Income and health are inextricably linked. It is well documented that people with low income more likely to have poor health, whether measured by self-reported health, mental health, prevalence of chronic conditions, or many other indicators. In Ontario:
- Over three times as many people in the lowest income group report their health to be only poor or fair than in the highest;
- Five times as many men and three times as many women in the lowest income group report their mental health to be only poor or fair than the highest;
- People in the lowest income neighbourhoods had significantly higher rates of probable depression and hospitalization for depression than those from the highest income neighbourhoods;
- The percentage of people with diabetes or heart disease was three to five times higher in the lowest income group than the highest;
These inequities don’t affect just the quality of life, they also affect mortality: in Toronto, men in the lowest income group have a life expectancy 4.5 years less than men in the highest, while for women the gap is 2 years.
These inequities are not because of lifestyle, genetics or bad luck, but are rooted in structural features of contemporary Canadian society far beyond individuals’ control. The foundations of these health inequities lie in the effects of poverty and income inequality, precarious work and unemployment, inadequate housing and homelessness, racism and other lines of social exclusion, inequitable access to social, health and other services and support, and other social determinants of health.
So why does the social assistance system cause poor health?
Social assistance offers only a very low level of income and health supports. This means that people on social assistance are among the most disadvantaged in terms of the social determinants of health, and as a result, face the greatest burden and risk of ill health. And even amongst those on social assistance, some people face cascading disadvantage owing to racism, sexism, or other forms of discrimination.
Unfortunately, the current social assistance system in Ontario tends to reinforce health inequities and limit opportunities for good health:
- It does not provide enough income or other supports to obtain adequate housing, nutritious food, and health supports essential for good health – thus directly contributing to health inequities;
- Nor does it accommodate the complex and changing needs of people with episodic, chronic and other health conditions – reinforcing their unhealthy situation;
- Even when some provisions have a positive health impact – such as dental care and access to medications – the inability to keep these benefits if moving to precarious and lower paid jobs traps people on social assistance.
This is the challenge that we face in reforming the social assistance system. The Wellesley Institute was part of a broad partnership of health sector leaders that came together to ensure that health and health equity are emphasized in the review. In our submission to the Commission for the Review of Social Assistance in Ontario, we argued that reform should be built from a vision of a health-enabling social assistance system – more about this in an upcoming blog.