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Canada Without Poverty has three times (1993, 1998, 2006) appeared before the United Nations to provide testimony on Canada’s upholding of internationally agreed economic and social rights. We expect to do so again in 2011, when Canada’s performance on these rights is next up for UN review.
Canada Without Poverty anchors our approach with reference to the Universal Declaration of Human Rights, and to supporting international treaties to which Canada is signatory, such as the International Covenant on Economic, Social and Cultural Rights. (Click here for more information on these treaties.) Indeed, we use a definition for poverty employed by the UN Committee on Economic, Social and Cultural Rights, which captures the complexity of this phenomenon:
Poverty is a human condition characterized by 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.
Homeless Manon Street
A Right to Health, but Not Enjoyed by All
Article 25 of the Universal Declaration of Human Rights declares the right of everyone “to a standard of living adequate to the health and well-being of himself [herself] and of his [her] family.” Sixty-one years after the Declaration was adopted, Canada has yet to ensure this right for all. Indeed, there are people in Canada who since the adoption of the Declaration in 1948 have never enjoyed such a standard of living, and thus good health. (Admittedly, it must be noted, most people who experience poverty in Canada do so at one or more points in their lives, less commonly for the duration of their being.)
The right to health was critically underscored in 2008. Then, through its work to produce a major report on “health equity,” the World Health Organization’s Commission on the Social Determinants of Health made the welcome observation that “health is a universal human aspiration and a basic human need.” Moreover, the Commission went on:
The development of society, rich or poor, can be judged by the quality of its population’s health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantage as a result of ill-health….
The right to the highest attainable level of health is enshrined in the Constitution of the World Health Organization and numerous international treaties. This right obliges governments and others to act – to take steps that increase all individuals’ chances of obtaining good health. The realization of this right, however, will take not just access to health care but action on the social determinants of health….[which are] the fundamental structures of social hierarchy and the socially determined conditions these structures create in which people grow, live, work and age. [bold lettering added for emphasis]
Within this frame, Canada is not yet the “developed” country one may believe it to be. Nor is Canada yet a nation with the character of courage and the spirit of generosity to fully address the social determinants of health.
True, thanks to investments in social development and social services over many years and, partly related to this, rising economic productivity, life expectancy in Canada is among the highest of any nation, while infant and maternal mortality is among the lowest. At any point in time, most Canadians are enjoying comparatively good physical and mental health.
And yet, sharp inequities in health among differing socio-economic groups and, in turn, profound disparities in incomes and wealth (among the most critical of the social determinants of health) are increasingly defining our nation – and crying out for an effective public policy response.
Powerful evidence of health inequities is presented in a 2008 report from the Canadian Population Health Initiative. Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada shows that for 20 of 21 health indicators examined in each of 15 Canadian cities, significant differences in health outcomes exist between low-, middle- and high-income neighbourhoods.
Indeed, as stated in 2006 by Dr. David McKeown, Chief Medical Officer of Health for the City of Toronto:
Toronto has some of the healthiest and least healthy communities in Canada. The incidence of common health problems can vary twofold from one neighbourhood to another as a result of the basic determinants of health, such as income, housing, employment and education.
Among the glaring examples of these health inequities, persons from low-income compared to high-income neighborhoods are more than twice as likely to be admitted to hospital due to diabetes or a mental health concern, and more than three times as likely due substance-related disorders. The poor are also much more likely to smoke, be physically inactive and to rate their own health below that typically rated by high- and middle-income Canadians.
Severe constraints on income invariably mean lesser access to food of sufficient quantity and quality, housing that is affordable and in good condition, and to other common and critical needs. In turn, income insecurity and material deprivation heighten anxiety and stress levels, themselves adding to poorer health while contributing to further problems such as depression, anger, alienation, and substance and other forms of abuse.
Justifiably, then, was Gandhi’s insight that “poverty is the worst form of violence.”
