Doing nothing is still a decision, and doing nothing on poverty is very bad for our health.
Last week my students were discussing public health ethics. One group pointed out, correctly, that doing nothing is a policy decision. What then are we to make of the BC government’s persistent policy, over the past 15 years, to do little or nothing about poverty reduction? In effect, their decision to do nothing is a ‘pro-poverty’ policy; it seems they prefer to prolong and deepen poverty, and to fail to offer adequate relief for those living in poverty, in an attempt to force them into the low-wage workforce.
BC remains the only province that has not adopted a poverty reduction plan, and seems to glory in having a low minimum wage and low rates of social assistance. In fact BC, a wealthy province, has the second highest rate of poverty in Canada at 13.2 percent – almost 1 in 7 people – according to a January 2017 report from the Canadian Centre for Policy Alternatives (CCPA).
The report notes that “BC’s minimum wage was frozen at $8 an hour for nearly a decade between November 2001 and April 2011”. While it has increased since then, someone working full-time at minimum wage in BC today is about $3,500 below the poverty line for a 35-hour week and about $750 below if they work a 40 hour week. So even if they buy into the government’s mantra that the best social program is a job, they are going to live in poverty unless they get a second job or work overtime (if it’s available).
"Their decision to do nothing is a ‘pro-poverty’ policy."
Social assistance rates are even more impoverishing; rates have been frozen since 2007 and are now the third lowest in the country, at $610 a month for a single person, in a province that has a high cost of living. According to a 2015 Caledon Institute report cited by the CCPA, a single person on welfare in Metro Vancouver in 2015 would have reached only 40 percent of the poverty line, while a single parent with one child - mainly women - would reach 66 percent of the poverty line.
Moreover, many of the jobs that are being created in BC are in part-time, low-wage work. In its submission to the 2017 Budget Consultation, the CCPA pointed to Statistics Canada data showing that in the first quarter of 2016 “among the ten occupations with the most job vacancies in BC . . . five paid less than $12/hour”.
As they drily note, “these are not family-supporting wages”, while Irene Lanzinger, president of the B.C. Federation of Labour commented to the CBC in January that "We have not seen good, permanent full time family-sustaining jobs created by the [province's] job plan,"
Not only is the lack of attention to poverty an ethical lapse, it does not make economic sense, because poverty is associated with higher levels of ill health, which costs the health care system a great deal in additional care.
A 2016 report from BC’s Provincial Health Services Authority reported that people who live in local health areas with high socio-economic status (SES) “are expected to live nearly four years longer than people living in low SES areas” and that “people in the highest income group reported significantly more favourable rates than those in the lowest income group for a number of indicators” of health.
Not surprisingly, a 2016 report from the Public Health Agency of Canada on the economic costs of health inequality noted that “health care costs generally decline as income rises”. Overall, they found that in 2007-8 “socio-economic health inequalities cost Canada's health care system at least $6.2 billion annually” – and they were only looking at about a quarter of all health spending. This finding was echoed in a 2015 report from the Canadian Institute for Health Information, which also noted “there has been minimal progress in reducing the health gap between lower- and higher-income Canadians over the past decade”.
A government truly concerned about the health of both its citizens and its economy and the financial sustainability of its health care system needs to act on the understanding that poverty is both sickening and expensive, and that investing in poverty reduction is a smart and healthy decision. Let us hope the next government is sufficiently wise to see this.
Dr. Hancock is a Professor and Senior Scholar at the School of Public Health and Social Policy, University of Victoria. He was lead author and editor of the report for CPHA on the ecological determinants of health, and an expert reviewer for the report of the Lancet Commission on Planetary Health.