I have a little confession to make. I can’t stand inspirational quotes. Well, most of them anyway. Some are, I admit, clever. But I think it’s their trite reductionism that brings out my inner sneer. The worst ones, to my mind, are the oft-used statements on wealth. You know, the “money can’t buy happiness” type of boring blanket observation. Yeah sure, whatever, but it sure can buy a lot of other things, often including health. Income is one of the most important social determinants of health. Income, I would argue, is everything. It determines where we live, how we live, our stress levels, the quality of our early life, how well we live in later life, and even how long we live.
Now some of you reading this may be thinking “but money doesn’t mean anything if you don’t have health.” That’s the conventional belief. Its one that swipes wealth and class privilege aside and assumes all things are equal when they’re not. But think about it. Chemo is a lot easier when you can afford the nutritious or easy to ingest foods needed to survive, or make you feel better. Nobody wants to be ill, but trust me, being sick with means is better than being sick without. You’re also more likely to get sick and remain sick if you are poor, even with socialized health care in the mix. Let me explain why…
If you have access to reading materials nowadays (newspapers, Internet, etc.) you most likely have come across the catchphrase “social determinants of health”. It’s something used by those who work in the fields of public health, social work, social planning, health planning, government, and academia to describe the influences and factors that shape the health of a population. There are several theories and “models” for the social determinants of health. Most include a number of variables, including gender, race, income, unemployment and employment (and working conditions), education, disability, access to health services, access to healthy foods, or food security, social safety net, social inclusion/exclusion, early life (or childhood experiences such as low birth weight or malnutrition), and Aboriginal status. That’s a lengthy list, but essentially what it means is that each of these variables has an impact on a person’s health and the impact is statistically greater than behavioural factors such as say, smoking (but any number of them can contribute to behavioural factors such as smoking or excessive drinking).
Let’s boil that down. So, if you are poor, whether unemployed, disabled, or employed in a low-paying job(s), you are less likely to be able to afford good food or housing. A chronically deficient diet (or simply, too little food) leads to illness and an inability to concentrate. Poor housing or lack of housing is a major contributor to chronic stress, and chronic stress contributes to a number of health issues, from higher risks for depression to heart attacks. You are also less likely to be able to access higher education (or more in debt if you are able to access it) if you are poor. This makes it harder to find a stable, living wage job. And so on and so on. Of course, we all know these things anecdotally. But there is also ample hard and tested evidence to show that poverty makes life nasty, brutish, and short. In Canada, our much-vaunted social safety net means trips to the doctor or stays in hospital are covered (phew). But treating an illness caused by poverty isn’t the same as preventing it.
Ultimately, the social determinants of health are more than variables. They are entrenched inequities in our society. On a sliding scale, the poorest people in our communities and our country suffer the most, and these people are more likely to be women, the disabled, Aboriginal, unemployed or underemployed, with fewer social connections, and often less formal education. But this inequality isn’t just an unchangeable fact of life. It isn’t just “how the chips fall” or something that “is what it is.” Income inequality is a policy issue—something determined by the decisions we and our governments make. We decide to be a less equal society and we can decide to change that so that we all benefit.