“The social determinants of health are the economic and social conditions under which people live which determine their health”. [Public Health Agency of Canada, 2008]
York-West has is one of the most culturally diverse areas in Canada; and has two of the most impoverished postal codes in all of Canada, and perhaps the worst of 21 ‘high poverty’ areas in the City of Toronto. It has an unemployment rate that is more than double the national average. It also has one of the highest birth rates in Ontario, which is economically significant in that the population of Ontario will not increase dramatically over the next 20 years. But by 2030, for every person under 40, there will be two persons over 65; and a strong birth rate will stimulate much needed consumerism.
- The health of the community is exacerbated by poverty and other social determinants.
- Poverty, to a large degree is created form the unequal distribution of wealth and government handouts rather than a hand up.
- Resources have been misappropriated by the City of Toronto and unequally distributed causing pockets of poverty, crime and pollution.
“…..humanity is at the crossroads of the most serious economic and social crisis in modern history.” Global Research Institute
Poverty: a human condition characterized by the sustained or chronic deprivation of the resources, capabilities, choices, security and power necessary for the enjoyment of an adequate standard of living and other civil, cultural, economic, political and social rights.
In spite of solid economic growth over the last decade, there have been cuts in social services. This has had an adverse effect on the women and children of York-West who are far more likely to be in poverty then men.
Canada has entered into agreements such as the: Convention on the Elimination of all forms of Discrimination against Women (CEDAW). However, the problem of poverty and pay inequality is worsening.
Poverty for women and children is quite complex. And, the average income and the gap between the average income of the poor, and the amount needed to bring their income up to the level of LICO (low-income cut off) is increasing.
a) In Canada, one in seven women is in poverty. FAFIA, A Decade of Going Backwards: Canada in the Post-Beijing Era (Ottawa, 2004) p. 4
b) One in ten, or one in seven children are in poverty [depends on the source].
c) 51.6% of lone parent families headed by women are poor. http://www.statscan.ca/english/Pgdb/famil41a.htm
d) 41.5% of unattached, women over 65 are poor. http://www.statscan.ca/english/Pgdb/famil41a.htm
e) 35% of women under the age of 65, living on their own, live in poverty.
f) In 2008, the 20% of persons with the highest family after-tax income had, on average, 5.4 times the family after-tax income as those in the lowest 20%. This ratio has been virtually unchanged since 2000. http://www.statcan.gc.ca/daily-quotidien/100617/dq100617c-eng.htm
The lack of day care and education are the two most important and overlooked determinants to poverty, and consequently, health. Women are often unemployed because they can’t get, or afford daycare, and haven’t finished high school or received additional training.
The Organization for Economic Cooperation and Development (OCED) describes Canada’s child care system as a “chronically underfunded patchwork of programs with no overarching goals”. Canada ranks last amongst developed nations in terms of access to early years learning and child care spaces, and last in terms of public investment.
The lack of affordable or available child care limits the choices of women for paid employment. Many are “housebound as a consequence”. In 2006 the number of regulated child care spaces could accommodate only 17.2% of children age 0-12; and only one in five children aged 0-5 received coverage in full or part-time child care spaces.
The Liberals promised $5B to create 250,000 additional child care spaces during the 2004 federal election. But when the Harper-led Conservatives won the election they scraped the Liberal plan. Instead, they introduced a $100 per month allowance for all children under the age of six. This “taxable” payment pays for one child – for three days – if such a space could be found.
“Only Newfoundland and Quebec have comprehensive anti-poverty strategies similar to those adopted by European Countries. The UN emphasizes that equality and non discrimination are essential elements in a human rights approach to poverty reduction. Most comprehensive strategies make special efforts to address gender equality and the needs of women”. [Canadian Institute of Child Wealth]
The Government, media, and financial institutions have the disinformation apparatus in high gear. Over the next 20 years unemployment will rise to well over 25%. This is based on a shrinking economy, in that: consumerism is in decline; globalization is taking effect, and we are in an information/technology age that replaces workers with capital, machinery and technology. Poverty is spreading at pandemic rates.
Poverty is a “business” for the top 2% of income earners, who can not empathize with the poor. They understand that, for the most part the poor have not been as fortunate as them, and that they don’t belong to unions, or have political affiliations or political aspirations, and that they do not have a voice – they exploit them as a consequence.
