Unit 3 - Income and Health.pdf

Income and Health Unit #3 HTHSCI 1RR3  Land Acknowledgment 1. Only take what you need 2. Leave something in the dish for other people...

Income and Health Unit #3 HTHSCI 1RR3  Land Acknowledgment 1. Only take what you need 2. Leave something in the dish for other people 3. Keep the dish clean Source https://www.whose.land/en/treaty/dish-with-one-spoon AGENDA Quiz 1 OCT 7 Know sequence of things Don’t need to know specific dates or stats Know larger trends Defining poverty Practice Questions Income as a SDOH According to WHO conceptual framework what is considered a structural determinant of health? Social gradient Social policies What was significant about 1974 lalonde report? It emphasized the export ace of lifestyle and environment on health Improving quality of health The psychobiological stress response is a combination of stressors and resistance factors: True (no true and false on the quiz) In terms of Canadian healthcare system what is a federal responsibility? Delivering direct health services to specific groups (refugees, rcmp, military) Mickey Mouse gets stung by a wasp you check if the care is medially necessary and covered by OHIP what CHA criteria? Comprehensiveness (what is medically necessary and what is not) Which CHA criteria refers to everyone being covered under the same terms? Universality Difference between equity and equality Equity means fairness and justice at the forefront Poverty is “…the condition of a person who is deprived of the resources, means, choices and power necessary to acquire and maintain a basic level of living standards and to facilitate integration and participation in society.” We think of poverty from a financial standpoint (Government of Canada, 2018) But also involves: Social connectedness Basic human needs (a lot are tied to money but not all of them) Power Ways to Measure Poverty Survival is threatened Ex. Someone in a rural village in poor country Absolute poverty Having less than an absolute minimum income level (fixed poverty line), based on the cost of basic needs (deprivation of basic needs; things that threaten survival, eg, shelter, food, etc); SURVIVAL Disadvantages of the absolute poverty measure: 1. Difficult to select a minimum set of necessities 2. The cut-off of what is considered the minimum income level, changes over time Depends on country Rural, urban setting Relative poverty Having less than the AVERAGE standard in a society; EXCLUSION Linked to social inequality Someone who has a job but can’t afford eating out or a new phone (unable to keep up with that standard living)  Poverty rate in Canada In 2020, 6.4% of Canadians lived in poverty, down from 10.3% in 2019 Poverty rate gone up and down from 2012 to 2020 8 year period Highest in 2012 COVID-19 CERB (Giving 2k to people) Mitigating pandemics impact What are some potential Retrieved from https://www.statcan.gc.ca/en/topics-start/poverty reasons for the decrease in 2020? Conceptual framework for action on the SDOH CONSIDER: The alignment of income and poverty within the framework Downstream vs upstream interventions The meaning of downstream Treating heart attack pts Downstream: during covid managing cases showing The meaning of Prevention up in emerg Upstream: introducing upstream PA vaccine, social distancing, Weight management Monitoring for co-morbid Solar, O., & Irwin, A. (2010). and masking measures conditions Nutrition Mean vs Median Income Mean Income: average income (sum of a set of numbers, divided by the count of numbers in the data set) Better representation Median Income: the midpoint level of income whereby half of the population has a higher income, and the other half has a lower income Mean calculation becomes less useful Scews distribution Misrepresentation of actual population Your Town Your Town with Bill Gates Mean income: $50,000 Mean income: $51,000,000 Median income: $50,000 Median income: $50,000  What would happen if we remove the fence? Let’s say it represents structural Equality vs Equity determinants of health = liberation Inequality and Inequity Inequality = uneven distribution of resources, opportunities, Inequality or outcomes among different groups The condition of being unequal (may or may not be fair) Inequity Inequity = unfairness or injustice in these differences Unfairness or bias Often occurs when differences relate to factors such as race, gender, sexuality, or intersectionality of factors (Raphael, 2020) Income Inequity in Canada ** Note age of report % of Canadians living in low income If values were flipped here you could see more equity Retrieved from: Public Health Agency of Canada. (2016). Health status of Canadians 2016. Retrieved from: http://healthycanadians.gc.ca/publications/department-ministere/state-public-health- status-2016-etat-sante-publique-statut/alt/pdf-eng.pdf Why is INCOME an important SDoH? Look at it from 2 perspectives Individual Income SHAPES: Population Overall living conditions affecting physiological and psychological functioning Adoption of health-related behaviours such as quality of diet, physical activity, tobacco use, and excessive alcohol use Income DETERMINES: Quality of other SDoH such as food security, housing, education, early childhood development, etc. Income is most important sDoH Impacts quality of other sDoH (Raphael, 2020; Bregman, 2017)  Higher income = more power Understanding POWER Power The ability to do something or act in a particular way The capacity of ability to direct or influence the behaviour of others or the course of events (New Oxford American Dictionary, 2022) Synonyms