The Health in Wealth Brenna Sloan 1
It is unfortunate that the value of being healthy is often not realized until an individual (himself or herself) or someone close to them has their health compromised. Being a parent of a child diagnosed with cancer, having a friend with a chronic condition, or caring for an elderly family member are some examples where one comes to realize the vulnerability of good health. Asking any individual who has experienced poor health or had a loved one suffer will assist in one s understanding that health is wealth. Health cannot simply be purchased; an individual with some type of serious illness will suffer to some degree regardless of their financial situation. Yet it would be naive to deny that health is not impacted by wealth at all. Many of the factors that contribute to health of an individual are indirectly related to the wealth in an individual s environment. A population s health is directly linked to the availability of sufficient resources to provide the opportunities, services and supports for everyone. Our country Canada is a perfect illustration of a wealthy country that is able to offer universal healthcare and as a result many Canadians are reasonably healthy. Alberta is the wealthiest province in Canada, due to the abundance of natural resources, specifically oil and natural gas (Crowley & O Keefe, 2006). In 2004, Alberta experienced an economic boom, accompanied by strong economic growth. Recently Alberta s economic growth has been sluggish however it still remains a wealthy province. However despite its wealth, Albertans are not necessarily any healthier than residents in other provinces across Canada. Albertan s rates of high blood pressure, instances of asthma, arthritis and cancer are comparable to that of other provinces and in some cases higher (Statistics Canada, 2009). The province of Alberta illustrates that although health can be a measure of wealth, wealth in return cannot be utilized as a reliable measure of health. 2
Having wealth alone will not ensure good health for the citizens of a province; the policies and decisions made in regard to the utilization of resources must also reflect that a healthy population is a significant objective and relevant value. In order to understand the impact of a province s resources on the health of residents, it is necessary to understand the main factors associated with wealth that can influence health. The Social Determinants of Health are factors that can be combined to assess the health of a population. The main Social Determinants of Health that can be directly impacted by the wealth of the province are; income and social status, employment, education, social environments, social support networks, physical environments, health services and personal health practices (Pubic Health Agency of Canada, 2009). There are also a number of other determinants, such as biology, gender, culture and child development that affect the health of individuals which are not always directly impacted by the wealth of a province (Public Health Agency of Canada, 2009). It is impossible to isolate one specific factor that will determine the health of an individual; all factors are interrelated and can affect everyone differently (Public Health Agency of Canada, 2009). Yet, it is undeniable that similarities can be discovered as a direct result of the province in which people live. Although it has been shown that cancer does not discriminate based on class, race or socioeconomic status, it also known that income and social status are two factors which can be most significant in determining health (Public Health Agency of Canada, 2009). It has been shown that a higher income and social status will result in better health. A higher income can afford individuals access to adequate housing, choices in food and health services. The Second Report on the Health of Canadians found that only 3
47% of Canadians in the low-income bracket declared their health as very good/excellent compared to 73% of Canadians in the high income group (Public Health Agency of Canada, 1999). Low-income Canadians are more likely to pass away at a younger age and to experience more illnesses during their life than Canadians in the higher income bracket (Public Health Agency of Canada, 2009). A significant aspect to the income and social status of a population is the distribution. The distribution of income across the population can determine health; a population with an equitable distribution will be healthier than one with large gaps (Public Health Agency of Canada, 2009). Large gaps with respect to income lead to greater social problems and poorer health (Public Health Agency of Canada, 2009). Understanding the affects of the distribution of income is significant when considering Alberta s wealth. A large number of Albertans are privileged to have relatively high incomes compared to residents of other provinces in Canada (Statistics Canada, 2009). The province of Alberta has one of the highest numbers of individuals earning an income of $250, 000 and over (Statistics Canada, 2008). At the same time Alberta also has disparity in income across its population that is indicated by the total median income being $31, 500 (Statistics Canada, 2008). The median income indicates that although a number of Albertans may have high incomes and overall the province of Alberta is wealthy, there are a number of Albertans who have much lower incomes and may be under pressure to meet their basic needs. Having access to job opportunities is necessary to earn an income. Not only does a job provide an income, it affords necessary access to services and benefits. A job also provides an individual a sense of identity and purpose, social interaction and opportunities for personal growth (Public Health Agency of Canada, 2009). 4
