Poverty Reduction: Poverty as Public Health Problem

Is there a link between poverty and public health?


Dr. Monika Dutt

“Definitely,” says Monika Dutt, a family doctor and medical officer of health with the Nova Scotia Health Authority in the CBRM. “It’s always been there, but I think now there’s more and more evidence to really show there is a clear link between poverty and health.”

Sometimes that link is indirect—poverty makes it difficult to access good food, poverty can make getting regular exercise a challenge. Says Dutt:

[I]f you’re working two jobs…you’re…too exhausted to go for a walk, much less get a gym membership and go to a gym. That’s just another factor that makes it harder to be healthy.

One of the most ineffective things is just to tell people, ‘You know, you need to eat healthy and you need to exercise’…It’s a little part of it, but unless there’s an environment that actually supports that, it makes it really hard to actually be healthy.

Poor housing conditions can exacerbate illness: “If you have a moldy house and you have trouble breathing, that’s going to affect your health,” says Dutt.

But some of the links between poverty and health are more direct. Poverty can cause “actual, physiological changes—changes in your body, changes in the biochemicals of your brain,” says Dutt.

For instance, a 2015 study by Nicole L. Hair, et al, Association of Child Poverty, Brain Development and Academic Achievement, found that:

Poverty is tied to structural differences in several areas of the brain associated with school readiness skills, with the largest influence observed among children from the poorest households.

(The study was published in the United States in 2013, when a full 51% of students in the public school system came from low-income families.)

The Wellesley Institute, which has done extensive research into the poverty/health connection, found that there is:

 …a well-established gradient of health in which people who are in the lowest income group have worse health than people who are even just one step further up the income ladder.

“We know there’s higher rates of depression and suicide among people who are living in poverty; we know there’s more heart disease; we know even certain types of cancers,” says Dutt.

That link?

“It’s definitely there.”


The Bottom Line

This section is for those people who hear that poverty is linked to poor health and are moved not a whit. (Do such people really exist? I’m not entirely convinced they do. And if they do, I rather doubt they read The Spectator. But, for the sake of argument, let’s assume there are such people and the only way to appeal to them is through their wallets. )

Those people should read The Direct Economic Burden of Socioeconomic Health Inequalities in Canada: An Analysis of Health Care Costs by Income Level, from the Public Health Agency of Canada. (They could, of course, wait for the movie but I fear they’d wait a long, long time.)

Canadian research indicates that individuals with lower incomes, less education or lower occupational skill levels tend to be less healthy than those who enjoy greater advantages in these areas. This uneven distribution of health across different socioeconomic status (SES) groups is referred to as ‘socioeconomic inequality in health.’

Evidence of the economic cost of health inequalities helps us understand the benefits of reducing these inequalities. However, the data needed to generate such evidence is difficult to obtain. A lack of Canadian data linking health costs and socioeconomic characteristics means that assessment of the degree to which health costs are associated with socioeconomic inequalities at the national level is limited.

The authors take a bash at associating health costs with socioeconomic inequalities by working with StatsCan. They divide the population into “quintiles” (like the Dionne quintuplets, except not) according to income. They then compare the cost of providing health care to each quintile for one year (2007-2008). Actually, let’s be more precise, they compare the cost of providing three health care services to each quintile: acute care inpatient hospitalizations, prescription medications and physician consultations (general practitioner and specialist). Together, these three services represented about one quarter of all health care expenditures in Canada that year.

Doing this analysis allowed the authors to “assess one dimension of economic impact: the direct economic burden of socioeconomic inequalities in health in Canada.”

So what did the report find?  It [SPOILER ALERT] found that:

Socioeconomic health inequalities impose a direct economic burden of at least $6.2 billion annually, or over 14% of total expenditures on acute care inpatient hospitalizations, prescription medication and physician consultations.

Canadians in the lowest income group account for 60% ($3.7 billion) of the total direct economic burden. Improving the health of the lowest [socioeconomic status] group could have a significant impact on the costs of socioeconomic health inequalities in Canada.

We could, in other words, save millions of dollars by addressing “socioeconomic health inequalities” in this country.



If you read the first installment of this Poverty Reduction series, you’ll know that it’s (loosely) based on a document from the Tamarack Institute called 10—A Guide for Cities Reducing Poverty, presented during the Cities Reducing Poverty: When Mayors Lead conference in Edmonton in February.

The document includes 10 real-life poverty reduction strategies from 10 real-life Canadian cities and the city singled out for recognizing poverty as a public health problem is Saskatoon, Saskatchewan. This isn’t to say that Saskatoon has succeeded in eradicating the problem, just that, according to a 2016 University of Saskatchewan study (Dutt was not kidding when she said this issue was well researched) “there has been considerable work examining health inequalities, primarily within the Saskatoon Health Region, where monitoring and reporting on health inequalities has led to improvement initiatives within the health sector and by the Saskatoon Regional Intersectoral Committee.”

(By the way, if you’ve been wondering which came first, the illness or the poverty, one of the authors of that study, Dr. Cory Neudorf, has your answer. He told the Saskatoon Star Phoenix that “while the link between wealth and health outcomes runs both ways, the former mostly influences the latter. That can be due to people having less access to chronic disease management, while simply living in constant stress amplifies the effects of any specific condition.”)

The main point, for me, is that Saskatoon is a city. That is, a municipality. And yet, it sees poverty reduction as within its mandate.

Dutt, who says that as a physician she can personally take poverty into account when assessing a patient, also says “the best solutions are at a municipal or provincial or federal or…at higher policy levels.”

I asked her for some ideas as to how municipalities, in particular, could help and she said;

[A] lot of municipalities have really taken on addressing poverty as a municipal issue and there’s different things municipalities can do…Some have done things like looking at a living wage and how much does it cost to live in this municipality…[A]t the least we need to make sure we’re paying our [municipal] employees that, so we can be an example to other employers to say, ‘It costs $17 an hour to live in the city area if you’re working full-time.’

The Canadian Centre for Policy Alternatives and United Way Halifax crunched the numbers for the Halifax Regional Municipality (HRM) in 2015 and determined that a “living wage” in that city is $20.10 per hour (compared to the minimum wage of $10.60 per hour).

Dutt says there are a few “people and groups,” Public Health among them, hoping to do a similar calculation for the CBRM.

And before you start squawking about such a wage being impossible for small business owners to pay (I see you there, all ready to squawk), let me point out that there are two ways to use this information: one would be to set a higher minimum wage, the other would be to address the cost of living.

But there is also a role for municipalities in addressing the problems of sub-standard housing and precarious housing and homelessness (all of which contribute to health problems). Dutt says Public Health, along with the Cape Breton Community Housing Association and “a few other partners” is just completing a detailed analysis of homelessness and precarious housing in the CBRM. The study, which will be launched in November, involved 40 community organizations “collecting information around the housing situations of people they interact with.”

The municipality, which plays a role in the rental market as well as some role in public housing, could be part of the solution to these problems.

Nobody is saying it will be easy, but a municipality that has hired port developers with the goal of “making transportation history,” is surely up to the challenge.


Featured image: Cape Breton Regional Hospital by Verne Equinox (Own work) CC BY-SA 3.0,via Wikimedia Commons


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