Exploring how those living in poverty are vulnerable to adverse health outcomes.
In a previous blog post I reviewed applying an ecological model to employee mental health and it was here that I acknowledged the privilege that comes with employment. Because, as cited there and again now, “employment is one of the most fundamental social determinants of health and life …” (Brydsten, et al., 2018, p.7). In this blog I am approaching with curiosity the impact that living in poverty in Canada has on individual health. As a professional who works in workplace health promotion, improving understanding of the inequities to health for those living in poverty is important to appreciate and recognize the health opportunities that are present for those with employment. With, poverty is not synonymous with unemployment. Someone who is employed may still experience similar barriers to health as those with low income.
Rate of Poverty in Canada
In 2019, 10.1% of the Canadian population (3.7 million individuals) were living under the poverty line and the variation between provinces ranged from 8.2% (Alberta) up to 12.5% (Saskatchewan) (Employment and Social Development Canada, 2021). Not only does the rate of poverty vary between provinces, but also between demographic populations. For example, National Advisory Council on Poverty recognizes that certain groups such as Black Canadians, racialized Canadians, immigrants, refugees, Indigenous people, persons with disabilities, and 2SLGBTQ individuals, children and youth experience higher rates of poverty (Employment and Social Development Canada, 2021). Table 1 offers insight on the rate of poverty amongst various vulnerable groups, as available. With this impacting so many Canadians, it is an important determinant of health to research and take action on mitigating.
Group | Poverty rate |
Indigenous people (off-reserve) | 18.1% |
Immigrants, refugees, and ethno-cultural and racialized groups | 11.6% (all immigrants), 22.8% (newcomers, less than 5 years since landed) |
Persons with disabilities | 19% (less than 65 years old) |
2SLGBTQ individuals | not available |
Women | 10.4% |
Children | 9.6% |
Youth | 16.3% |
People in institutionalized care | not available |
People working in the underground economy | not available |
Table 1. Data retrieved from the report Understanding Systems: The 2021 report of the National Advisory Council on Poverty, this table shows the rate of poverty amongst various groups in Canada (Employment and Social Development Canada, 2021).
Impact of Poverty on Health
From my review of resources, it seems to be difficult to isolate how income as a determinant on its own, impacts health outcomes because poverty and low income seem to be associated and intertwined in cause/effect with other determinants of health such as employment, education, physical environments, access to health services and race. Bryant and colleagues (2011) highlight this “chicken and egg” scenario; how in some analysis of the social determinants of health it is the unequal distribution of income that is the cause of health-related inequalities, whereas others state that it is the lack of material and social resources along with low income that results in poorer health outcomes. Whatever the cause of low income or poverty, its presence is associated with negative health outcomes. In a 2016 report from Health Quality Ontario, they note that the poorer a resident in Ontario is, the more likely that they are to have the following health risks:
· Smoke
· Be physically inactive
· Have inadequate fruit and vegetable intake
· Have a diagnosed chronic medical condition, including obesity
· Be overdue for a health screening such as colorectal cancer
“The lower an individual’s socio-economic position, the higher their risk of poor health” (World Health Organization, 2018).
Experiencing poverty in childhood specifically is associated with poorer health outcomes than children in families with a higher income. This includes infant mortality, low birth weight, asthma, overweight and obesity, injuries, mental health problems and difficulties learning. Furthermore, childhood poverty also impacts adult health. Adults who experienced poverty as children are more likely to experience physical disability, depression, obesity, unhealthy behaviors such as smoking and premature death (Gupta, et al., 2007).
Supports in Alberta
There are many advocacy groups and research into the barriers and possible strategies to support the vulnerable population in our society who experiences low income and poverty. In my resource exploration this week I came across a hub of information from the Alberta Health Services, Healthier Together program which is specific to financial wellness. This site includes a section on Take Action which spotlights resources which communities can utilize to assist in assessing for financial strain and a map of community assets. I believe community-led initiatives, as opposed to individual level interventions can be more effective to creating capacity to support those struggling financially. Check out the short video from this site, Reducing the Impact of Financial Strain (imbedded below), where the importance of the topic is spotlighted.
Furthermore to resources in Alberta, as highlighted in my joint blog post with Mary Ann a couple of weeks ago, Food insecurity & mental health through an ecological model of health, there was a report published in 2022 by Alberta Health Services which recommends that in healthcare settings patients are screen for poverty to help identify food insecurity. The goal being that the treating healthcare provider may support that individual to address their financial strain rather than only refer the patient to a temporary resource such as a food hamper program. If the clinician is well-versed in relevant and appropriate referrals, this more upstream intervention could provide more sustainable and meaningful support to the individual.
Summary
Over 10% of Canadians are living in poverty (Employment and Social Development Canada, 2021) and for those Canadians that is a determinant factor in increasing their risk for adverse health. Experiencing poverty or low income could be a result of many life circumstances, including many which are out of control of the individual. I was able to share a couple of resources available in Alberta which focus on supporting individuals with financial strain, but more needs to be done to support this vulnerable population so they may have equitable opportunity to good health.
- Kylie
References
Alberta Health Services, Healthier Together. (n.d.). [video] Impact of financial strain on wellness. Government of Alberta. https://financialwellness.healthiertogether.ca/
Alberta Health Services. (2022, March 22). Reducing the impact of Financial Strain. https://www.youtube.com/watch?v=Y9x0O4WwSlA&t=90s
Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy, 101(1), 44–58. https://doi.org/10.1016/j.healthpol.2010.08.022
Brydsten, A., Hammarström, A., & San Sebastian, M. (2018). Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health. International Journal for Equity in Health, 17(1), 59. https://doi.org/10.1186/s12939-018-0773-5
Employment and Social Development Canada. (2021). Understanding Systems: The 2021 report of the National Advisory Council on Poverty. Government of Canada. https://www.canada.ca/content/dam/esdc-edsc/documents/programs/poverty-reduction/national-advisory-council/reports/2021-annual/advisory-council-poverty-2021-annual(new).pdf
Gupta, R. P.-S., de Wit, M. L., & McKeown, D. (2007). The impact of poverty on the current and future health status of children. Paediatrics & Child Health, 12(8), 667–672. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528796/
Health Quality Ontario. (2016). Income and Health: Opportunities to achieve health equity in Ontario. http://www.hqontario.ca/portals/0/documents/system-performance/health-equity-report-en.pdf
World Health Organization. (2018, February 22). Health inequities and their causes. https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes
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