[Background: In Ontario the Tory government will be announcing a massive
transfer of funds from the poor to the rich through a 15% income tax reduction.]

For Ontario-based people, you may find this of interest.  No newspaper would carry
it -- except for the newspaper of the homeless, the Outreach Connection.

            Inequality: The Real Threat to Health Care
                 Dennis Raphael and Toba Bryant

Most Canadians are not aware that ours is a profoundly inequitable society. By the
end of the 1980's,the wealthiest 10% of the Canadian population possessed more
than 50% of the nation's economic resources. In the Wealthy Bankers's Wife, Linda
McQuaig cites United Nations data that finds that,among Western countries,
Canada is second only to the United States in economic inequality.

Inequality is increasing. Drawing from 1990-1993 Statistics Canada data, Bruce
Little described how the earnings of the poor have collapsed (Globe and Mail, Feb.
12, 1996). Daily headlines trumpet soaring company profits while these same
companies lay off employees. There is little evidence, however, that inequality is
high on the Canadian social policy agenda.

What looms large is the crisis in health care. Neo-conservative pundits foresee the
death of Medicare.  Federal and provincial governments struggle with increasing
health care costs. Is there a relationship between economic inequality and the
health of Canadians? If so, is there a message that is not reaching Canadians?

The evidence is in.  Countries in which economic inequality is greater generally
show an increased incidence of ill health. Among Organization for Economic
Cooperation and Development members,for example, economic inequality is the
best predictor of infant mortality rates. Within Western nations, social class -- an
excellent proxy for economic resources -- is reliably related to death and illness
among its citizens.  These differences are not limited to "lifestyle diseases" such
as lung cancer or coronary disease. Social class is related to almost any malady:
infectious diseases, diabetes, uterine cancer, suicide, accidents, and numerous
others. These effects were first documented in the United Kingdom in the Black
Report and the Health Divide.  Class-related health differences are also evident
in Canada.

The costs of inequality-related illnesses to Canadians are great. In a 1989 edition
of Health Reports,Wilkins conservatively estimated, based upon Statistics Canada
data, that 22% of total potential years of life lost prior to age 75 were due to
economic inequality. In 1995, Jin and others, in the Canadian
Medical Association Journal, documented the negative effects of unemployment on
health. The extent of and profound health effects on children of poverty were
described in the 1994 report The Health of Canada's Children published by the
Canadian Institute of Child Health.

The mechanisms by which economic inequality contributes to poor health are
becoming apparent.  On one level, individuals with fewer economic resources
suffer obvious deprivations related to nutrition,housing, clothing and other basic
needs. Such effects are related to resistance to disease. On another level, there is
increasing evidence that lack of economic resources is related to a sense of
powerlessness and lack of control over one's environment.  Lack of control is
being shown to be related to decreased immune system functioning.  Put simply,
individuals with fewer resources are at risk for poor health.

Residents of Ontario recently had the opportunity to see a clear demonstration of
these effects. Last fall, a number of Toronto personalities voluntarily went on the
Dave Tsubouchi -- the Ontario Minister of Community and Social Services -- welfare
diet.  All of these individuals reported feeling listless, weak, and generally
disconnected and disoriented. All commented on their lack of sense of control and
increased perceptions of powerlessness.  These individuals, however, were able
to return to their regular diets. None of them became ill.  Many who must remain on
the welfare diet may not have that luxury.

Knowing what we now do about health and economic inequality, consider the
potential effects of recent Ontario government policies on the health of Ontario
residents -- adults as well as children.However rationalized or packaged for public
consumption, cutting welfare benefits by 22% -- in order to provide an income tax
break for others -- will at a minimum increase economic inequality.  Will this
increased inequality lead to poorer health?  Extensive research leaves little doubt
that it will.  Will poorer health lead to increased health costs?  Extensive research
leaves little doubt that it will.

Why then has this message not reached Canadians? There are many reasons. In
North America,economic inequalities and associated effects on individuals have
been the focus of researchers and
other professionals in social welfare and education, rather than the health
sciences. Most Canadians know, for example,  that poverty is related to violence
and poor learning.  There has been less inquiry into the health effects of economic
inequality.

Another reason for the neglect of the economic inequality and poor health
relationship may be the domination of the political agenda by those profiting from
inequality. Some economists argue that high unemployment levels serve to
depress wage settlements. Politicians find it easier to blame welfare and service
recipients for policy failures rather than their own ineptitude.  And, as pointed out
by John Ralston Saul in The Unconscious Civilization, we have allowed ourselves
to be dominated by the corporatist agenda. Canadians have passively accepted the
marketplace ideology and the globalization agenda.

For too long, Canadians have seen poverty and economic inequality as a social ill.
 We were less likely to view inequality as a cause of escalating health costs.
Canadians should oppose economic inequality because it is unjust. This argument
appears to carry little weight nowadays.  Perhaps Canadians should pay attention
to economic inequality because it threatens their access to quality health care, and
therefore, their health.  For the health of many Canadian adults and children,
economic inequality is already taking its toll.

Dennis Raphael is an associate professor of Community Health at the University of
Toronto.  Toba Bryant is a social policy analyst and consultant in health promotion.
She will begin Ph.D. studies in social work at the University of Toronto in the Fall of
1996.



Dennis Raphael, Ph.D., C.Psych
62 First Avenue
Toronto, Ontario
M4M 1W8

Tel: 416-465-7455