• Photograph by Free World Charter (altered)

A basic income guarantee may be the best medicine

194 physicians signed a letter sent today to Ontario's Minister of Health requesting his leadership to introduce a Basic Income Guarantee for the people of Ontario.

It is a reflection of pervasive income-related health problems they see every day. Adequate, stable income is the only treatment.

Last week a 22 year-old woman living with HIV from rural Ontario dropped in at an urgent care clinic complaining of severe dental pain. She was grimacing in agony during the appointment, her head down. She lived in a shelter and was supported by Ontario Works, from which the maximum amount of financial support available to her is currently $656 per month. She had been assessed at a free dental clinic, but her condition was so advanced that she required specialized dental care not available there. The pain was so great she could not eat.

Ontario Works does not cover the dental repair she needed. She was sent home with a prescription for pain killers. If she'd had adequate income support, she could have provided a down-payment and afforded the monthly dental bills. She could have started eating again. Instead, she was given pills when she needed income to pay for dental work.

At the community level, poverty also has deep and lasting impacts — some visible, some not. We've seen these visible impacts in Simcoe County Ontario, where one of us works. One in four single-parent families experience moderate or severe food insecurity at some point every year. A family of four receiving Ontario Works would have to spend 93% of their monthly after-tax income on rent and nutritious food alone, leaving little remaining for all other necessary expenses.

We see the population health impacts too, where those living in the fifth of neighbourhoods with the lowest income had a death rate from preventable causes more than 50% higher than those living in the fifth of neighbourhoods with the highest income. Self-rated mental and physical health were also significantly worse among those living in the low-income neighbourhoods.

"A basic income guarantee would be a key societal support in the face of rising precarious employment."

None of this is surprising, given the strong impact that income has on health at all ages, demonstrated over decades of research. For example, it has come to be understood that the experience of poverty in early childhood can lead to what is termed "toxic stress", with profound implications for physical and mental health from childhood to adulthood.

Enter, a (BIG) idea — basic income guarantee. As defined by Basic Income Canada Network (BICN), a BIG ensures everyone an income sufficient to meet basic needs and live with dignity, regardless of employment status. A BIG also ensures that everyone can participate in society, and reduces steep income inequalities.

Basic income is a concept that has been examined and debated for decades, including pilot projects in the United States, Canada and other countries. The Dutch city of Utrecht is currently embarking on its own test of basic income. The Canadian Mincome Experiment was an encouraging pilot project of basic income for working-age adults conducted jointly by the federal and Manitoba governments in the 70s, which demonstrated outcomes of improved health and higher rates of secondary school completion. Basic income also resembles income guarantees currently provided in Canada for seniors and children, which have contributed to health and social improvements in those age groups.

"A different approach is clearly warranted and feasible."

In addition to providing an effective policy response to poverty and inequality, a basic income guarantee would be a key societal support in the face of rising precarious employment in Canada. Given the trend towards fewer opportunities for secure, permanent jobs providing living wages and benefits, a basic income guarantee could help to buffer the effects of precarious employment by protecting people from slipping into poverty during challenging times.

There has been a groundswell of recent support for a basic income guarantee from several public health, medical and social organizations, as well as a growing number of grassroots citizen groups. There are also increasing expressions of support from politicians at the municipal, provincial and federal levels in Canada — including the mayors of Calgary, Edmonton and Charlottetown, the Premier of PEI, and resolutions passed by the Liberal and Green parties of Canada.

This week we look to Minister Hoskins for provincial leadership on this important policy issue, with hopes to establish a BIG trial program or demonstration project. Ontario, like other provinces and Canada as a whole, has a long history of trying and tinkering with other approaches to addressing poverty that simply haven't had the necessary impact. A different approach is clearly warranted and feasible — for the health and social benefits so rightly deserved by all. Perhaps now is the time.



Dr._Berger2.jpgDr. Philip Berger is the medical director of Inner City Health Program at St. Michael's Hospital. He's also an Associate Professor in the Department of Family at the University of Toronto. He has helped establish human rights related health organizations arising from his work with torture victims, people with HIV and refugees and has been involved in campaigns to fight poverty and on behalf of addicts. In 2013 he was inducted as a fellow of the Canadian Academy of Health Sciences.

Dr.Lisa.Simon.jpgDr. Lisa Simon is an Associate Medical Officer of Health with the Simcoe Muskoka District Health Unit, where she works in the areas of chronic disease and injury prevention, maternal and child health, and the social determinants of health. She received her medical degree from the University of Calgary and her residency training in public health and preventive medicine, as well as family medicine, from McMaster University. 


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