The Hamilton Spectator -- Final
Forum Friday, August 25, 2000 A11

Is this the future we want?; Canadians should be careful what
we wish for by looking at U.S. health and social well-being

Dennis Raphael

The Spectator

STORY TYPE: Opinion
LENGTH: Long

In Hard Right Turn: The New Face of Neo-Conservatism in
Canada, political scientist Brooke Jeffrey argues that
premiers Ralph Klein of Alberta and Mike Harris of Ontario,
and Alliance leader Stockwell Day share a desire to move
Canada closer to policies implemented bythe United States.
What could Canadians expect if this were to occur?

Recent health research would suggest the greater inequality of
income and wealth among citizens typical of the U.S. would
translate into poorer population health. This would occur
since economic inequality creates poverty, weakens social
structures that support health
such as social and community services, and decreases social
cohesion. In fact these findings are so consistent that the
British Medical Journal recently editorialized: "What matters
in determining mortality and health in a society is less the
overall wealth of that society and more
how evenly wealth is distributed. The more equally wealth is
distributed the better the health of  that society."

Is there any evidence that the greater economic inequality
seen in the U.S. is associated with greater incidence of
poverty, poor health, and societal disintegration?

Health status of Americans

Despite spending a greater percentage of gross domestic
product (13.5 per cent) on health care than any other
industrialized nation, the U.S. compares poorly in
international health status comparisons. One observer stated:
"For nearly all available outcome measures, the United States
ranked near the bottom of the OECD (Organization for Economic
Co-operation and Development) countries in 1996, and the rate
of improvement for most of the indicators has been slower than
the median OECD country."

This data indicated that among the 29 OECD nations, U.S. life
expectancy ranked 19th for females and 22nd for males. The
World Health Organization recently calculated "healthy life
expectancy" among 139 nations and the U.S. placed 24th in
those rankings. The reasons given for this low ranking
included the very poor health status of native Americans,
rural African Americans, and inner-city poor. The U.S. also
has very high levels of cancers related to tobacco use,
coronary heart disease rate, and levels of violence,
especially homicide, when compared to other industrialized
nations.

The U.S.-based Fordham Institute for Innovation in Social
Policy has for the past 12 years reported overall U.S. and
state scores on an Index of Social Health that consists of 16
indicators of health and well-being. Overall scores on the
index have been declining in the United States since the mid
1970s even as gross domestic product has increased. From 1970
to 1996, indicators worsened for child abuse, child poverty,
teenage suicide, number of health-care uninsured, average
weekly wages, inequality, and violent crime.

What is particularly illuminating are comparisons of U.S.
social indicators with other nations. (See chart in box
above.) For comparison purposes, I have included rankings of
Canada and Sweden. The figures were culled from various
international sources. Outside of unemployment rates, the U.S.
compares very unfavourably to other industrialized nations.

It should be noted that while Canada's ranking for rate of
youth homicide is close to that of the U.S., the actual
figures are 43 per 100,000 people for the U.S. and 5 per
100,000 people for Canada. The closest nation to the U.S. is
Northern Ireland with a rate of 22 per 100,000.

Older Canadians considering supporting the Stockwell Day's
Alliance party should take note of the rankings on elderly
living in poverty.

In addition to having the greatest incidence of child poverty,
the U.S. spends a smaller percentage of gross domestic product
on social services and supports than most OECD nations. The
result is that American low-income families are at a distinct
disadvantage compared with similarly situated families in
other nations.

Current trends

The U.S. has witnessed an unprecedented increase in inequality
of income and wealth in the past two decades. Former U.S.
Secretary of Labor, Robert Reich observes: "Almost two decades
ago, inequality of income, wealth, and opportunity in the
United States began to widen, and today the gap is greater
than at any time in living memory. All the rungs on the
economic ladder are farther apart than they were a generation
ago and the space begins them continues to spread."

A recent report concluded: "More U.S. children are in deep
poverty than in the two comparison nations [of Canada and the
U.K.] ... the income disparities between the rich and poor and
near poor are much larger in the United States than in Canada
or the United Kingdom."

Indeed, a recent report in the British Medical Journal found
that Canadian mortality rates were strikingly lower than those
in the U.S., as was degree of economic inequality. All of
these trends led one American observer to comment that "in the
U.S., government policies of the past 20 years have promoted,
encouraged and celebrated inequality. These are choices that
we, as a society, have made. Now one half of our society is
afraid of the other half, and the gap between us is expanding.
Our health is not the only thing in danger. They that sow the
wind shall reap the whirlwind."

Is this the future Canadians want?

This material is taken from Health Inequities in the United
States: Prospects and Solutions, which will appear in the
U.S.-based Journal of Public Health Policy. Web sites:
www.utoronto.ca/qol and www.utoronto.ca/seniors

Dennis Raphael was born in Brooklyn, N.Y., and is now an
associate professor of public health sciences at the
University of Toronto. E-mail: [log in to unmask]

USA, Canada, and Sweden rankings compared to other
industrialized nations

(In ranking, 1 is best)

Measure                         USA     Canada  Sweden

Infant mortality (1996)         24/29   17      2

High school dropouts (1996)     17/17   16      10

Elderly poverty (1990)          15/17   4       5

Life expectancy (1996)          20/29   4       3

Child poverty (1990)            17/17   14      2

Youth suicide (1992-1995)       15/22   16      10

Wages (1996)                    13/23   15      6

Inequality (1990)               18/18   11      3

Youth homicide (1992-1995)      22/22   19      5

Unemployment (1996)             2/10    7       8

ILLUSTRATION

DOC. #: 20000825HS278143