Social Policy and Population Health

The Importance of Policy Policies shape how money, power and material resources flow through society and therefore affect the determinants of health. Advocating healthy public policies is the most important strategy we can use to act on the determinants of health. Current policies that emphasize deficit reduction and private sector economic growth can be unhealthy for people. These policies may increase economic inequalities, environmental degradation, social intolerance and violence. CPHA Action Statement on Health Promotion, 1996

Human and Income Poverty in Canada and Four Comparison Nations, CanadaDenmarkSweden UK USA Ranking Source: United Nations Human Development, Report, 2002

People Lacking Functional Literacy Skills in Canada and Four Comparison Nations, CanadaDenmarkSwedenUKUSA Source: United Nations Human DevelopmentReport, 2002 Percentage

Population Below Income Poverty Line of 50% of Median Income in Canada and Four Comparison Nations, CanadaDenmarkSwedenUKUSA Source: United Nations Human Development Report, 2002 Percentage

Inequality in Consumption or Income in Canada and Four Comparison Nations, 2000: Share Held by Richest and Poorest 10% of the Population CanadaDenmarkSwedenUKUSA Source: United Nations Human DevelopmentReport, 2002 Percentage Held Richest 10%Poorest 10%

Child Poverty in Lone-Parent and Other Families in Canada and Four Comparison States, CanadaDenmarkSwedenUKUSA Source: Innocenti Report Card on Child Poverty in Rich Nations, June 2002 Poverty Rate (%) Other FamiliesLone-Parent

Percentage of Persons Living in Poverty in Lone- Parent Working and Non-Working Families in Canada and Four Comparison States, CanadaDenmarkSwedenUKUSA Source: Society at a Glance, OECD, 2001 Poverty Rate (%) Non-Working SingleWorking Single

Priorities in Public Spending: Public Expenditure on Education and Health as a Percentage of GDP in Canada and Four Comparison Nations, CanadaDenmarkSwedenUKUSA Source: United Nations Human DevelopmentReport, 2002 Percentage of GDP Spent EducationHealth

Public Social Expenditure by Broad Social Policy Areas as Percentage of GDP in Canada and Four Comparison Nations, Source: Society at a Glance, OECD, Canada DenmarkSweden UKUSA Percentage of GDP Spent Total Spending as Percentage of GDP Cash BenefitsServicesTotal Spending

Net Replacement Rates at the Earnings Levels of 2/3 of an Average Production Worker In the First Month of Benefit Receipt and For Long- Term Benefit Recipients, in Canada and Four Comparison Nations, 1999 CanadaDenmarkSwedenUKUSA Single Short-term62%89%77%73%59% Long-term35%67%84% 73% 10% Married Couple Short-term65%94%77%88%59% Long-term57%94%100%88%18% Couple - 2 children Short-term69%95%90%83%51% Long-term77%92%100%95%61% Lone Parent - 2 children Short-term67%89%96%69%51% Long-term77%82%100% 81% 51% ____________________________________________________________________________ Source:SGR Report (OECD, 2001).

Long-Term Care Spending as a Percentage of GDP in Canada and Four Comparison Nations, Source: International Reform Monitors Newsletters, CanadaDenmarkSwedenUKUSA Percentage of GDP Spent Total Spending as Percentage of GDP Public SpendingPrivate SpendingTotal Spending

Social Policy, Health Determinants and Health in the USA and Canada Today

Policy Decisions Create Poverty and Economic Inequality Changing tax structures in the USA and Canada Does globalization make this inevitable? How does economic inequality come about?

Rising Together and Drifting Apart - USA Changes in Family Income and

The Wealth Gap in the USA Distribution of Net Worth, 1997

Economic Inequality and Health: Policy Implications Poverty and economic inequality is on the rise in the USA and Canada Poverty is bad for health Economic inequality is dangerous for the health of all of us Policy decisions create poverty and economic inequality Citizens can influence policy decisions to improve health

Low Income % Source: Wilkins et al., 2002

Policy Directions and Population Health The policies that Canada has developed to improve population health reflects its more egalitarian structure. Examples include various tax and economic transfer policies that help to limit income differences across the country, as well as provision of important social services... If a healthy population is the goal, we must enter the political arena and fight to maintain the social contract that has sustained Canada as one of the world leaders in health. Stephen Bezruchka, CMAJ, 2001

Canadian Policy Directions It has become obvious that people on the low end of the income scale are cut off from the ongoing economic growth that most Canadians are enjoying. It is also obvious that in these times of economic prosperity and government surpluses that most governments are not yet prepared to address these problems seriously, nor are they prepared to ensure a reasonable level of support for low-income people either inside or outside of the paid labour force. -- Poverty Profile, Ottawa: National Council of Welfare Reports, Autumn, 2000.

