HH/HLST 3510 Poverty and Health

Mondays, Wednesdays 11:30-2:30 PM

May 6, 2013

Poverty in the News and in Your Life

Source: Campaign 2000 (2011). www.campaign2000.ca/election2011/FedElectionShortPartyGrid.pdf

Source: Glazier R.H. et al. (2007). Neighbourhood Environments and Resources for Healthy LivingA Focus on Diabetes in Toronto: ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences.

Source: Charron, M. (2009). Neighbourhood Characteristics and the Distribution of Police-reported Crime in the City of Toronto. Ottawa: Statistics Canada.

Source: United Way of Greater Toronto. (2004). Poverty by Postal Code: The Geography of Neighbourhood Poverty, 1981-2001. Toronto: United Way of Greater Toronto.

Source: Toronto Star

Overview of Course
Course

Description Course Objectives Required Text and Readings

Poverty in Canada, 2nd edition
Week

by Week Evaluation Other Issues / Questions

Accessing Lecture Slides

Go

to: http://tinyurl.com/d25pjwv Presentation Slides

click

click

on the lecture file: its a .ppt Powerpoint file

What is Poverty?
Write the first three things that come to mind.

What is Poverty?
Lacking
What

of basic necessities? what is expected of a typical

are basic necessities?

Lacking

citizen?
What

can be expected of a typical citizen in order to be happy and healthy?

How

do you decide which definition is correct?

What

are the implications of your choice?

What are the Causes of Poverty?

Individual characteristics? Features of the community? Economic and social conditions? Which we have control over? Which we do not have control over? Political issue? Political ideology of the ruling government? Political ideology of the dominant class?

Think of the Educational, Social, and Health Events that are Best Avoided
Educational Social Health

How Does Canada and Other Nations Rank Among Modern Nations in Wealth (GDP)? (n=34) where 1 is best and 30 is worst
Rank
1-5 6-10 11-15 16-20

Canada

Sweden

USA

21-25
26-30

How Does Canada and Other Nations Rank Among Modern Nations in Wealth (GDP)? (n=34) where 1 is best and 30 is worst
Rank
1-5 6-10 11-15 16-20 11 9

Canada

Sweden

USA 4

21-25
26-30

How Does Canada and Other Nations Rank Among Modern Nations in Life Expectancy? (n=30) where 1 is best and 30 is worst
Rank
1-5
6-10 11-15 16-20 21-25 26-30

Canada

Sweden

USA

How Does Canada and Other Nations Rank Among Modern Nations in Life Expectancy? (n=30) where 1 is best and 30 is worst
Rank
1-5
6-10 11-15 16-20 21-25 26-30 29 13 8

Canada

Sweden

USA

How Does Canada and Other Nations Rank Among Modern Nations in Child Poverty? (n=23) where 1 is best and 30 is worst
Rank
1-5
6-10 11-15 16-20 21-25 26-35

Canada

Sweden

USA

How Does Canada and Other Nations Rank Among Modern Nations in Child Poverty? (n=35) where 1 is best and 35 is worst Rank Canada Sweden USA
1-5
6-10 11-15 16-20 21-25 26-35

8 24 34

USA, Canada, and Sweden Rankings on Health and Social Policy Indicators Compared to Other Industrialized Nations (2000-2002) where 1 is best
(Ranking, 1 is best)

Measure Life Expectancy Infant Mortality Child Injury GDP per Capita Child Poverty Income Inequality Low Paid Employment Unemployment Benefits Public Social Expenditure Public Share Health Spending

USA 20 of 26 24 of 30 23 of 26 2 of 30 22 of 23 18 of 21 24 of 24 18 of 20 24 of 28 28 of 29

Canada 9 16 18 8 17 13 20 13 23 23

Sweden 6 1 1 17 1 3 1 11 1 1

Where are we Coming From?

What images does the term poverty conjure up for you? How about poverty in Canada? How have you come to acquire these images? What has formed the content of your discussions about poverty you may have had with parents or friends?

All conceivable evils are heaped upon the poorThey are given damp dwellings, cellar dens that are not waterproof from below or garrets that leak from above They are supplied bad, tattered, or rotten clothing, adulterated and indigestible food. They are exposed to the most exciting changes of mental condition, the most violent vibrations between hope and fear... They are deprived of all enjoyments except sexual indulgence and drunkenness and are worked every day to the point of complete exhaustion of their mental and physical energies
Frederich Engels, 1820-1895. The Condition of the Working Class in England

We know what makes us ill. When we are ill we are told That its you who will heal us. When we come to you Our rags are torn off us And you listen all over our naked body. As to the cause of our illness One glance at our rags would Tell you more. It is the same cause that wears out our bodies and our clothes.