Unemployment is often associated with poor health. It has been found that unemployed individuals can experience a reduced life expectancy and suffer considerably more health problems than people who are employed. In 2005, Alberta had close to 233,000 job vacancies that went unfilled (Cross & Bowlby, 2006). As a result of the job opportunities that arose in Alberta from 2004-2006, the province had a number of individuals relocate to the province to attain a greater opportunity for income, stability and access to benefits. However many of the job opportunities available in Alberta during the economic boom were for unskilled laborers and did not necessarily offer stability or benefits. In 2008, job opportunities began to decrease and currently many Albertans are facing job loss. The changing job market in Alberta directly reflects on the health of residents. As Albertans experience job loss and fewer opportunities, adverse health effects are incurred. The World Health Organization found that high levels of unemployment and economic instability could cause significant mental health problems and negative effects on the physical health of individuals and their families (World Health Organization, 2009). It is undeniable that education will provide an individual with greater job opportunities, higher earning potential and enhanced health. Education provides individuals with an overall sense of value and knowledge required to understand and access necessary information and services to maintain their health (Public Health Agency of Canada, 2009). With the job opportunities and earning potential that accompanies education, individuals are more likely to have a higher socioeconomic status that will increase the likelihood that their children will also value education. The Second Report on the Health of Canadians found that individuals with higher levels of education have better access to healthy physical environments and are better able to prepare their 5
children for school (Public Health Agency of Canada, 1999). It also revealed that Canadians with weaker literacy skills are more likely to be unemployed and in a lowincome bracket, to suffer from poor health and have shorter life expectancies than Canadians with high levels of literacy (Public Health Agency of Canada, 1999). A province can influence the number of educated residents it has and in return their health through the available incentives provided for completing high school and entering post secondary programs. Having available educational opportunities that are affordable or attainable funding to subsidize the expenses of post secondary education is a major incentive in encouraging individuals to complete post secondary training. In Alberta, there are a number of scholarships and bursaries available for students. One example is the Rutherford Scholarship that is available to all high school students that attain honors (an 80% average) in grades 10, 11 and 12 for use upon entering post secondary education. There are also other scholarships and bursaries available for both post secondary and trade programs (Government of Alberta, 2009). The number of funding opportunities for those entering trades increased significantly as a result of the economic boom and increased demand for trades people. The number of Albertans receiving degrees, diplomas and certificates enlarged from 9,645 in 2004 to 17, 481 in 2005; a significant and positive increase (Statistics Canada, 2009). Nevertheless, post secondary tuition costs also continue to steadily increase. The tuition costs for an undergraduate student in 2008-2009 were $5,361, one of the highest in Canada (Statistics Canada, 2009). Regardless of the scholarships and bursaries in Alberta, many students continue to complete post secondary education amassing a considerable amount of debt. In Alberta in 2005-2006, the average student loan was $5682.00 for one year of school 6
(Statistics Canada, 2009). At this rate, after completion of a four-year degree, the minimum a student would owe would be close to $23,000.00. Beyond income, job opportunities and education, the actual physical environment in which a person resides also influences their health. The levels of contaminants and pollutants within one s physical environment directly impact their health (Public Health Agency of Canada, 2009). Having access to quality air, food and water is an essential aspect in leading a healthy life. Adverse physical environments have been linked to increased rates of types of cancer, respiratory illnesses and birth defects. A province can develop and determine guidelines for food safety, levels of contaminants released into the air, water and soil. In Alberta s recent economic boom, there have been major developments in the oil sands. As a result there has also been increased awareness and concern regarding the environmental impact of the oil sands process. Although development of the oil sands led to greater wealth in the province, it was not without negative impacts on the physical environment, which can in return negatively impact the health of Albertans (CBC News: The National, 2007). The value and norms within a society influence the well being of its members. Individuals will most likely benefit if health, equality, safety, acceptance, stability and respect are valued. Sharing core values will provide individuals with a sense of support and meaning. Having support gives people the ability to access resources they need to maintain good health as well as the ability to cope with health problems (Public Health Agency of Canada, 2009). Much of what is valued in a province can be viewed by where the resources are concentrated. Having access to social networks, beyond the greater social environment is also important in the health of individuals. Support from families, 7
