I just read an editorial that reminded me about why I need to pay attention to
our tax system.  Thought I would share it with you and invite comments.

"Decades of research in Canada and abroad show a strikingly strong correlation
between income and a variety of indicators of physical, psychological and social
health."  And "The 'growing gap between rich and poor' is a potent image
reminding Canadians of the dark side of life in the nation that consistently
ranks at or near the top of the United Nations Human Development
Index."  Thus says Ken Battle in an editorial entitled "Incomes and Outcomes,"
in the latest issue of the Canadian Journal of Public Health (Dec. 1999, vol.
90, no. 6, pp 366-367).  I think he speaks directly to us as population health
promoters.  Quotes below are from this editorial.

In case you don't have it handy, I'll summarize what he says.  Ken offers a
concise analysis of what has actually been happening in Canada to the income
gap. Actually, as he points
out, there are TWO income gaps.
a)   The gap in family market income (income from employment, investments,
private pensions and other private sources - before-tax income) has been
widening since 1981:  in 1997, families
in the lowest 20 % of the income spectrum had 2% of the market income, compared
with 44 % share for families in the top 20 % bracket.
b)   But, the gap in after-tax income (taking into account the increase in
income from social programs and reduction in income from paying federal and
provincial income taxes) has
remained fairly consistent over that time period, and it's narrower:  in 1997
the lowest-income families had 7% of after-tax income, while the highest income
group had 37%.

He concludes that "government transfers and taxes have managed to almost
completely offset increasing inequality of market income" in Canada.  Government
transfers and taxes are what
he calls "after-the-fact" corrective measures, because they redistribute income
from the "have-a-lots to have-nots" so that there is less inequality in
after-tax income.

Makes you want to look closely at proposals to change the tax system, doesn't
it?  It reminds me of one of the functions of the tax system - redistributing
income and thereby reducing
the gap between rich and poor, or at least keeping it from widening.  So I would
want to look at how proposed changes would impact on this important function of
the system...changes
like those proposed by the recent Tax Commission in Saskatchewan, for example.

Ken also identifies a second approach to combatting inequality of market income:
"preventive measures - such as medicare, education and a wide range of
pro-employment programs - that
attempt to tackle market income inequalities at their source by improving
equality of opportunity and by providing certain goods (notably essential health
care and public education)
considered too important to be left to the market."  This reminds me to also
look at proposed tax changes for their likely impact on our ability to fund
important programs that improve
"equality of opportunity" to get and keep jobs that will generate adequate
market income.  We need the public resources to invest in these preventive
measures.

Finally, his editorial reminds me of why I have to concern myself with more than
the health sector, if I'm interested in promoting health.  "The coming of
medicare was one of the rare
triumphs of societal action against inequality because it most improved access
to health care for the poor, who face the highest health risks.  But the
income-based health gap remains,
because the health system can only do so much to tackle the deep social and
economic roots of health inequalities.  A broad and complex range of both
corrective and preventive measures
are required that go well beyond the health system."

I highly recommend this article as food for thought.  And I'd be interested in
other people's comments.

Joan Feather
University of Saskatchewan


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   Where a great proportion of the people are suffered to languish
        in helpless misery,
   That country must be ill-policed and wretchedly governed:
   A decent provision for the poor is the true test of civilization.

   -- Dr. Samuel Johnson, 1770
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Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
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