[homeles_ot-l] In the news - 1. poverty, 2. socio-economic status & health
Lynne Browne
lbrowne at ysb.on.ca
Tue Nov 25 12:00:15 EST 2008
FYI, here are two stories in the media, one on poverty (Kate Heartfield
mentions the ATEH Forum) and one on mental health and Socio-Economic Status.
Lynne Browne
Coordinator, Alliance to End Homelessness (ATEH)
147 Besserer Street, Ottawa, ON K1N 6A7
HYPERLINK "mailto:lbrowne at ysb.on.ca"lbrowne at ysb.on.ca, 613-241-7913 ext 205
www.endhomelessnessottawa.ca
1. Dealing with poverty
Kate Heartfield
The Ottawa Citizen
Tuesday, November 25, 2008
There are two basic attitudes toward poverty. The first is that it's a
preventable condition that can and should be alleviated if possible, by
society or government or both. The second is that it's impossible to rid any
society of poverty because it's a character flaw, an indelible blot on human
nature that no one can really do anything about.
Strange as it may seem, it's the second attitude that's responsible for
massive and ineffective expenditures of public money.
Our network of private and public services is set up to treat poverty as a
permanent condition. It treats the symptoms of poverty -- and I mean that
literally. If we divide Canadians into five groups based on income, the
quintile with the lowest income is responsible for 31 per cent of public
health-care costs. Those are the Canadians whose household incomes average
about $20,000 a year.
Last week, the Ontario Association of Food Banks released a report called
The Cost of Poverty. It's a serious document, edited by Don Drummond, senior
vice-president and chief economist of TD Bank Financial Group. It determines
that poverty costs the taxpayers of Ontario between $10 billion and $13
billion a year, in such fields as health care, policing and lost
productivity. "In real terms, poverty costs every household in the province
from $2,299 to $2,895 a year."
I do quibble with the numbers. For one thing, one of the costs of poverty in
the report is lost tax revenue. This seems so obvious as to be tautological:
Ontario would be richer if more Ontarians were richer. If the bottom
quintile made more money, the government would pull in more tax. But that's
true of every other quintile too; why is it only a "cost" when applied to
the bottom quintile?
But as for the other "costs," they're hard to argue against. Poverty is
associated with more frequent trips to emergency rooms, and more frequent
encounters with police. Those services cost money.
The question becomes, then: If the incomes in the bottom quintile got closer
to the country's median income, would those costs decrease? And is it
possible to make that happen?
As the authors of the report acknowledge, much depends on how poverty is
tackled. They argue that the government would spend less money on health
care and crime if it spent more money on early childhood development,
workplace training for immigrants and literacy programs. Eventually, "a
comprehensive strategy to stifle the roots of poverty could possibly even
pay for itself."
The most extreme cases of poverty -- the chronically homeless -- are also
the most expensive. In 2006, Malcolm Gladwell wrote in The New Yorker about
"Million-Dollar Murray," a street alcoholic whose hospital bills and other
public services cost the state of Nevada about $1 million over 10 years.
There's a national effort underway in the United States to reduce the costs
of homelessness by "helping a few people a lot," as Gladwell put it. It's
cheaper and more effective to give the addicted homeless free apartments and
teams of support workers, than to let them keep getting picked up by the
police night after night. All it requires is letting go of the vaguely
Victorian attitude that these men deserve to be punished for their failings
-- and that we, as taxpayers, should pay over and over again for that
punishment.
Last week, the Alliance to End Homelessness held its 2008 Community Forum at
the University of Ottawa. One of the speakers was Chief Vern White of the
Ottawa Police service. He spoke honestly and movingly about the hard truth:
His officers know, better than most, the massive costs of chronic
homelessness. But they don't have the tools to change anything. And they
never will; that's not their job.
The Ontario government's new cabinet committee on poverty reduction will
announce its strategy early in December. In this economy, the government has
a duty to be cost-effective. That means helping poor people change their
lives, so that, a few years from now, they don't cost the rest of us so
much. And the process should start with the most expensive cases, the most
extreme.
But that's a bold approach, and Premier Dalton McGuinty isn't known for
boldness. He saw what happened to his Liberal colleague, Stéphane Dion, when
he tried to sell a bold plan based on sound economics. It rubbed people the
wrong way, and that was that. Mr. McGuinty is too astute a politician to
risk a similar approach to poverty.
As Gladwell pointed out, the right doesn't like a pragmatic approach to
homelessness, because it violates the idea that people should get only what
they deserve. The left doesn't like it because it's cold and efficient and
reduces people to figures in a ledger. It might work, but that's besides the
point, if you're a politician.
So we'll probably continue spending just enough money on poverty to
perpetuate it.
2. Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada
Link HYPERLINK
"http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_2509_E"http://secure.
cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_2509_E
(news release): Canadians in lower socio-economic groups more likely to be
hospitalized for mental illness, child asthma
New CIHI study examines health differences in 15 urban areas in Canada;
finds gaps wider in some areas than others
OTTAWA, Nov. 24 /CNW Telbec/ - In major urban areas across Canada the
situation is similar: the lower your socio-economic status, the more likely
you are to be hospitalized for any number of health issues, from childhood
asthma to mental illness to diabetes. A new study from the Canadian
Institute
for Health Information (CIHI) is the largest of its kind to examine
differences in health and health system use between Canadians in high-,
average- and low-socio-economic status groups.
Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban
Canada
compares 21 health-related indicators between three socio-economic status
groups-low, average and high-within and across 15 of Canada's largest census
metropolitan areas, representing 66% of Canada's urban population as defined
by CIHI analyses. Socio-economic status (SES) is a measure of an
individual's
economic and social position relative to others, based on income, education
and employment.
CIHI's study examined hospitalization rates for different types of
admissions (such as for injuries and anxiety disorders) over a three-year
period (between 2003-2004 and 2005-2006) and found the effects of SES were
more noticeable for some types of admissions than for others. For example:
<<
- Hospitalization rates for mental illness in the low-SES group were 2.3
times those in the high-SES group (596 per 100,000 people compared to
256 per 100,000). Hospitalization rates for substance-related
disorders
in the low-SES group were 3.4 times those in the high-SES group.
- Urban Canadians in low-SES groups were more than twice as likely to be
hospitalized for chronic conditions that could potentially be treated
in the community, known as ambulatory care sensitive conditions. For
example, they were 2.4 times more likely to be hospitalized for
diabetes and 2.7 times more likely to be hospitalized for chronic
obstructive pulmonary disease.
- Children from low-SES groups had 56% higher hospitalization rates for
asthma than children from high-SES groups.
- Gaps were less pronounced, however, for low-birth-weight babies and
hospitalizations for injuries in children.
>>
"Knowing where the health gaps are widest can help those of us on the
front lines better address the underlying reasons those gaps exist," says
Dr.
Cordell Neudorf, Chair of the Canadian Population Health Initiative (CPHI)
Council and Chief Medical Officer of Health for the Saskatoon Health Region.
"Where there are small differences in health status between socio-economic
groups, universal programs aimed at the general population may be more
successful, but when there are large gaps, these concerns may require more
targeted programs tailored for specific groups."
CIHI's study also looked at differences in self-reported health status.
Using Statistics Canada's Canadian Community Health Survey, the study found
Canadians in low-SES groups were nearly twice as likely to report smoking as
those in high-SES groups. However, there were only small gaps between groups
for rates of influenza immunization, alcohol binging or being overweight or
obese.
"Today's study reveals new information on the effect income, education
and employment status may have on hospitalization rates across the country,"
says Jean Harvey, Director of CPHI, a program of CIHI. "Canadians with lower
socio-economic status are more likely to be hospitalized for conditions like
mental illness and other chronic diseases, conditions that might potentially
be prevented or treated in the community."
Health status across 15 urban areas in Canada varies
The health status of the urban population in Canada varies within and
across urban areas, as do the gaps between socio-economic groups. Of the 15
urban areas examined in this study, Regina and Winnipeg had the most
profound
differences in hospitalization rates of people in different socio-economic
groups, while Ottawa-Gatineau and Toronto had the least, with more
consistent
rates across the three levels of SES. For example, hospitalization rates for
mental illness in the low-SES group in Regina were about 4.5 times that of
the
high-SES group. In Ottawa-Gatineau, the mental health hospitalization rates
for those in the low-SES group were 2.0 times those in the high-SES group.
For self-reported health, residents in Halifax and St. John's were the
most likely to report similar health status, regardless of SES group, while
Victoria and London had the greatest gaps between SES groups.
About this report
This report was prepared by CIHI's Canadian Population Health Initiative
in collaboration with CIHI's Health Indicators department, the Urban Public
Health Network, the Institut national de santé publique du Québec and
Statistics Canada.
About CPHI
The Canadian Population Health Initiative (CPHI) is part of the Canadian
Institute for Health Information (CIHI). CPHI conducts and supports research
to foster a better understanding of factors that affect the health of
individuals and communities; and to contribute to the development of
policies
that reduce inequities and improve the health and well-being of Canadians.
About CIHI
The Canadian Institute for Health Information (CIHI) collects and
analyzes information on health and health care in Canada and makes it
publicly
available. Canada's federal, provincial and territorial governments created
CIHI as a not-for-profit, independent organization dedicated to forging a
common approach to Canadian health information. CIHI's goal: to provide
timely, accurate and comparable information. CIHI's data and reports inform
health policies, support the effective delivery of health services and raise
awareness among Canadians of the factors that contribute to good health.
The report and the following figures and tables are available from
CIHI's
website at www.cihi.ca.
<<
Figure 1 Pan-Canadian Age-Standardized Hospitalization Rates by Socio-
Economic Status Group (Figure 2 in the report)
Figure 2 Pan-Canadian Ratio of Age-Standardized Hospitalization Rates
Between Low- and High- Socio-Economic Status Groups (Figure 4
in the report)
Figure 3 Pan-Canadian Age-Standardized Self-Reported Health Percentages
by Socio-Economic Status Group (Figure 3 in the report)
Figure 4 Pan-Canadian Ratio of Age-Standardized Percentages of Self-
Reported Health Between Low- and High-Socio-Economic Status
Groups (Figure 5 in the report)
Table 1 Ratio of Age-Standardized Hospitalization Rates Between Low-
and High-Socio-Economic Status Groups in 15 Canadian CMAs
(Table 2 in the report)
Table 2 Ratio of Age-Standardized Self-Reported Health Percentages
Between Low- and High-Socio-Economic Status Groups in 15
Canadian CMAs (Table 3 in the report)
>>
For further information: Leona Hollingsworth, (613) 241-7860 ext. 4140,
Cell: (613) 612-3914, lhollingsworth at cihi.ca; Jennie Hoekstra, (613)
241-7860
ext. 4331, Cell: (613) 725-4097, jhoekstra at cihi.ca
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