Poverty in Canada
Using the Low Income Cut-Off (LICO) After Tax, a measure of low income commonly (although not necessarily appropriately) employed as a proxy for poverty lines (Canada lacks official, robust poverty indicators), the national poverty rate between 1976 and 2006 oscillated between almost as low as 10% and almost as high as 16%. Drawing on the more robust Market Basket Measure or (used for international comparison) the Low Income Measure, 12% of Canadians lived in poverty in 2006.
Canada’s remarkably stable poverty rate over several decades has occurred despite:
- Near-continuous annual economic growth, including a doubling in growth between 1981 and 2005;
- The building of one of the world’s largest economies (currently about $1.5 trillion annually, with a GDP per capita in 2008 of about $47,000); and
- Ever-mounting awareness and activism on poverty, engaging hundreds of civil society organizations (and yet too often focused on symptoms and charity rather than on causes and justice).
As troubling as the persistence of poverty has been the increase in its depth – how far below Canada’s informal poverty lines the poor find themselves. Based on LICO data and on average, by 2006 a person in poverty was $4,000 short of reaching his or her poverty line, up from $3,500 back in 1976 (a modest increase in poverty depth, but an increase nonetheless). Based on the Market Basket Measure and again on average, in 2006 a poor Canadian lacked three out of every ten dollars needed to meet his/her basic needs. Hence the classic phrase, “pay the rent or feed the kids.”
The depth of poverty dynamic helps explain the presence of nearly 700 food banks across Canada. Every month, these frontline centres of goodwill serve 700,000 or more people lacking in food security (a minimum number that has held steady since 1997).
The depth of poverty dynamic also helps explain the presence of hundreds of homeless shelters in Canada. On any given night, these additional centres of goodwill tend to some 150,000 to 300,000 men, women, children and youth lacking in housing security. (The number range is broad as it is impossible to accurately estimate the number of homeless people, many of whom are not necessarily visible on city streets.)
While poverty can grip anyone at some point in one’s life, often due circumstances beyond one’s control, people within certain groups are much more susceptible to its chains. Notably at risk are Aboriginal people on and off reserve, recent immigrants, single parents (particularly women) with young children, persons with disabilities, and “unattached adults” between the ages of 45 and 64. As well, a sizeable and growing number of the poor are those holding down low-paying and/or precarious (e.g., part-time, contract) work, increasingly characterizing the Canadian labour market.
Even children and youth – among the most vulnerable of all – remain at considerable risk of poverty. Despite Parliament’s famous pledge in 1989 to “seek to” eliminate child poverty by 2000, the percentage of children and youth in poverty in 2006 was about the same as it was 17 years previous (about 11% according to LICO After Tax data; by other measures it was higher – 14% or 15%).
Income Inequality in Canada
“You need a lot of money to create a lot of poverty.”
Whether this is a truism or not, we ought not to ignore the contradiction of poverty amidst plenty or, as reads the title of an important 2007 report on the Canadian reality, “homelessness in a growth economy.”
Alongside the dynamic of persistent and, in general, deepening poverty is found the phenomenon of the “growing gap” – the ever-widening chasm between the incomes and wealth of the rich and those of the poor. Although exemplified in most countries, this phenomenon increasingly defines the Canadian reality and psyche.
In 2004, the average earnings of the richest 10% of Canada’s families raising children were 82 times that earned by the poorest 10% – nearly triple the ratio in earnings of 1976. Looked at another way, by 2005 the median income for the top 20% of earners had increased by 16.4% since 1980, while the median income for the poorest 20% of earners fell 20.6%.
The figure below (courtesy of Dr. Lars Osberg, Dalhousie University) illustrates the concentration of wealth over 1984 to 2005.
From the next figure below (courtesy again of Dr. Osberg), it is clear that the growing gap is driven heavily by the top five to ten percent of the income spectrum, and even more so by the top one percent of earners. Within this top one percent is an even smaller sub-set – the highest-paid executives, professionals, financiers, celebrities etc. whose multi-million dollar annual incomes are at the core of the growing gap phenomenon.