for ‘power’ Control, authority, influence, dominance, mastery, domination, sway, weight, leverage, strength, force… Power Injustices Small group hold disproportionate power Evidence that Canadian social structures and unequal power relationships contribute to “social injustice [that] is killing people on a grand scale” (Raphael, et al., 2020, p. 8) Power plays a role in income, income distribution and health but also in many of the other SDoH (Raphael et al., 2020) Wealth brings political power (OXFAM estimate- richest 26 billionaires hold as much as the bottom half of humanity) (Raphael et. al, 2020, p. 76) Wilkinson TED Talk Income inequality is more significant within societies as opposed to between societies (life expectancy between countries not as significant as life expectancy within our own societies) UNICEF index of child well-being – kids do worse in the more unequal societies Differences between us and how we relate to each other are most significant Social Gradient Defined as the variation among individuals and groups due to income (CPHA, 2022) Poorest of the poor have the worst health Within countries, the lower an individual’s socioeconomic position, the worse their health (WHO, 2021) Is a global phenomenon seen in low, middle, and high income countries i.e. whether you live in Greece lower income or Norway higher income. (Wilkinson, 2011) How do health inequities affect us all? Social Gradient (Wilkinson, 2011) Countries that fare worse are more unequal General social dysfunction is related to inequality (most things go wrong) Although countries may culturally look very different, e.g. Japan, Sweden, it doesn’t matter how they get to greater equality, as long as they do.  Men in wealthiest 20% of neighbourhoods live 5 years longer than men in poorest 20% Comparative for women-2 years Other facts: Suicide 2X in lowest vs. highest Infant mortality 46% higher in poorest neighbourhoods. Figure 1. Life Expectancy of Males and Females by Income Quintile of Neighbourhood Adapted from Mikkonen, J. & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts, p.15. Retrieved Raphael, 2020 from http://thecanadianfacts.org/the_canadian_facts.pdf Gini Coefficient Single metric of income inequality Also known as the Gini index or Gini ratio Number between 0 and 1 that measures income or wealth distribution 0 (or 0%) = perfect equality (everyone has the same income) 1 (or 1%) = perfect inequality (one person has all of the income) For equity/equality is high or low percent more desirable? Low percent (Raphael, 2020) Gini coefficient by country 2022 Mapping of Gini index by countries, please use link below: https://worldpopulationreview.com/country-rankings/gini-coefficient-by- country Gini index samples Ukraine - 26.1% (population: 43,466,819) Norway - 27% (population: 5,465,630) Canada - 33.3% (population: 38,067,093) USA - 41.1% (population: 332,915,073) South Africa - 63% (population: 60,041,994) Nordic and scandenivian countries Note where Canada falls in OECD Nations OECD = Organization for Economic Co-operation and Development OECD international collaboration, goal to foster prosperity, equality, opportunity and well-being Encourage, growth, development  Hamilton Closer to home Neighborhood level Census Tract (CT) 37 surrounds Hamilton City Hall – from James to Queen streets, between King and Hunter streets. CT 37 has a Gini coefficient of 0.67, higher than the most unequal country in the world. This neighborhood has the city’s second shortest lifespan at 66.4 years, the lowest median household income and the highest poverty rate at 46% Hamilton Spectator (2019). Code Red: Ten Years Later. Retrieved from https://projects.thespec.io/codered10/ Downtown Hamilton CT 17 and CT 37 CT 17 and 37 are less than 1km apart! Average life span What are Doubled Even things you might not your think will be effected by low income is effected thoughts? such as low birth weight, no family physician Gini Index CT 37=.67 CT 17=.21  Understanding the problem How world’s wealth is divided The Global Pyramid of Wealth Less than 1% Who have most of world’s wealth 8.6% of 86% of world wealth population Middle class  Hardest Hit Populations The next slides will outline some of the populations, most impacted by income and income inequality: Women and children Older adults (65+) People experiencing homelessness Racialized groups Women and children Children in lone-parent families remain more vulnerable to poverty In 2019, the child poverty rate was 5.8% for children living in couple families, compared to 26.2% for children in female lone- parent families Campaign2000 details the experiences of children living in poverty (since 1991) (Raphael, 2016) One in five children live in low-income families *** Canadian Income Survey did NOT include First Nations’ communities https://www150.statcan.gc.ca/n1/en/daily-quotidien/200224/dq200224a- eng.pdf?st=jqDpC0Ls  Measurement terms related to income Low Income Cutoff After Taxes (LICO-AT) The level at which families or individuals spend 20% or more than average, on food, shelter, and clothing Example – average family in Toronto spends 40% of their income on food, shelter, and clothing. If a family in Toronto spends 63% of more of their income on these things they fall below the LICO-AT Cutoffs are regularly updated to reflect changes Low Income Measure (LIM) Fixed percentage (50%) of median adjusted household income; considered low income if a family’s income is below the LIM for family type and size Example – if the median income in Canada is $50,000, then a family earning less than $25,000 would be