friends and communities has been associated with better health (Public Health Agency of Canada, 2007). Having someone to share with, confide in, love and care for provides individuals with a greater well being which in turn benefits their overall health. With a greater amount of wealth, more money can be spent on programs and supports. Individuals that have a greater abundance of resources are usually more willing and likely to donate to charitable and non- profit organizations. The province is able to increase its overall expenditures on programming for those that may be most vulnerable in society, such as seniors, individuals with a disability or those below the low-income barrier. Having greater access to resources and supports can reduce stress and positively impact the health of citizens (Public Health Agency of Canada, 2009). Although Alberta is the wealthiest province in Canada, its current spending on social support programs is less than that of other provinces (Statistics Canada, 2009). A major aspect of public programs is health care services. Having access to quality health care services to a great extent affects one s health. Part of healthcare services are public health programs that provide education to the public regarding issues related to their health. Having strong, comprehensive public health programs can prevent adverse health affects and in return reduce costs to the healthcare system. Before the economic boom in Alberta, the provision of healthcare services was not a perfect model. There has been a shortage of qualified health professionals including but not limited to nurses, homecare workers and physicians for a while. The shortage was magnified by the population increase as a result of the new job opportunities that Alberta offered. Many people are unable to maintain a family physician. Hospital stays have continually been shortened over time as a result of fewer resources and cut backs to 8
hospital bed numbers. Many Albertans have been and continue to receive brief episodic healthcare, rather than comprehensive, patient centered care. Although healthcare premiums have been eliminated and new facilities built, Alberta continues to struggle with the provision of healthcare services. During the current economic slow down additional issues have arisen, such as increased wait times for essential surgeries and the delisting of a number previous insured healthcare services. The present situation in Alberta portrays a province attempting to cut back on their health care spending. It is undeniable that these cutbacks will negatively impact health as necessary services continue to be constrained. It is the reality that although there is universally insured healthcare in Alberta, many low and moderate income Albertans already have limited or little access to services such as eye care, dentistry, mental health counseling and prescription drugs (Public Health Agency of Canada, 2009). Chiropractic services can now be added to the list of services people will have limited or little access to as a result of its recent change to becoming an uninsured service. These healthcare services are just as valuable to an individual s overall health and yet less people are receiving less than they did previously. The programs that help to promote and maintain the health of Albertans require funding by the province. Unfortunately, it seems that full access to programs which are thought to be public within the province of Alberta have been and are continuing to be restricted, regardless of the economic situation. It is necessary to identify that along with the wealth of a province, the values of the province equally influence the health of individuals. The values of the province will directly impact how the wealth is utilized and what programs and services are significant to provide public access to. If the province 9
values health, this will be displayed through universal public healthcare, public health programs, access and affordability of post secondary education and extensive supports and services for those in need. When compared to other countries, Canadians on the whole have the benefit of good health. Canada provides an example of how health can be used to measure wealth. The overall provision of what is required for health is extensive and Canada has the resources to do a reasonable job. Within Canada, the health of residents in each province varies. By examining the wealthiest province, Alberta, it is revealed that health can provide a measure for wealth, yet wealth is not a reliable measure of health. If a province has wealth, it will only result in good health if the wealth is equally distributed and health of the citizens is valued. Since Alberta s is the wealthiest province in Canada, it is naturally assumed that it would be the healthiest, yet the fact emerges that the unequal distribution of its wealth and decreasing value of Albertans health may be inhibiting the potential for optimal health for this province s citizens. 10
Resources CBC News: The National. (2007). Crude Awakening. Retrieved February 22, 2009 from http://www.cbc.ca/national/blog/video/environmentscience/crude_awakening.htm l Cross, P. & Bowlby, G. (2006). The Alberta Economic Jaggernaut: The boom on the Rose. Canadian Economic Observer, 19, 1-113. Crowley, B. & O Keefe, B. (2006). Why some provinces are more equal than others. AIMS Special Equalization Series, 1, 1-7. Government of Alberta (2009). Alberta Learning Information Service: Scholarship and Bursary Information. Retrieved June 13, 2009 from http://www.alis.gov.ab.ca/et/fo/scholarships/info.html Public Health Agency of Canada (1999). Toward a Healthy Future: The Second Report on the Health of Canadians. Retrieved June 20, 2009 from http://www.phacaspc.gc.ca/ph-sp/report-rapport/toward/index-eng.php Public Health Agency of Canada (2009). What Makes Canadians Healthy or Unhealthy? Retrieved June13, 2009 from http://www.phac.gc.ca Statistics Canada (2008). Retrieved June 20, 2009 from http://www.statcan.gc.ca World Health Organization (2009). Adverse Health Effects of Changing Work Circumstances. Retrieved June 21, 2009 from http://www.who.int/whr/2008/08_chap4_tab01_en.pdf 11