Bertolt Brecht, 1898-1956. Workers Speech to a Doctor

Poverty and Health

Where

are we coming from? Poverty as a social determinant of health Poverty in Toronto Review of book material

Disease is not something personal and special, but only a manifestation of life under modified (pathological) conditions. If medicine is to fulfil her great task, then she must enter the political and social life. Do we not always find the diseases of the populace traceable to defects in society?

Rudolph Virchow, 1821-1902

Discourses on Poverty
What

is a discourse? Discourses on health care? Discourses on the role of government? Discourses on childcare? Discourses on taxes? Discourses on the role of women? Discourses on poverty?

The MUD (Moral Underclass) Discourse

the underclass or socially excluded are culturally distinct from the mainstream a focus on the behaviours of the poor rather than the structure of society benefits are bad for those who receive them as they encourage dependency gendered: idle men become criminals; women become single mothers unpaid work is not acknowledged dependency on the state is seen as a problem while personal economic dependency especially of women and children on men -- is not.

The RED (Redistributionist) Discourse views poverty as a prime cause of social exclusion poverty can be reduced through benefit increases it can place a value on unpaid work by addressing social, political, and economic citizenship it includes a critique of inequality and moves beyond minimalist models of inclusion focuses on the processes that create inequality implies radical reductions of inequalities and a redistribution of power and resources.

The SID (Social Integrationist) Discourse

has a narrow focus on paid work does not ask why people not working are consigned to poverty obscures issues of inequalities among paid workers has little focus on women and their lower pay than men, ignoring gender and class issues does not illuminate inequality between owners of productive capacity and the bulk of the population ignores unpaid work, implying increase in womens total workload undermines the legitimacy of non-participation in paid work.

Table 1.1: Examples of MUD, RED and SID Discourses in Canada

Moral Underclass Extremely low social assistance benefits across Canada Redistributionist Hands-Off Campaign to end clawback of the National Child Benefit to social assistance recipients Growing Gap Report and similar initiatives from the Centre for Social Justice Numerous reports and statements from the National Council of Welfare Social Integrationist Vibrant Communities Initiative

Reduction of eligibility for employment insurance in Canada Poor-bashing by Canadian governments and media

Laidlaw Foundation Inclusion Initiative

Workfare Initiatives across Canada*

Note that many punitive elements associated with these initiatives can easily be placed within the MUD discourse.

Poverty as a social determinant of health

Defining Population Health

Population health focuses on improving the health status of the population rather than individuals. Focusing on the health of populations also requires reducing health inequalities between groups. One assumption of a population health approach is that reductions in health inequities require reductions in material and social inequities.

Source: Health Canada. (2004). Population Health Approach.

What are Social Determinants of Health?

SDOH are the economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole. SDOH determine whether individuals stay healthy or become ill (a narrow definition of health). SDOH also determine the extent to which a person possesses the physical, social and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment (a broader definition of health). SDOH are about the quantity and quality of a variety of resources that a society makes available to its members.

A Policy-Oriented Approach to the Social Determinants of Health

early life education employment and working conditions food security health services

housing income and income distribution social exclusion social safety net unemployment

Source: Raphael, (2004). Social Determinants of Health: Canadian Perspectives. Toronto: Canadian Scholars Press.

Defining Public Policy

What is Public Policy?

Public policy is a course of action or inaction chosen by public authorities to address a given problem or interrelated set of problems. Policy is a course of action that is anchored in a set of values regarding appropriate public goals and a set of beliefs about the best way of achieving those goals. The idea of public policy assumes that an issue is no longer a private affair.
Source: Wolf, R. (2005). What is public policy? Available at http://www.ginsler.com/html/toolbox.htp

Income and its Public Policy Determinants taxation policy minimum wages social assistance levels family supports cost of housing costs of services acceptance of foreign credentials enforcement of anti-discrimination laws

Incomes Effects on other Health Determinants

early life education employment food security health services housing locus of control, self-efficacy, etc. recreation

Why is this Important?

Greatest challenge to developed nations is sustaining vibrant economies to support the quality of life of citizens. To do so, it is important to apply a life-cycle approach to sustainability of the welfare state. Post-industrial society must invest in citizens, especially children to support the economy and other institutions. Supporting children will nurture strong, resource and productive adults. Promote social inclusion: Active versus passive income and labour policy. Source: Esping-Andersen, G. (2002). Why We Need a New Welfare State, 2002. New York: Oxford University Press.