As noted above, significant health disparities exist between low- and high-income population groups. The link between these disparities and income/wealth disparities seems powerfully clear. And yet, as said by the Hon. Monique Bégin, former Canadian cabinet minister and member of the WHO Commission on the Social Determinants of Health:
The truth is that our country – the ninth richest in the world – is so wealthy that it manages to mask the reality of poverty, social exclusion, discrimination, employment erosion, mental health and youth suicides. In doing so, we hide the fact of a very serious national public health problem.
Health for All, Dignity for All
A recent Environics Research poll found that 86% of Canadians believe that the federal government should take action on the growing gap between the rich and poor. As well, 85% believe that if government took concrete action, poverty in Canada could be reduced. These survey results suggest that proactive federal leadership on poverty and income inequality – and therefore by extension, health inequity – is not only just and overdue: such leadership will be widely supported by the Canadian public.
Heartened by the fairness that Canadians hold dear and in response to the lack of progress on poverty (from a macro view), Canada Without Poverty and Citizens for Public Justice (www.cpj.ca) are in 2009 co-founding and co-convening Dignity for All: The Campaign for a Poverty-free and Socially Secure Canada. Along with additional partners, we seek through this campaign to realize several goals:
- The articulation, creation, implementation and monitoring of a federal plan to combat poverty and promote greater social security: this plan is necessary to complement and enhance recent and emerging leadership and actions by the provinces and territories – with special note and applause to the first three provinces to create jurisdiction-wide poverty action strategies (Québec, 2004; Newfoundland and Labrador, 2006; Ontario, 2008);
- The articulation, creation, implementation and monitoring of a federal Act to combat poverty and social exclusion: inspired by the landmark 2002 Québec Bill of identical focus, this federal Act would help ensure (a) an ongoing and appropriate federal role in social policy and social development; and (b) a framework for federal accountability for results;
- Sufficient (and fairly raised) federal revenue to invest in social security: Canada’s overall level of taxation is below that of many other OECD countries. So too is our social spending as a percentage of GDP – 16% in 2005, compared to 28% for Denmark which that year had the OECD’s lowest poverty rate, 5.3%. (Click here to access and be able to query for a graphical depiction of poverty rates and social spending in OECD countries over time.)
Dignity for All endeavours to overcome the dominant perception of the so-called “tax burden” and the mania for “tax relief.” Backed by evidence, we aim to help Canadians understand that the more Canada is prepared to invest in social security, the lower will be Canada’s level of poverty (and inequality), and the higher will be Canada’s economic and social performance. (Click here for an insightful report on the social benefits and economic costs of taxation.)
Dignity for All will be framed, in part, around the idea that poverty renders an unacceptable impact and cost to Canada – of course upon the poor but also to all other Canadians. Extrapolating from a recent estimate that poverty in Ontario costs Ontario alone some $32 to $38 billion per year (5.5% to 6.6% of provincial GDP), it may be that poverty in Canada as a whole costs the nation over $100 billion per year (i.e., ~6% of national GDP).
Dignity for All will also be framed with strong reference to Canada’s international human rights commitments, including to the right of everyone “to a standard of living adequate to the health and well-being of himself [herself] and of his [her] family” (per the Universal Declaration of Human Rights). To uphold this right – to realize health equity for all – will require the federal government, in cooperation with the provinces and territories, to address the social determinants of health, e.g., to ensure adequate income, housing and other forms of social security.
To attain those objectives will require a more equitable distribution of income than what Canada has today. Are we, fellow Canadians, up to the challenge?
More specifically, are proponents of action to address the social determinants of health in Canada willing to promote and support public policies that effect greater economic equality in Canada, for example minimum wage levels that enable full-time minimum wage workers to have income at or above a single person’s poverty line, or higher rates of taxation on high income earners to enable greater income redistribution?
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