Written by Cheyenne Thomas
For Prof. Tavish McDonell
On a pack of cigarettes, we have a gruesome warning label, informing us of the health consequences we expose ourselves to when we smoke. When buying packaged and processed foods, we have a nutritional label at our disposal, to allow us to decide for ourselves if we want to fill up on calorie-dense foods with little to no nutritional value. We have ad campaign posters lining the hallways of maternity units, informing new mothers that “Breast is Best”; canisters of infant formula must carry this message. As healthcare professionals, we teach people the important role that diet, exercise, and smoking cessation plays in our health so that people have the tools to make informed choices. As a society, we have made huge reforms in the way we address health. We advocate for it. We no longer sit passively by, watching and waving as it slips away, leaving behind a backbreaking, textbook-sized hospital chart filled with a slew of pathologies in its wake. As our knowledge about health continues to grow through research, and as that knowledge is distributed and made readily available through public health initiatives, we consistently work toward finding ways to hold accountable those whose profits flourish outside of our best health interests and then we educate. Each of these processes nurses are actively a part of.
However, what if this was only the tip of the iceberg and looming beneath the surface was a massively cold and uncomfortable truth? What if, more than anything, our health outcomes were determined by wealth and social status? In the face of low income, our ability to comply with various health ideals is seriously undermined and the situations poverty creates provide an ideal environment for illness and disease to thrive. In a prosperous country like Canada, health is out of reach for many men, women, and children. For example, if we look at reports from food banks working within Canada, more and more people rely on these organizations to supply one of their most basic needs—the need for food. It is estimated that about 1.1 million Canadians experience food insecurity (Mikkonen); what’s disturbing is that children represent a huge portion of this figure (Food Banks Canada). The negative impact this has on development puts these already disadvantaged children at an even greater disadvantage (Mikkonen and Dennis 26). If this is true, who is held accountable and where do we stamp that infamous warning label? How do we proceed to educate and initiate change? The answers aren’t simple. Many healthcare professionals are stepping up and chipping away at this complex issue. Ultimately, society’s ideologies about health and poverty allow health disparities to continue to plague an unacceptable number of Canadian citizens.
Statistics are often used to measure the success of capitalism, but this functions as a mask, hiding the reality of poverty within society. Canada’s status of prosperity conceals the unfavorable reality that many citizens endure. Canada is the ninth richest country in the world (quoted in Mikkonen and Dennis 5), so if health is largely determined by wealth, we might assume that health should be attainable for the majority of us. However, health researchers are finding that the health of a country has less to do with overall wealth and more to do with how equally wealth is distributed throughout society (Pickett and Wilkinson 81). According to The Conference Board of Canada, income inequality, which refers to how unevenly income is distributed throughout a country, is and has been increasing in Canada. Dr. Anna Reid, president of the Canadian Medical Association (CMA), points out that “many Canadians underestimate how much poverty is among us and how many people in our communities lead very challenging, difficult lives.” Canada isn’t the only country experiencing these inequalities; many countries are becoming more and more unequal. However, it is a mistake to think that wealthy nations just function this way and that we should accept it. In fact, Austria and Denmark, which have similar incomes to Canada, have managed to increase income equality (The Conference Board of Canada). For income inequality to be addressed, awareness of its presence within society needs to be raised.
Capitalist economic systems are often left to thrive by creating inequalities, where the rich get richer and the poor get poorer. In the documentary The Forgotten Space, one of the issues addressed by Sekula and Burch is the dizzying manner in which capitalism throws our world out of balance. It not only functions by creating inequalities between countries on a large scale, but also transcends groups of people within countries on a societal level. We recognize how capitalist economic systems prey on people within other countries through practices such as unfair trade, child labor, and sweatshops. Society is less attuned, however, to its characteristic parasitic quality and how it functions within developed countries.
Poverty is not the failure of individuals. It is the failure of government who should serve to protect their people from the exploitative nature of capitalism. In order for a small percentage of individuals to prosper to absurd heights, money has to be transfused from somewhere or someone, and the means of extraction involves some form of exploitation. Sekula and Burch bring to light the large number of truck drivers in Los Angeles receiving pitifully low wages, which is a good example of this phenomenon. Companies like the trucking one mentioned in the film bank on selling employees short. In addition, they have a tendency to hire many workers on a contract basis versus salary employment. This employment trend is presently growing right here in Canada, as well as other countries. The problem with it is that it allows companies to dodge some of the responsibility and costs associated with full-time employees, and its characteristic instability creates psychological stress for workers (Grant). Employers do not have to pay vacation days, benefits, or pension plans to these workers. Generally, contract employees receive an even lower pay than salary employees and are often not unionized (Freeman). Companies may even receive tax breaks or bonus money under a myth that they are beneficial because they create jobs. Joseph Stiglitz points out in “The Price of Inequality” (xvi-xvii) that more often than not, these companies not only fail to deliver increased employment opportunities, but even prosper further. These are examples of factors that contribute to creating income gaps and how wealth accumulates among a select few, leaving too little to “trickle down” to people at the middle and the bottom of the socioeconomic ladder (The Conference Board of Canada). Income inequality is a growing issue in Canada, which as mentioned earlier, comes with serious health consequences (Health Nexus).
