Posted by Ryan Meili · September 25, 2013 12:34 PM
Social factors play a significant role in determining whether we will be healthy or ill. Our health care is but one element of what makes the biggest difference in health outcomes. This has been understood for centuries, and empirically validated in recent decades with study after study demonstrating health inequalities between wealthy and disadvantaged populations.
Yet political conversations about health still tend to fall into familiar traps. When we talk about health we return by reflex to doctors and nurses, hospitals and pharmacies. And when we talk about politics — the field of endeavour with the greatest impact on what determines health outcomes — a narrow and economistic outlook seems to trump any attempts to address those social determinants.
The high-profile Toronto Centre federal by-election features two well-known opposition candidates who agree that soaring income inequality, especially the fast-rising income share of the top 1% with all of its well-documented negative effects, is the defining political issue of our times. At issue is what we should be doing about it, through changes to public policy.
In thinking about this question, it is useful to distinguish between policies that affect the distribution of income by the market (called predistribution) and policies that make incomes after taxes and transfers more equal than market incomes (redistribution).
Every month, Statistics Canada comes out with the unemployment rate, and every month it gets a lot of attention. But the unemployment rate provides quite limited information about the actual health of the labour market.
The addition of two other pieces of information nearly doubles the unemployment rate: the proportion of the labour market employed part-time but looking for more work, and the proportion that would like a job but aren’t actively looking for work, and so aren’t officially counted as being in the labour market.
A new study by the Fraser Institute argues that introduction of anti-union “right to work” laws in Canada would boost manufacturing output and jobs. While they are right that these laws, which make dues payments voluntary, severely weaken unions, it is far from evident that unionization comes at the cost of poorer economic performance.
This is because collective bargaining has benefits for employers as well as for workers, and because collective bargaining outcomes reflect economic realities.
In their book “The Spirit Level: Why Equality is Better for Everyone” Richard Wilkinson and Kate Pickett argue that social well-being – measured using a range of widely accepted indicators – varies a lot between advanced industrial countries. They show that there is little relationship between the level of GDP per capita within a country and social well-being. However, they find that there is a strong positive relationship between a low level of income inequality and well-being; in other words, they find that societies with a high degree of income equality among its members are generally happier and healthier than more unequal societies.
When the leaders of the world’s most powerful economies meet at the Group of 20 summit in St. Petersburg, Russia, on Wednesday and Thursday, they face an economic puzzle only half-solved. Co-ordinated monetary and fiscal stimulus by the G20 in 2008 and 2009 narrowly prevented a repeat of the Great Depression. However, almost five years after the onset of the global financial crisis, the world economy remains mired in slow growth and high unemployment.
As Coyne himself agrees, top incomes (incomes of the top 20%) rose much faster than those of middle and lower income groups for two of the last three decades. Things got worse over the 1980s and 1990s, and then there was a change, of sorts.
I attended the annual meeting of the Canadian Medical Association (CMA) as a representative of Canadian Doctors for Medicare last year. The meeting was not at all what I'd expected.
The CMA, as a professional association representing doctors, has often been seen — fairly or unfairly — as working primarily for the interests of the physicians it represents with patients and health equity appearing at times to be an afterthought. This impression was particularly prevalent during the presidencies of Brian Day (2007-8) and Robert Ouellet, (2008-9), both vocal advocates for privatization (and owners of private, for-profit health care facilities) who used their tenure to advocate for greater private payment for essential health services.
Last year the Metcalf Foundation released a report on working poverty in Toronto. It found that 113,000 people were living in working poverty in the Toronto region in 2005, a 42% increase from 2000. The report's findings indicate that people living in working poverty most commonly work in sales and service occupations; work comparable hours and weeks as the rest of the working population; are over-represented by immigrants; and are only slightly less-educated than the rest of the working age population.
Legislated employment standards are a cornerstone of a strong, healthy society, as well as a robust, thriving economy. They ensure that everyone who works earns a minimum wage for their labour, and that nobody is subjected to inhumane working conditions or unduly harsh treatment at the hands of their employer. It is because of employment standards that workers in Canada have the right to rest periods during and between shifts, to maximum work hours each day and week, to extra pay for working on public holidays, and to a couple of weeks of paid vacation every year. In short, employment standards are there to shield workers – especially non-union workers – against the natural tendency of the labour market to gravitate towards overwork and underpay.