“ . . . if past recessions are any guide, between 750,000 and 1.8 million more Canadians will be counted as poor before recovery is complete. More than one in seven Canadians may have tumbled into poverty before this is over. Many of them will be working.”
Armine Yalnizyan, Canadian Centre for Policy Alternatives. 2010
3) Social Inequality:
The problem of social inequality among the poor; but particularly women [and children] is not thoroughly understood by the general public. It is a discriminatory practice that goes on unabated, and contributes to dependence. It has been exacerbated by funding cuts, and bad government policy at all levels of government. It undermines the Social Cohesion of communities and contributes too; and does exacerbate criminal behaviour, in the home, school and community.
“Canada ranks 10th out of 93 countries on the UN’s gender empowerment measure (GEM). This reveals whether women are taking an active part in economic and political life. It tracks the share of seats held by women in Parliament, senior officials, managers, and of female professional and technical workers – and most notably the gender disparity in earned income.” [United Nations 2008:4]
4) Infant Mortality:
Canada’s health care system is in decline with respect to other countries on infant mortality. This is a very important economic indicator – – in that it indicates that things are going wrong with society and the economy.
- Canada ranks poorly among OECD nations on infant mortality (22 out of 31 nations).
- “The infant mortality rates of those living in the poorest areas of Canada experience 60% higher infant mortality rates than the rest of Canada, and the prospects of low-birth rates is 43% higher. A Low-birth rate (less than 2500 grams) is an important measure of health status as it is related to the experience of some chronic diseases in adulthood”. [KPMG]
“The Infant mortality rate is more than a technical measure of the deaths of young children. It is an indicator of seismic fault lines in the delivery of the best we have to offer in health services for mothers and children. It is a proxy measure of the compassion of a society for its most vulnerable, and the commitment of a government to all of its citizens.”
UNICEF Canada 2009
5) Social Determinants on Health:
“The social determinants of health are the economic and social conditions under which people live which determine their health”. Public Health Agency of Canada, 2008
Income, social status, social support networks, education, employment, housing, food security, and early child hood development all effect a person’s overall health. The two most important social determinants are [early] education and income.
York-West has a high proportion of:
- older population
- low income families
- single parent families
- visible minorities
- non-graduated students
These determinants contribute to a higher incidence of poor health; and higher health costs per capita.
|Total Pop.||% Plan Area||% 65 +||Median $||% Low $||% Minority||% Immig’||% ESL||% 20 + No H.S. Ed.|
|Central York Region||204,207||12.36||10.5||$94,000||4.84||8.87||20.6||15.7||17.32|
|South East York Region||465,683||28.19||10.46||$93,000||5.01||51.57||55.4||52.3||18.52|
|South West York Region||230,536||13.96||9.19||$97,000||3.69||21.87||45.4||50.6||22.66|
Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut
- “In all countries, it is well established that poorer people have substantially shorter life expectancies and more illnesses than the rich. This phenomenon has been observed since at least the nineteenth century when Chadwick (1965) investigated the health of the working classes in Victorian England.”
- “Social Determinants of health are the economic and social conditions that influence the health of individuals, communities and jurisdictions as a whole. Social determinants of health determine whether individuals stay healthy or become ill (a narrow definition of health). Social Determinants of health 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). Social Determinants of health are about the quantity and quality of a variety of resources that a society makes available to its members”. (Raphael, 2004)
- “Low income limits people’s choice and works against desirable changes in behavior”. (Raphael, 2004)
- “…….an individual’s health can be compromised by living in neighborhoods with concentrations of unemployment, poor housing, a poor environment and limited access to services”. (Wilkinson & Marmot, 2003)
- “There is a graded relationship between household income and emotional and behavioral problems in childhood – the lower the household income, the higher the incidence of these problems”. (Canadian Institute for Health)
- “Material deprivation, such as: shelter, food and warmth removes the prerequistes for healthy development and the ability to participate in society”. (Canadian Nurses Association)
- “The Gap between the rich and poor is a more significant social determinant of health than absolute poverty. The rich have better health than the poor! (Canadian Nurses Association)
The poor are exposed to a greater chance of being killed or being in an accident; and visiting the emergency department of a Hospital that the more “well off”.
