In 1978, researchers Wilkins and Adams demonstrated that the richest Canadians received 12 additional years of good health relative to poor Canadians. Nearly four decades have passed and the problem persists. The link between social status and health is referred to as “social health inequality” (Association of Faculties of Medicine of Canada, 2014). This is an unfair and avoidable situation where socioeconomic conditions determine an individual’s risk of getting sick, and access measures to prevent or cure the disease (WHO, 2008).
The World Health Organization describes the “social gradient” of health as an exponential line between income and health. It is a link associating an individual’s income level with health, morbidity, and mortality. The difference is exponentially proportional to each level, and not just between the richest and the poorest.
The latest report on the health of Canadians shows that 47% of people with low income considered themselves in good or excellent health, compared with 73% of those with high incomes (Public Health Agency of Canada, 2013). In other words, the more Canadians move up the pay scale, the less they report having poor health. In addition, they have a longer life expectancy. This is partly because money offers some control over living conditions, including the location of housing and food choices (Mikkonen, J. and Raphael, D., 2011).
Moreover, the income of a country includes to the following concepts: the total wealth of the country (also called the absolute income or Gross Domestic Product) and the distribution of income within the population (called relative income). Studies by Wilkinson and Pickett in 2010 showed that the “absolute income” of a developing country is indeed proportional to the health of its population, but it is the “relative income” that predicts the health of a population in a developed country like Canada. Thus, the inhabitants of the countries where there is little economic difference (small gap between the incomes of rich and the poor), such as Japan and Sweden, have very good health compared to people in countries with a large economic gap such as the United States or the United Kingdom.
To correct this discrepancy, Mikkonen, J. and Raphael, D. (2011) propose several solutions:
- Raise the minimum wage and provide more assistance to those who are unable to work.
- Implement a progressive tax system.
- Encourage unionization, which prevents amassing profits at the expense of the health and well-being of employees.
There are five provincial strategies for reducing poverty in Newfoundland and Labrador, Nova Scotia, Quebec, Ontario and Manitoba (ACTS, 2009). The benefits of these strategies include providing safe housing at affordable prices, increasing income of families in need, and access to medication. Some disadvantages of these strategies include the costs associated with implementation and the discrepancy between the needs of the population and the available funding (ACTS, 2009).
It is clear that an equitable resource allocation benefits population health. However, is it possible to have a balance between social services (childcare, housing, postsecondary education, recreational activities and resources for retirement) offered by a state and the best quality of care (research, new technology) that is provided?
Agence de la Santé Publique du Canada (2013) Pourquoi les Canadiens sont-ils en santé ou pas ? tirée du lien : http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-fra.php#income
Association Canadienne des Travailleuses et travailleurs Sociaux (2009) Une revue des approches provinciales de lutte à la pauvreté. Tiré du lien : http://www.casw-acts.ca/fr/une-revue-des-approches-provinciales-de-lutte-%C3%A0-la-pauvret%C3%A9-decembre-2009
Association des facultés de médecine du Canada, (2014) Les déterminants de la santé et les iniquités en santé tiré du lien : http://phprimer.afmc.ca/Latheoriereflechiralasante/Chapitre2LesDterminantsDeLaSantEtLesIniquitsEnSant/Lesdterminantsdelasant
Mikkonen, J. et Raphael, D. (2011). Déterminants sociaux de la santé : les réalités canadiennes. Toronto : École de gestion et de politique de la santé de l’Université York p. 12-14
OMS (2008) Principaux concepts relatifs aux déterminants sociaux de la santé, tiré du lien : http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/fr/
Wilkins, R., et O. Adams (1978), Healthfulness of Life, Institute for Research on Public Policy, Montréal.
Wilkinson R.G. et Pickett K., (2010) The Spirit Level: Why Equality Is Better for Everyone, Penguin Books, Canada.
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