considered low income Older Adults Low-income rates rising for older adults Middle-income Canadians have been unable to save (Raphael) Many retiring without any employer pension plan Challenging to live off CPP or ORPP (Ontario Retirement Pension Plan) Many not able to save enough for retirement “The poverty rate was 1.7% for seniors living in families and 7.9% for unattached seniors.” (Statistics Canada, 2020)  People experiencing homelessness Most live below the low-income cutoff (LICO) *LICO – devoting a larger share – 20% more – on shelter, food, and clothing than the AVERAGE family/individual in a given location Hamilton LICO 2020 for 1 individual ($22,060) (Statistics Canada, 2020) Racialized Groups Experience income disadvantages compared to non- racialized groups Several hypotheses for the disadvantages have been debunked: Function of skin colour Immigration status Racism White immigrants didn’t experience this 8 Education Language (Raphael, 2016) Consider intersectionality (the interconnections between social categories, race, class gender, etc) What are some Income Strategies? Source  Rates have been frozen since 2018 Welfare in Ontario Ow has been frozen Single person on OW receives $733 and $1169 if on ODSP* rate has increased to 1228.00 Leaves recipients living at 40%-60% below the poverty line Advocacy groups working to push the government to raise the rates (reflective of inflation, pandemic, etc) Employment clawbacks: OW = $0.50 for every $ >$200/month ODSP = $0.50 for every $ >$200/month (Raphael, 2016) *Point is that our government approach does not help to lift people out of poverty Just offering a bit of income Basic Income Government program that provides a certain sum of money to a country’s or certain region’s citizens (no strings attached) Intention – guaranteed income so people can afford basic needs to help them thrive Pilot programs with limited duration (various countries) In 2017, Hamilton was a chosen city for pilot program under Liberals– cancelled prior to data collection due to Conservative government believing it would disincentivize people to join the workforce Dauphine canada In Manitoba (Edmonton Social Planning Council, 2020)  The Poverty Conundrum Essentially poverty increases risk for any possible disease Remember that not only the depth of poverty can influence health but the duration that the individual lives in poverty Poverty/deprivation during childhood contributes to poor health over the entire course of the life span (even when poverty is removed) Guaranteed (basic) income could be part of a robust social safety net. Poverty is persistent and costly-investment in programs could ease the burdens on health, justice and social services (long-term savings) (Raphael, 2020; Bregman, 2017; Edmonton, Social Planning Council, 2020) Why does income influence health? Underinvestment in human capital Not investing in public infrastructure (education, health services, transportation, housing, occupational regulations, etc.) Underinvestment in social capital Diminishing community solidarity/cohesion Psychosocially mediated effects Frustration and biological processes that are harmful (Raphael et al., 2020 p 100-103) Bringing it Back Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health: Social determinants of health discussion paper 2. Geneva, Switzerland: World Health Organization Press.  Upstream: Welfare and Governance § Welfare state – a system where the government provides various social services to ensure the well- being of its citizens § Canada’s electoral system a barrier to welfare state development – single party majorities or unstable minority governments (instability in policy development) § Implementation NOT impossible but requires members of society to demand policy changes in health and health equity (Raphael, 2020 p. 86- 87) Policy Implications Income inequality is a key health policy issue that must be addressed by government and policymakers Increase minimum wage to living wage and boost social assistance levels for most disadvantaged would provide health benefits Reducing inequalities with progressive taxation using revenues to provide universal programs and services More unionization in workplaces to set limits on wealth equalities (Raphael, 2020, p. 18) Screening for Poverty  Link isn’t working Cukier, A. (2018). Retrieved from https://locallove.ca/changemakers/dr-gary-bloch-is- fighting-poverty/#.XVvp9i3MxQI *note link doesn’t work. Screen everyone for poverty Universal Pharmacare: Are We Almost There? What is it? Why should it be included as part of Canadian universal care? What does this have to do with income?  References Please note that the various references used are noted on individual slides.  Critical thinking discussion 1. Why is it more difficult to study the relationships between income and health than it is to study other factors such as smoking and health? Multi-interdisciplinary Day to day survival No forethought for good future decision making Less direct effect e.g. living conditions Smoking - a + b = c No positive changes on individual level Transparency about income and health 2. Why is it challenging to increase the level of health of Canadians by focusing on the medical system alone? Downstream thinking Pt centred care Need money to do research, not a lot on women, 3. Often social justice requires a redistribution of the benefits of our current economic situation. What are you willing to forego in order for others to have more? Next Week Unit 4: Work and Health Complete prep work –define key concepts, terms, required readings and media files.