Globalization and the Health of Canadians Ronald Labonté Canada Research Chair Globalization and Health Equity Supported by CIHR Grant #80070 With additional support from the Population Health Improvement Research Network (PHIRN) of MOHLTC

Research questions 1. What are the major causal pathways by which globalization affects or is likely to affect health with special reference to low-income families with children in major metropolitan areas? 2. How does globalization affect the international context in which Canada must address health equity and determinants of health? 3. How effectively has Canadian public policy responded to the challenges for health outcomes and determinants of health presented by globalization? Globalization and the Health of Canadians, December 12, 2012

Research questions (cont.) 4. What demonstrably effective best practices to avoid or mitigate the potentially negative health effects of globalization can be identified from the experience of other countries? 5. What are the key policy entry points for addressing the impact of globalization on health disparities in the future? What opportunities will be available to Canadian governments for using those policy entry points? 6. What key data and research needs must be addressed for purposes of future Canadian research and policy in this area? Globalization and the Health of Canadians, December 12, 2012

Topics included: A critique of neoliberal globalization’s impacts on the welfare state Globalization and social insecurity The global crisis affecting families A population approach to urban health in Canada Poverty and spatialized communities Growing economic gaps in Canada Neighbourhood approaches to urban health Inner suburbanization Transformations in state/civil society politics Health and the future of the Canadian metropolis Globalization and the Health of Canadians, December 12, 2012

Research projects McGill Institute for Health and Social Policy global comparative policy platform (focus on unemployment and on pensions) New research on families with young children in low-income urban and peri-urban neighbourhoods (Vancouver, Toronto, Montreal) Systematic review of place-based effects on health for evidence of globalization-related pathways Structured narrative reviews of gendered health impacts of globalization-related pathways and of the health impacts of labour market informalization Comparative policy analysis of municipal responses to mitigate negative health impacts Development of scenarios for the future of urban health in a globalized economy Globalization and the Health of Canadians, December 12, 2012

Major globalization pathways Labour markets: decline in manufacturing, rise of the ‘precariat,’ flexibilization and polarization of incomes Metropolitan land and housing markets: speculative investments, real estate bubbles, spatial segregation and problems of affordability Migration: defining component of globalization, with globalization a major ‘push’ to flows to Canada and primarily its major urban centers, but with declines now in the ‘healthy worker’ effect Social protection measures: rise of the ‘competitive state’ and changes in scope and redistributive aspects of social spending, alongside impacts of tax competition, neoliberal economic policies and expansion of offshore financial centers and capital flight Globalization and the Health of Canadians, December 12, 2012

Labour markets less, not more, secure; insecurity a risk for CVD In Mumbai, unemployment more than doubled between 1981 and 1996, while informal employment and self-employment increased substantially In São Paulo, 23 percent of manufacturing jobs disappeared between 1985 and 2003 as the country’s economy was opened to international markets In Johannesburg, informal employment increased as a percentage of total employment from 9.6 percent to 16 percent in just three years ( ); in 2001 the city’s official unemployment rate was 37 percent Across Latin America in 2011, some 57% of all employment in its cities resides in the ‘informal’ (underpaid, lower paid, insecure) sector Sources: T Schrecker and R Labonté “Globalization,” in D. Vlahov, J. Boufford, C. Pearson and L. Norris, eds., Urban Health: Global Perspectives (New York: Jossey-Bass/John Wiley & Sons, 2010). Inter-American Development Bank Urban Sustainability in Latin America and the Caribbean, Globalization and the Health of Canadians, December 12, 2012

Statistics Canada. No date. Table Labour Force Survey Estimates (LFS), Annually (table). CANSIM (database). Using E-Stat (distributor). Last updated June 8th, (Sam Caldbick, MPH student practicum) Growth in part-time employment rate in Canada:

Land and real estate Globalization and the Health of Canadians, December 12, 2012

Migration, employment and housing Recent immigrants are better educated and skilled than their earlier counterparts but experience extreme difficulties in the job market The income gap between recent immigrants and other Canadians has been increasing Recent immigrants with low income had very limited access to affordable housing, paid a large share of their income on housing, and were unlikely to have enough money to spend on food, clothing, transportation and educational supplies Recent immigrants with low incomes have experienced substantial housing deprivation (such as poor environmental conditions, overcrowding and homelessness) that can have serious health implications Globalization and the Health of Canadians, December 12, 2012

Social protection: all the rage but can it survive the austerity agenda? Globalization and the Health of Canadians, December 12, 2012

Inequalities on the Rise High net worth individuals: 24 million with liquid assets of between $1 and $50 million. Ultra-ultra high net work individuals: 8.5 million worldwide (1/10 th of 1 percent of the population) who own 84% of global personal wealth Between USD 23 and 32 trillion in high net worth individual income (to say nothing of wealth) sits in tax havens Sources: Credit Suisse, Wealth Reports 2010, 2011; Henry, Price of Offshore Revisited, / Globalization and the Health of Canadians, December 12, 2012

Oh, Canada… Globalization and the Health of Canadians, December 12, 2012

Agenda Mapping globalization and health in urban settings –Major pathways –Gender dynamics –Area-based effects The three cities experiences –Vancouver, Toronto, Montreal Mitigating globalization health inequities –Global, Canadian labour market and social protection policies –Recent Canadian trends (Ontario focus) –European policy approaches (Canadian implications) –Future scenarios and urban level policy options Closing panel and wrap-up Globalization and the Health of Canadians, December 12, 2012