- “People with less social standing usually run at least twice the risk of serious illness and premature death than those with more”. (Wilkinson & Marmot, 2003)
The silent killer! Stress is known to undermine health status. Cancer is a disease that is caused, or at least aggravated by stress.
- “Social and psychological circumstances can cause long-term stress”. (Wilkinson & Marmot, 2003)
- “Continual anxiety, insecurity, low self esteem, social isolation, and lack of control, overwork and home life, have powerful effects on health, especially on cardio vascular and immune systems”. (Wilkinson & Marmot, 2003)
6) Health Service Needs and Assessments:
Overview: As we will see, there is an increasing need for health care in the Jane-Finch area over the coming decades. Poverty will exacerbate health care needs. Many can not afford a bus token to the proposed sight at Keele and Wilson – when ill – and could die as a consequence. The feasibility of the new site and the “prospective” conversion of the Finch site into an ambulatory care center is the product of a fractured epistemology – by politicians and powerbrokers – who assume that just because they could get to a hospital if necessary – everyone else could too. The community has not been consulted. The convenience, from the Jane-Finch community, to the Finch site is a matter of extreme importance; because the new sight at Keele and Wilson just isn’t feasible for the poor to commute to!
York-West has the second highest rates in the Central LHIN for Emergency Department visits. This is because:
- The population tends to wait until they are quite ill.
- Limited access to primary care in the community.
- Can’t afford public transit.
By 2018 the incidents of Diabetes type 2 in York-West will more than double to 18,000 cases. Most Diabetics also have another chronic condition and are three times more likely to have cardiac or stroke related hospital admissions – and require dialysis because of chronic kidney failure. The topic is extensive. The concerns are many. Diabetes type 2 is exacerbated by the social determinants that manifest because of low income.
In 2007/2008 a team of researchers from York University’s School of Health Care Policy and Management and the School of Nursing made the following findings:
- “An explosive increase in death rates from diabetes among residents of low-income neighbourhoods across Canadian cities”.
- “Accumulating evidence that the social determinants of health – the living conditions
Canadians experience – are the primary factors shaping the incidence of type 2 diabetes and its successful management”.
- “Type 2 Diabetes is a complex, chronic condition resulting from the body’s inability to either adequately produce and/or effectively utilize insulin. It accounts for 90% of cases of diabetes in Canada. The mechanisms by which type 2 diabetes comes about are not well understood”.
“Traditional explanations focus on genetic and lifestyle causes, but increasing evidence is coming to support the view that type 2 diabetes is primarily a disease of material and social deprivation associated with poverty and marginalization. If not controlled, it can lead to serious complications such as heart disease, kidney failure, lower limb amputation and blindness”.
- “Lower-income older Canadians are twice as likely – to have type 2 diabetes than wealthy, older Canadians”.
- “A Toronto Star compilation of data from various surveys shows that the maps of prevalence of diabetes, rates of poverty, and percentage of visible minorities in Toronto are virtually identical”. http://www.thestar.com/staticcontent/77209
- “It well documented that adverse early childhood experiences such as fetal malnutrition and poverty are important predictors of the onset of type 2 diabetes in later life”.
The prevalence of diabetes in Canada has increased dramatically in recent decades. According to the Canadian Diabetes Association, it is estimated that:
- 3 million or more Canadians suffer from diabetes;
- Life expectancy for people with type 2 diabetes may be reduced by 5 to 10 years;
- Healthcare costs for diabetes and its complications have reached $13.2 billion annually and are rising;
- Direct costs to individuals with diabetes for medicine and supplies can be as high as $15,000 per year.
Osteoarthritis is the most prevalent chronic disease in Ontario. This is expected to rise as the population ages. Women in York-West will have a higher than average prevalence rate and men will be at or below the provincial average.
Chronic Obstructive Pulmonary Disorder (COPD) is most prevalent in the older age categories (55). Smoking is the cause in 80% of cases. York-West men and women are expected to be at the provincial average.
York-West will have higher than provincial average incidents of Hypertension and Cardiac Disease. Heart Disease increases with age, and one in four over the age of 75 will have it. It is the leading cause of death; and inpatient and emergency department usage. One in eight children under 12 report having hypertension. The prevalence rate is at 16.22%, over the provincial average of 15.29%. Heart Disease is not as chronic as many conditions – but the leading cause of death – inpatient separations – and emergency department visits.
