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Untreated social ills make for higher medical costs

By Andre PicardToronto Globe and Mail, June 22, 2006

Many of us revel in thinking of Canada as a great place to live, a generous, caring country with a well-woven social safety net that protects the sick and poor from harm.

But that feel-good image is largely a myth, according to Monique Begin, the respected former minister of health and welfare.

While we have a generous medical care system, Canada's welfare system is parsimonious at best, she told delegates to the recent annual meeting of the Canadian Public Health Association.

More striking still is her proposed solution. "Rebalancing of the health budget is what is needed," Dr. Begin said.

In other words, let's spend less money on health care and more on keeping the population healthy.

How do you do that? By tackling what renowned social scientist Sir Michael Marmot calls the "causes of the causes of poor health" -- the social determinants of health.

Dr. Begin, unlike so many of today's politicians, is bold enough to say that, in Canada, we spend too much money on dealing with the proximate causes of disease -- $142-billion in health spending in 2005 -- and far too little on tackling the root causes of illness in much of the population -- a lack of adequate income, poor housing, inequality, hopelessness.

Welfare is in her vocabulary and it's not a dirty word, as it is in most mainstream political circles.

A recent report from the United Nations Committee on Economic, Social and Cultural Rights underscored just how frayed Canada's social safety net has become. It became a central talking point at the CPHA conference where delegates heard, among other things:

  • Minimum wage (which varies by province) is inadequate, to the point where one-third of full-time workers can't make ends meet.
  • Only about one-third of people who are unemployed are actually eligible for employment insurance.
  • Almost 40 per cent of all jobs are part-time or seasonal.
  • There are 1.2 million poor children in Canada, and nearly 320,000 of them rely on food banks for their daily bread.
  • Welfare rates (which vary by province) provide income that is about half the poverty rate.
  • Our social programs have perverse disincentives, such as those that require people to quit their jobs and go on welfare to get catastrophic drug coverage.
  • There is shocking poverty among native peoples; not surprisingly, their health is abysmal.
  • Child care is inadequate almost everywhere but Quebec.
  • There is an army of unpaid caregivers that has virtually no official help.
  • Social housing is virtually non-existent.

In Canada, only 17.8 per cent of public expenditures are on social programs other than health; in Sweden, by contrast, that figure is 36.8 per cent. According to the Organization for Economic Co-operation and Development, 21 European countries spend more on social programs than Canada, including Poland and the Slovak Republic. Not coincidentally, all those countries spend less than Canada on health.

The lesson we should be taking from European countries is that one of the most effective health interventions is income redistribution.

Money is the best drug we have. And, paradoxically, providing people with a decent income is probably cheaper than treating the illnesses of poverty, which tend to be expensive conditions such as diabetes, heart disease and cancer.

Notably absent from the lists of Canada's welfare shortcomings are seniors. The poverty rate in the over-65 age group is 5 per cent in Canada, compared with 20 per cent in the United States.

Our elderly are among the best off in the Western World because we made a determined effort to improve their lot with programs such as the Guaranteed Income Supplement and progressive tax measures.

This demonstrates that where there is political will, we can tackle social inequalities.

But look at what we do with children. Ottawa provides poor parents with the Canada Child Benefit and the National Child Benefit Supplement.

But most provinces negate that measure by clawing back -- reducing provincial welfare payments by an offsetting amount, or through taxation.

Poverty in children has a life-long reach. Poor children will grow up to be unhealthy adults.

Dr. Begin, who is currently serving on the World Health Organization Commission on the Social Determinants of Health, said the message that social justice is good for our collective health and that the speed at which we perform hip replacements is not the most pressing health problem in this country is a tough sell.

Baby boomers are distinguishing themselves as the most selfish generation to have ever walked the face of the Earth. We love our health care (which is more accurately described as sickness care) and, increasingly, we hate welfare.

Yet it is a false dichotomy and a false economy. We can pay now with decent social programs or pay later with increased health costs.



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