Implications of Increasing Family Poverty Given the disturbing increases in income inequality in the United States, Great Britain, and other industrial countries, it is vital to consider the impact of placing ever larger numbers of families with children into lower SES groups. In addition to placing children into conditions which are detrimental to their immediate health status, there may well be a negative behavioural and psychosocial health dividend to be reaped in the future. -- Why Do Poor People Behave Poorly? Variation in Adult Health Behaviours and Psychosocial Characteristics by Stages of the Socioeconomic Life Course, J.W. Lynch, G.A. Kaplan, & J.T. Salonen. Social Science and Medicine, 1997, 44,

Policy Trends Responsible for Shift Towards Home Rather than Hospital Care for Canadians debt/deficit pressures, a recognition of the limits to health care, increasing technology and associated costs, and the increasing perception of health as a business leading to: increased privatization with negative effects upon women as a) care recipients; b) health care workers and c) informal caregivers within the home (Armstrong, 2002).

US/Canada Disparities in Infant Mortality Mortality rate ratios (Canada=1.0) Source: Wilkins et al., 2002

US-Canada Life Expectancy Trends Years (at birth), total both sexes Source: Wilkins et al., 2002

Source: Dunn, 2002

Components of the Index of Social Health Children Youth Adults infant mortality teen suicide unemployment child abuse drug abuse weekly earnings children in poverty HS drop-outs health insurance coverage Elderly All Ages - Poverty among those -homicides 65 and over -alcohol-related traffic fatalities - Out-of-pocket health - social assistance rates cost for those 65 and over -access to affordable housing - gap between rich and poor Source:Brink & Zeesman, HDRC, 1997

Reducing Health Inequalities We consider that without a shift of resources to the less well off, both in and out of work, little will be accomplished in terms of a reduction of health inequalities by interventions addressing particular downstream’ influences. -- Report of the Acheson Independent Inquiry into Inequalities in Health, 1998, p. 33.

Social Policy, Health, and the Welfare State

The Role of Values and Principles in Public Health and Health Promotion The public ideas – and the language associated with them – which currently envelop us are those of the market, corporatism, fiscal restraint, and globalization, ideas which are driving the near universal dismantling of the welfare state, and eroding any notion we might have of the common good. Health promotion represents one possibility for countervailing ideas: ideas about equity, social justice, interdependence, the common good. -- Robertson, 1999, p. 130

Key Tenets of Neo-liberalism markets are the most efficient allocators of resources in production and distribution; societies are composed of autonomous individuals (producers and consumers) motivated chiefly by material or economic considerations; competition is the major market vehicle for innovations - Coburn, 2000.

Defining the Welfare State The welfare state is a capitalist society in which the state has intervened in the form of social policies, programs, standards, and regulations in order to mitigate class conflict and to provide for, answer, or accommodate certain social needs for which the capitalist mode of production in itself has no solution or makes no provision. - Teeple, G. (2000). Globalization and the decline of social reform.

Forces that Led to the Development of the Welfare State Strong national identities at end of WWII Need to rebuild Western economies after WW II Strength of labour unions within national labour boundaries Perceived threat of “socialist” alternatives Political compromise to avoid boom-bust cycles of the economy - - Teeple, G. (2000). Globalization and the decline of social reform.

Forces Leading to the Decline of the Welfare State Weakened national identities as a result of trade agreements Internationalization of investment thereby weakening nationally-based labour unions Political compromises between business, labour and governments becoming unnecessary Perceived threat of “socialist” alternatives removed Slowing of economies and concentration of corporate and media ownership - - Teeple, G. (2000). Globalization and the decline of social reform.