Mental Health and Addictions: Poor females have higher suicide rates than those females that are better off.
- “Suicide rates are much higher for Canadians living in the poorest of conditions”. [Raphael, 2004]
7) Social Cohesion:
“Social cohesion is the ongoing process of developing a community of shared values, shared challenges and equal opportunity within Canada, based on a sense of trust, hope and reciprocity among all Canadians.”(Social Cohesion Research Workplan, March, 1997)
Poverty, low income, resulting poor health, and a number of other negative factors all undermine social cohesion. Government has been able to get a way with making decisions that don’t include the community. People are so busy just trying to survive that they don’t have the time to participate in their community and don’t know how. Few know how to work for change in a Parliamentary Democracy; and count on their governments to do the right thing. Municipal, Provincial and Federal governments deny newcomers and the impoverished, the opportunity to make the best of them selves, because they don’t provide the resources to do so.
The reluctance, of Government, to provide mutual support gives way even more to open antagonism. The root-cause of the Government’s moral bankruptcy, is the ability to be shielded from the consequences of its’ actions. The more apt someone is, to get away with harming others, without ever having to worry about the other’s reactions, the more that entity will profit from the habitual indifference about the fate of others.
- “Black and ethnic minorities have often found that, for them, the continuing reality has been one of racism and discrimination, as evidenced by disadvantage at just about every social and economic indicator.” [Cantle, 2004]
- “Race and community relations have always been vulnerable to the routine ‘playing of the race card’ by those usually on the extreme right of the political spectrum, to whip up the fear and hatred of minorities and to secure the support of the majority voting population”. [Cantle, 2004]
- “The concept of multiculturalism is now being questioned. However, in part because of the way in which it encompasses such a wide spectrum of difference and fails to reconcile them within a societal framework. Further, it has for some commentators at least, actually become the vehicle by which divisions and inequalities are reinforced”. [Cantle,2004]
- “Multiculturalism has entrenched the divisions created by racism; and encouraged people to assert their cultural differences”. [Cantle, 2004]
- “The Liberal response has been to maintain the idea of ‘cultural pluralism’ or a ‘community of communities’ and this has been helpful in the past as a means to emphasizing the need to respect differences and avoid assimilation. However these models are no longer adequate and have become a justification for continual separation and coexistence, which has mutated against the development of mutual trust and co-development”. [Cantle, 2004]
- “There is, however a more collective national hypocrisy in which the indigenous population (or their governments) encourage immigration whenever it suits there economic circumstances and at the same time, do little or nothing to create an equal place for those migrants that inevitably become, or aspire to become, longer-term residents and citizens”. [Cantle, 2004]
- “As the powerful find that they can get away with making decisions affecting others with out the latter having a meaningful say about them, the more those decisions would neglect the needs of the wider community”. [Tam, 2009]
- “The subjects compete against one another to win the favor of those with the ruling power and those in control pursue, in the absence of a genuinely shared interest, a strategy of divide and conquer”. [Tam, 2009]
8) Summary and Recommendations:
“Education is the most powerful weapon which you can use to change the world”. Nelson Mandella
As the population in the Jane-Finch community ages, it will depend on the Finch Hospital site more and more. Worsening economic conditions will escalate the health care needs of the citizens, due to the poor health they will experience as a consequence of their age, and poor social and economic environment. People are busy trying to survive. They count on their government. The government has let them down!
“Community cohesion is created by sharing experiences and values; not entrenching separation, recognizing and reinforcing differences”. [Cantle, 2009]
- “Establishing a clearer sense of political unity is, nevertheless, no easy option, especially as mainstream politicians have been reluctant to enter into such debate because of fears that it may either provide extremists with a platform or create uncertainties within the minority communities upon which vote they depend”. [Cantle, 2009]
- “Clearly leadership has been lacking, reflecting the uncertainties and ambivalence of the political mood of the time”. [Cantle, 2009]
- “The capacity for whistle-blowing by the few and sustained protesting of the many must be reinforced and built in to the machinery of civic vigilance”. [Tam, 2009]
- Citizens should be routinely engaged in the exercise of collective decision making so that none becomes permanently marginalized”. [Tam, 2009]