in the United States in recent weeks. Learning about it makes me grateful that our society decided decades ago upon a system in which care is provided to those in need, regardless of their income.

However, we still have a long way to go. We will only truly be addressing health outcomes when we decide that poverty in our society is as unacceptable as having to pay to see a doctor.