Canadians urgently need to begin understanding health in a more complex manner; ideas about health need to be challenged. Health is determined by much more than just the sum of our lifestyle choices, access to health care, and genetics; too many Canadians are unaware of that fact (Mikkonen and Dennis 5). Our health is greatly determined by the various conditions that we experience in our everyday lives. These conditions are called the social determinants of health and consists of stress, income and distribution, education, unemployment and job security, employment and working conditions, early childhood development, food insecurity, housing, social exclusion, social safety nets, health services, aboriginal status, gender, race, and disability (Kozier 132). The most influential of these social determinants is income and income distribution. These factors determine 50% of our health outcomes. This relationship has been proven and well documented for at least 150 years; government and policy makers must be well versed on this topic. It’s with good reason too because, when you look closely, the favorability of these conditions are largely shaped and decided by them. Healthcare professionals believe that if more Canadians understood health in this light, citizens would more likely demand changes to society that reduce health inequities. This movement would in turn improve the health of the population; the strain placed on the healthcare system could be greatly reduced. Canadian health care could be much more sustainable (CMA 3).
Health outcomes worsen and improve as we gain and lose socioeconomic status. The many mechanisms behind how socioeconomic status is so intimately embedded into human health can be a long and lengthy topic in itself. A common example used is that if we have low income, we have fewer options in regards to where we live. If our housing is unsafe and full of, say, mold, we are often not in a position where we can just choose to pick up and move to safer housing. We may suffer asthma and respiratory infections as a result. While doctors can prescribe medications, they will never accomplish their expected outcomes if we must continue to live in this hazardous environment (Sudbury & District Health Unit, Halton Region). Another example involves the harmful impact of prolonged stress. When people’s wages do not cover basic needs, when work is unstable, or the quality of our work environment is deteriorated, it can create intense psychological and physiological stress. When we experience stress, our bodies mobilize a “flight or fight” response. This response is beneficial; it can allow us to do amazing things in life-threatening situations, like escaping a lion, for example. The body would begin producing cortisol, a hormone that mobilizes energy stores, and blood glucose would shoot up to meet the increased energy demands placed on it when running for dear life. The heart rate would increase to supply more oxygen needed for increased metabolism; blood vessels would constrict to increase blood pressure and blood is diverted away from less essential body systems such as the digestive and urinary systems. Just in case the lion bites us, blood-clotting factors are floating around ready to act. The immune system is more active and our mental state sharpened. These are important biological mechanisms that allow survival, but we don’t need to be chased by lions for them to be set into motion. Under prolonged stress, this response become incredibly harmful. Mental functioning deteriorates and depression often occurs; the immune system burns out and illness can easily settle in. Excess cortisol can encourage fat to accumulate around the abdomen, which is bad news for the heart, which is already working overtime. This stress contributes to how digestive problems, diabetes, heart disease, and high blood pressure take a high precedence in groups living in poverty. Poverty is shown to decrease life expectancy and increase infant mortality rates. The list of health issues it creates goes on and on (Wilkinson and Pickett 85-87).
Nurses play an important role in protecting, planning, and providing care to patients. If a nurse fails to evaluate a patient’s economic situation, she puts their safety at risk and this is recognized as an irresponsible practice today. These patients may be unable to comply with prescriptions and recommendations, which could result in preventable death or ineffective treatment. Nurses also have an intimate role in understanding how income inequality affects their patients and can be a voice to tell their stories (while respecting confidentiality of course), drawing awareness to the issue and advocating for change. Successful capitalistic countries are sometimes viewed as places where people live good lives surrounded by everything plus more than what is needed. However, not enough time is taken to acknowledge the people this economic system has been exploiting or excluding. Not enough links are being made to explain how this affects their health nor how it collectively affects all of us.
Canadian Medical Association. “Health Care in Canada: What Makes us Sick?” Canadian Medical Association Town Hall Report (2013): Web. 15 Nov. 2015.
Freeman, Sunny. “Temporary Jobs are Canada’s Future: Report.” The Huffington Post. 11 July 2014. Web. Nov. 30, 2015.
Grant, Tavia. “Canada’s Shifting Job Market: The Rise of Contract Work.” The Globe and Mail. Nov. 26, 2010. Web. 30 Nov. 2015.
Kozier, Barbara, et al. Fundamentals of Canadian Nursing: Concepts, Process, and Practice. 3rd ed. Toronto: Pearson, 2013. Print.
Mikkonen, Juha and Dennis Raphael. Social Determinants of Health: the Canadian Facts. Toronto (ON): York University School of Health Policy and Management. 2010. Web. 4 Dec. 2015.
Sekula, Allan and Noel Burch dir. The Forgotten Space. Verhey, Joost et al., 2012. DVD.
Stiglitz, Joseph E.. The Price of Inequality: How Today’s Divided Society Endangers Our Future. New York: W.W Norton & Company Ltd., 2012. Print.
Sudbury & District Health Unit, Halton Region. Let’s Start a Conversation About Health: User Guide. Oakville (ON) n.p. 2011. Web. 3 Dec. 2015.
Wilkinson, Richard and Kate Pickett. The Spirit Level: Why Greater Equality Makes Societies Stronger. New York: Bloomsbury Press, 2010. Print.
About the Author: Cheyenne Thomas is currently finishing up her second year of nursing. She is passionate about helping others, which is why she chose this field of study. She loves interacting with and listening to patients. She hopes to continue to study nursing at the university level and eventually work in a community setting, where she can help develop programs and initiatives to support and improve health.
Cheyenne is a mother of three young children. She comes from the Mohawk territory of Kahnawake.