Health and Poverty—Inquiry
Hon. Art Eggleton:
Honourable senators, I’m pleased today to speak on former Senator Callbeck’s inquiry on the link between poverty and health.
For millions of our fellow citizens, every day is a battle — a battle with insufficient income, unaffordable housing, inadequate clothing and unsatisfactory nutrition. Just struggling to get by, these families can’t even dream about getting ahead. At least 10 per cent of Canadians are living in poverty. Approximately 1 million of them are children. The rates are even higher among Aboriginal populations. An astonishing 50 per cent of Aboriginal children are living in poverty. That’s disgusting.
Perhaps more alarming is that the House of Commons committed 25 years ago, in 1989, to eliminating child poverty by the year 2000. Here we are, 14 years past the deadline, 25 years since the commitment, and 19 per cent or over 1 million of our children are still living in poverty according to Campaign 2000. In 2014, almost 900,000 Canadians used food banks every month, which is close to a record high, and over a third of those depending on food banks are children.
Honourable senators, we also have another alarming trend — increasing income inequality. The Conference Board of Canada ranks Canada twelfth out of 17 countries, giving it a C grade for inequality. This is the Conference Board of Canada, not some left-wing think tank. According to Statistics Canada, between 1980 and 2005, while earnings for the those in the top income group increased by over 16 per cent, those in the lowest income group saw their incomes fall by 20 per cent — 16 per cent up for the top group, 20 per cent down for the bottom group, and in the middle, earnings are essentially stagnant. The top-earning 1 per cent of Canadians’ share of national income went from about 8 per cent to close to 14 per cent over the past three decades.
Some will say that the situation isn’t that bad. They will often point to Statistics Canada’s study that said the median net wealth of Canadian families hit $243,800 in 2012, an increase of 44.5 per cent from 2005. But recent research shows that the gains are not equally shared. Inequality is increasing even in net worth. The top end of society has seen drastic increases while the bottom continues to decline.
We now have a situation where the top 10 per cent account for nearly 50 per cent of the total wealth in Canada and, if you add the next 10 per cent, the top 20 per cent control some 70 per cent of all the wealth in Canada. By contrast, the bottom 50 per cent own less than 6 per cent. This is not an equal society. This is not promising news.
Why should we care about poverty and increased income inequality at all? Why does it matter? It’s because poverty and inequality bring significant consequences to the fabric of our society, the health of our people and, as economists will tell you, the vigour of our economy. Whether it’s life expectancy or literacy levels, levels of crime or obesity, violence, incarceration or addiction, the more unequal a society is, the worse it does in those areas.
We can see this first off in our cities. In Toronto, for example, a report by University of Toronto Professor David Hulchanski found that Canada’s largest city is now really a tale of three cities. One part is very wealthy, but there is a huge area of poverty, and the portion once occupied by the middle class has shrunk from about 66 per cent in 1970 to 29 per cent. Meanwhile, the low-income neighbourhoods have grown from 19 per cent to more than half of the neighbourhoods in the city.
When it comes to health and poverty, the Canadian Medical Association proclaimed that poverty makes us sick. That’s what the CMA said. They showed in a 2013 report that 50 per cent of health outcomes can be attributed to the social determinants of health, such as poverty, housing and homelessness, and 20 per cent of the $200 billion spent on health care annually can be attributed to socio-economic disparities — a lot of taxpayers’ money on this account.
Here is something: A study done by the Hamilton Spectator documented the connection between poverty and inequality and mortality in Canada. It found a 21-year age difference in life expectancy between two communities only five kilometres apart in the city of Hamilton, one wealthy, one poor. How is it that two communities separated by just five kilometres can be worlds apart in terms of life expectancy? If that one community in Hamilton were a country, it would rank one hundred and sixty-fifth in the world for life expectancy, along with many poor countries.
In Saskatoon, honourable senators, a 2006 study found that the infant mortality rate was 448 per cent higher in low-income neighbourhoods than in the rest of the city. Just think about that — 448 per cent here in Canada.
One of the reasons for this is that when poor people get sick, they frequently can’t afford medication. A 2012 Statistics Canada report found that one in ten Canadians either does not fill their prescriptions for cost reasons or deliberately skips doses to be able to save money — money they don’t have.
Honourable senators, the harsh reality for many Canadians is that even the places they call home are making them sick. A home can anchor a family and provide a foundation for such key benefits as better health, higher educational attainment and greater stability in the workplace, but not every home is the same. There is a large deficit of quality, affordable and safe housing that’s available in this country.
