You may have read the evidence of the impact of being poor on health. But it really hits home when you see how poor access to health care affects someone you know.
My uncle Daniel lives in Ontario and has long term health problems which have been made worse by a lifetime of poverty. He has never been on social assistance. In fact, he has worked as much as he could his whole life. Despite this he is among the 33 percent of working Canadians who do not have proper prescription drug coverage.
Daniel worked a part-time minimum wage job. He couldn’t work more hours because physical limitations stopped him from working full time. But his employee drug plan was based on the number of hours he worked a week so part-time work meant he only had drug coverage every other month. When Daniel had infections like strep throat he could only sometimes afford to get treatment. In middle age when he was prescribed cholesterol-lowering medication which he had to take regularly, he could only afford it some of the time. And, when he had hip surgery in his late 50s he could only fill his prescription for pain medication every now and then. In Canada, only one-quarter of part-time workers have employer-provided health benefits.
Daniel may have had more medical problems because of his lifetime of poverty and the social determinants which increased his risk of ill health, but this was made worse because our response to his health care needs was also unfair.
During his working life, Daniel couldn’t access a drug plan for low-income working Canadians. There is no population-based coverage for people with low income living in Ontario. Now, at age 67, Daniel lives with chronic pain, unable to get up and down stairs and surviving off CPP and the Ontario Drug Benefit for low-income seniors. This is the context in which he currently lives and the circumstances which keep him sick and poor.
There are many levers we must pull in order to move the needle on poverty reduction. Good jobs and raising wages are always excellent measures to employ. But there are other systems we have developed that perpetuate poverty and inequality in this country. Canada’s health care system is not the universal equalizer we like to think it is. Our system is not meeting the needs of many Canadians, and some of the gaps we have in our system are actually exacerbating inequalities rather than preventing them.
Prescription drugs are an essential component of any health care system. As it currently stands, not all Canadians have equal access to them. A national drug plan is part of the suite of tools that Canada has at its disposal to reduce poverty. But the way that our current system is designed means that access to essential medications depends on where you live, your age, household income, source of income, and costs relative to household income. This is not an equitable way to provide coverage and it widens the already large gap between the rich and the poor.
Canada has a patchwork of public prescription drug programs that are complex, inaccessible and inequitable. There are 43 different public prescription drug programs run by the federal, provincial and territorial governments, each with their own eligibility criteria, expectations of payment and levels of coverage. Workers like Daniel in lower-paying jobs have lower levels of coverage than other working Canadians. This inequity is a uniquely Canadian problem: Canada is the only country with a universal health care system that doesn’t include prescription drugs.
More equality – whether it is in health care, education, or income – makes everyone healthier. On top of that, the simple implementation of a national drug plan would make society richer too: The estimated savings are $7 billion annually. A national prescription drug program is affordable. It’s easy. It improves health equity. It’s quite literally the least we can do.
Read our report, Low Earnings: Unfilled Prescriptions to learn more.