An article for Upstream from
Dennis Raphael, York University &
Toba Bryant, University of Ontario Institute of Technology
The crash of an airliner is a tragic disaster that triggers major investigations and quick action to make sure the same problem doesn’t occur again. As a result, these are events are, thankfully, extremely rare.
Imagine the response, from industry, government and the public, if a plane was crashing every day. If there were something that killed as many people in a day as this kind of disaster, you’d expect it to provoke a similarly concentrated response.
A recent report by Statistics Canada[i] highlights a preventable cause of premature death that is having exactly that kind of impact. This study demonstrates that income inequality is associated with the premature death of 40,000 Canadians a year. That’s equal to 110 Canadians dying prematurely each day. To put that into context, imagine a Bombardier CS-100 jet airplane full of passengers falling out of the sky every day for a year.
How does this report arrive at this conclusion? It followed 2.7 million Canadians over a 16-year period and calculated death rates from a wide range of diseases and injuries as a function of the person’s income. Canadians were divided into five quintiles of approximately equal numbers from poorest to wealthiest. It then compared the number of deaths of the wealthiest 20% of Canadians to the other 80% of Canadians. It came to the conclusion that if all Canadians were as healthy as the top 20% of Canadian income earners, there would be approximately 40,000 fewer deaths each year, every year. Of these, 25,000 fewer deaths would be among Canadian men and 15,000 among Canadian women. These numbers are comparable to eliminating all deaths from coronary artery disease.
If all Canadians were as healthy as the top 20% of Canadian income earners, there would be approximately 40,000 fewer deaths each year
The report also calculates the relative rate of mortality, comparing the likelihood of death between someone in the poorest 20% of Canadians and one of the wealthiest 20% of Canadians. Overall, this figure is 1.67 for men and 1.52 for women, indicating that a poor male has a 67% greater chance of dying each year and a poor woman has a 52% greater chance of dying each year than their wealthy counterparts. That’s an excess death rate of 19.4% for men and 16.6% for women.
The study goes into further details, outlining income-related statistics for specific diseases. Poor Canadian males have a 63% greater chance of dying each year from heart disease than their wealthy counterparts. For women it’s a difference of 53%. The excess cardiovascular deaths associated with not being as healthy as the wealthy are 19% for men and 18% for women.
In relation to mortality from diabetes, the figures are even more striking. Poor Canadian men have a 150% greater chance and poor women a 160% greater chance of dying from diabetes than wealthy Canadians.
Poor Canadian men have a 150% greater chance and poor women a 160% greater chance of dying from diabetes than wealthy Canadians.
This means that if all Canadians were as healthy as wealthy Canadians, there would be nearly 40% fewer deaths from diabetes and nearly 20% fewer deaths from cardiovascular disease every year. Similar numbers showing a profound difference between wealthy and poor Canadians and between wealthy and all other Canadians appear for virtually every known disease which can kill Canadians, including cancer, respiratory disease, injuries, HIV-AIDS, and many more.
In the United Kingdom, the publication of figures like these has been common over the last 40 years. They frequently lead to media coverage, responses from health care and civil society leaders, and even public outrage.
Politicians at all levels have ignored the relationship between income inequality and health
In Canada we have no such response. There is little media attention to these kinds of studies, and major disease associations refuse to acknowledge their implications for preventing life-threatening diseases such as heart disease, diabetes, and cancer. [ii] In addition, politicians at all levels have ignored the relationship between income inequality and health. This is related to a reluctance to talk about the distribution of wealth in our country, and the redistribution efforts that would be required to address these health inequities. Instead, we are distracted by a health care, a reactive approach to illness that precludes consideration of broader determinants shaping the unequal distribution of premature death.
Income inequality is not only bad for our quality of life and economic productivity, it is directly related to the deaths of Canadians on an almost unimaginable scale.
The Statistics Canada report also makes clear that these differences in health outcomes are primarily due to the material living circumstances and the associated psychosocial stresses associated with not being as well off as the wealthiest 20% of Canadians: “Income influences health most directly through access to material resources such as better quality food and shelter.” Income inequality is not only bad for our quality of life and economic productivity[iii], it is directly related to the deaths of Canadians on an almost unimaginable scale.
Canadians are increasingly concerned about growing income inequality and are becoming more aware of its health effects. It’s time for a serious response from policy-makers, media and the public. Otherwise we’ll simply continue to watch 110 Canadians falling out of the sky every day, each day, 365 days a year.
Dennis, Toba and their son Alexander visiting the uneven landscape of Norway, a country with much more even wealth distribution than Canada and better health outcomes as a result.
Dennis Raphael, PhD, is a professor of health policy and management at York University in Toronto. He is co-author of Social Determinants of Health: The Canadian Facts which can be downloaded at no cost from http://thecanadianfacts.org.
Toba Bryant, PhD, is an assistant professor of health sciences at the University of Ontario Institute of Technology and author of An Introduction to Health Policy.
[i] Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study by Michael Tjepkema, Russell Wilkins and Andrea Long, Health Reports, 2013, vol. 24, no. 7. Available at http://www.statcan.gc.ca/pub/82-003-x/2013007/article/11852-eng.htm.
[ii] Why are Canadians not being told the truth about disease? By Dennis Raphael, Hamilton Spectator, March 11, 2014. Available at http://www.thespec.com/opinion-story/4405922-why-are-canadians-not-being-told-the-truth-about-disease-/.
[iii] Canadian Income Inequality. Conference Board of Canada, 2014. Available at http://www.conferenceboard.ca/hcp/hot-topics/caninequality.aspx.