Many families settle for living in unacceptable environments because they simply have no other options. For a single mother, the challenge of finding affordable housing is even greater. Their children develop asthma and other respiratory problems because of mould. They live in fear of their neighbourhoods, causing unnecessary amounts of stress and mental health issues; and some do not have access to a sanitary water supply.
The past President of the Canadian Medical Association, Dr. Anna Reid, said this of the situation:
If a patient comes to a doctor with asthma, we can prescribe medication. But if that patient goes back to a home where there’s mould inside the walls and the air is unhealthy, all the medication in the world won’t make that person better.
Concerns about nutrition are also widely expressed in poorer communities, particularly the accessibility and affordability of proper nutrition. Children who live in food-insecure households are more likely to experience a range of health problems. According to a report by Canada Without Poverty, 80 per cent were more likely to report having diabetes; 60 per cent were more likely to report high blood pressure; and 70 per cent were more likely to report food allergies.
According to the Conference Board of Canada, as many as 1 million children go to school hungry in Canada. One million children go to school hungry here in Canada. Let me repeat that: One million children go to school hungry in Canada. This can lead not only to health problems, but also to decreased motivation, more absenteeism, lower grades and violence in school.
The state of health is even worse for those at the bottom end of society — the homeless. According to the Wellesley Institute, if you are a woman living in a shelter, you only have about a 60 per cent chance of living to age 75. If you are a man, you have a 32 per cent chance. These are the same odds that women had of living to 75 back in 1956; or for men, it’s like living in 1921. Those figures are for homeless people.
These are the realities of poverty and income inequality in Canada today. Let’s be clear: Poverty and inequality are not obscure issues that only concern economists or policy wonks. It’s degrading our economy, and changing the nature of our cities and the cohesion of our society. It’s skewing the cost of owning a home and creating unequal health outcomes for more and more of our fellow citizens.
It’s also taking a lot of money out of our pockets, from each and every one of us in this room. A study guided by economist and policy experts Don Drummond, Judith Maxwell, John Stapleton and James Milway estimates that poverty costs this country about $7.5 billion every year in health care costs alone; and between $8 billion and $13 billion in lost productivity. All told, they said that poverty’s bill is $30 billion a year. That’s an astounding number.
Honourable senators, where do we go from here? There are three areas where I think we need to focus. First, education is a great enabler and leveler in any society. In the Social Affairs committee report, In From the Margins, which was adopted unanimously by the Senate, we found a clear connection between the level of education achieved and the level of income received. We also found a classic Catch 22: For many, poverty keeps people from acquiring the kind of education and training they need and their lack of skills keeps them from getting the jobs that would lift them out of poverty. Breaking this cycle is critical, and breaking it begins in the earliest years of life.
Study after study confirms that children who arrive at school ready to learn become adults prepared to succeed. Among our recommendations in that report was a nation-wide federal-provincial initiative in early childhood learning. This would be money well spent. According to Canada’s former chief public health officer, every dollar invested in early years saves between $3 and $9 in future spending on health and criminal justice systems, as well as social assistance.
Second, we need to review the tax system. Our income tax system has become less progressive over time. Today, the top federal income tax bracket is 29 per cent, and it kicks in at $129,000. If you earn more, you don’t pay a higher rate. In the United States, by comparison, there are six federal income tax brackets with a top rate of 35 per cent, which kicks in at just under $380,000. The United States has a more progressive tax system than we have? That’s what the numbers say. President Obama, joined by Warren Buffet and others, is now calling for increasing taxes on the very wealthy. Let’s make our tax system fairer and more progressive.
Third, the report found that a whole range of programs, from social assistance to Employment Insurance, aren’t working. In many cases, we found that even when they did work, it was a sign they were producing two equally-devastating results. First, they were providing only enough income to keep people in poverty, not to lift them out of it; and, second, in some cases these policies were making it harder for people to escape the poverty trap.
I think the time is right to explore a basic income in Canada. A basic income through a negative income tax — which was touted by our former colleague Senator Hugh Segal on many occasions — may ensure that all Canadians would have income that pays for the basic necessities of life — food, clothing and a decent place to live. By itself, it wouldn’t provide them with the good life, but it would ensure that no one, including our children, falls below the poverty line.
Honourable senators, let me say as I close that we must decide together what kind of a country we want to live in. We must declare that the economy matters not as an end in itself but as a means to lifting up all people, not just the lucky few. If we get that focus right, then we can do better, be better and lead healthier lives.