Feb 19, 2009

The Budget: A Determinant of Health


I know this budget is supposed to be good news for health, but I want to argue here that the exact opposite is true.

We’ve had a lot of budgets like this in B.C., so this one is in keeping with its right wing predecessors. During the 1980s, for example, the never-ending Social Credit government used to table budgets that gave the boot to working people in general, unions in particular, the poor, women, youth and, their favourite target, public sector workers. While they slashed services Socred ministers reassured everyone that the public would never notice the difference despite the fact that fewer people would be there to deliver them and that those who remained looked increasingly haggard and exhausted.

The Liberals are continuing this tacky boondoggle. This week’s budget boosted health care more than any other sector, which gives you some idea of how poorly everything else fared. Finance minister Colin Hansen claimed that the $4.8 billion for the health sector over the next three years constitutes 90% of all “new spending”. But as Marc Lee pointed out in his excellent post, very little of what’s gone to health actually is new money — last year’s allocation was brought forward to this year’s budget, with a dash of $25 million on top.

But this budget’s spending reflects a more general malaise in the provincial government when it comes to health care. As with many of the policies it pursues, all of the evidence should have pointed to a decidedly different direction in regard to the budget.

Take, for example, evidence about the social determinants of health, those factors that can prevent things like cardiovascular disease and Type 2 diabetes, the latter of which is now described as an epidemic. These social determinants play a greater role in preventing disease than biomedical or lifestyle behaviour modification. A 2006 paper by Dennis Raphael identified 11 key social determinants of health: Aboriginal status, early life, education, employment and working conditions, food security, health care services, housing, income and its distribution, social safety net, social exclusion, and unemployment and employment security.

David Gordon’s sensible Ten Tips for Better Health put these in language we can all understand:


  1. Don’t be poor. If you can, stop. If you can’t, try not to be poor for long.
  2. Don’t have poor parents.
  3. Own a car.
  4. Don’t work in a stressful, low paid manual job.
  5. Don’t live in damp, low quality housing.
  6. Be able to afford to go on a foreign holiday and sunbathe.
  7. Practice not losing your job and don’t become unemployed.
  8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled.
  9. Don’t live next to a busy major road or near a polluting factory.
  10. Learn how to fill in the complex housing benefit/ asylum application forms before you become homeless and destitute.

Gordon, D., Posting (April, 1999) Spirit of 1848 listserv.

The increase in the incidence of Type 2 diabetes in Canada — 69% between 1997 and 2007 — can be linked to the rising number of people who aren’t able to act on these good suggestions. People who are poor are not only more likely to get Type 2 diabetes than their wealthier counterparts, but they are also more likely to hospitalized with complications related to the disease. This has been shown to be the case by Canadian and international researchers, including those associated with the World Health Organization and the Pan-American Health Organization.

According to a 2007 study published by Ontario’s Institute for Clinical Evaluative Sciences,for example, Toronto neighbourhoods where poor people live also have much higher rates of Type 2 diabetes and obesity. “Areas with lower socioeconomic status (SES),” the report said, “had…higher diabetes rates. These neighbourhoods clustered in the northwest and eastern parts of the city. Conversely, neighbourhoods with a more advantaged SES profile tended to be clustered in the centre of the city and had lower diabetes rates.” In January 2006, the New York Times reported that in East Harlem, where incomes average $20,000 a year and the poverty rate is 38.2%, between 16 and 20 percent of residents have Type 2 diabetes. That compares to the Upper East Side, where the average income is $75,000, the poverty rate is about 6.2% and an estimated 1% of residents have the chronic condition. Like Clyde Hertzman (UBC) and others in Canada and internationally, Raphael has argued that the most important policy options for governments are ones aimed at reducing poverty. Poverty reduction is not just a human right, not just a moral and ethical obligation of government, but strategies to achieve that goal would reduce the strain on our health care system as well.

Does the budget have anything to do with the growing mountain of evidence about what people need to be healthy?

Hmmm… let’s see. The $8 minimum wage is frozen at $8 an hour, well below the “living wage” of $16.74 an hour. Wages in the public sector are to be frozen for the next couple of years and there is no strategy to raise wages in the private sector. The budget projects unemployment at 6.2% but by last month it had already reached 6.1% and the “up to” 88,000 new jobs it projects are clearly inadequate. The social safety net? The only reference to safety that I could find was in reference to policing and roads. Housing? The housing budget has been cut and market housing prices are 55% above the average family’s ability to pay. Those on income assistance will see an increase of one-half of one percent, while the ministry of Children & Families got only a one percent boost in the budget.

I would say the budget failed to ensure that the determinants of health are more accessible in these looming tough times — a 100% percent failure rate, in fact. But don’t worry! While the budget fails on health determinants side, the government has engaged the pharmaceutical industry in public-private partnerships to deliver chronic disease management (CDM) programs. So British Columbians with Type 2 diabetes and other chronic conditions — if they can afford to do so — will be able to dip in to the medicine chest to heal the wounds inflicted by this budget.