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There’s a meme circulating on social media that summarizes quite neatly some of the challenges we face in ensuring equitable access to critical health and social services.
The meme says: Being poor now just leads to being more poor later. Can’t pay to clean your teeth? Next year, pay for a root canal. Can’t pay or a new mattress? Next year, pay for back surgery. Can’t pay to get that lump checked out? Next year, pay for stage III cancer. Poverty charges interest.
While memes are often humorous, many of them are pointed — sometimes sarcastic — insights into the human condition.
I spent 10 years working in public health and 10 years before that in public advocacy for the status of women. The meme captures the essence of the determinants of health philosophy.
In case you didn’t know already, Canada was one of the proponents of the population health model in the mid-1970s, in which the determinants of health look at what makes us and keeps us healthy.
According to the World Health Organization, “the context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health.”
Originally there were nine determinants of health in order of impact: income and social status, education, physical environment, employment and working conditions, social support networks, culture, genetics, personal behaviour and coping skills, and health services.
In the late 1990s, gender and race/ethnicity were added as factors in the determinants to address the inequities in access and the different experiences being male and female bring to health as well as the effect of racism and discrimination on health.
If you look at the list, you will notice that access to health services in the bottom in terms of its ability to ensure individual health. And yet when we look at the public discourse on health in this province and in Canada, we always default to health services as the priority.
I’m not saying health services aren’t important. They are a necessary part of our ability to maintain health. But they are not the No. 1 priority.
When I was growing up, kids were encouraged to eat their fruits and vegetables, and the tagline then (alas no memes!) was “an apple a day keeps the doctor away.”
When you are poor, you cannot afford apples, or fresh fruits and vegetables.
I was horrified a few years ago when winter freezes meant limited access to fresh foods, and so cauliflower, to give one example, was selling for $8 a head.
But for the person living on a low income (like earning minimum wage), everyday prices for fruit and veg are always out of reach.
If you are earning minimum wage, chances are you don’t have access to a health plan, in which you can get drug coverage, vision care and dental care.
This province offers a number of supports for people on low income, including drug coverage, some dental care, and some vision care, but not everything is covered. For example, preventative dental services such as cleanings and fluorides are not covered at all once you turn 13.
When we look at the determinants of health, income and social status is the most important indicator of health, followed by education, environment, and employment. If you are living in inadequate or precarious housing, for example, you may experience a variety of health issues arising from exposure to moulds, toxins, poor air quality etc.
If you or your children are hungry because rent and heat have taken up most of your earnings, then you and your children are not in a good position to work or learn.
Provincial budget hearings are in the works.
We need to look at continued investment in health strategies that focus on prevention and mitigation rather than those that focus on interventions when things have progressed beyond the simpler solutions.
Adjusting our priorities and being creative in programming would be a good place to start.
Martha Muzychka is a writer and consultant. Email: firstname.lastname@example.org