Being 'timely' and well-informed in this fast-paced, information-rich world is a challenge. The OHPE Bulletin was created as a means of condensing news, articles, resources and views on health promotion issues, and encouraging features on specific topics of interest. While many of the features in OHPE take weeks or months to develop and write - there are times that a quick compilation and review of news and actions best serves our readership. We apologize for the lateness of this Bulletin; it is the result of balancing multiple priorities and great information that needed to be framed and shortened.
Over the past 10 days on the Health Promotion list-serv Click4HP [see http://listserv.yorku.ca/archives/click4hp.html] there has been widely diverse, energetic and thought-provoking discussion on a variety of subjects related to income disparities and health. With the imminent World Trade Organization (WTO) talks taking place in Seattle, national news coverage of the failure of Canadian government to fulfill a 10 year old pledge to eliminate child poverty, and more cutbacks coming in Ontario affectinglow-income people - it is a challenge for health promoters to keep current. This feature is an attempt to put a framework to some of these issues, summarize discussions and references that have appeared on Click4HP, and provide a link to additional resources. Your comments are always welcome - please send them to info at ohpe.ca or directly to me, Alison Stirling (the compiler of this week's feature) Alison at opc.on.ca.
ON THE GLOBAL TRADE TABLE - CANADA'S HEALTH SYSTEM
The WORLD TRADE ORGANIZATION (WTO) Third Ministerial Conference Nov. 29-Dec. 3 in Seattle.
Maude Barlow, Council of Canadians, put a context to the WTO powers at the OPHA conference on Nov. 17, 1999. "There currently are 135 countries in the World Trade Organization, which works with governments around the world to set ground rules for trade. The WTO is the only international organization that has the power to overturn domestic laws in order to enforce international agreements. No other agreement (including international human rights agreements, environmental agreements, etc.) have a judicial enforcement element. In effect, the WTO is becoming a form of global government that now supercedes decisions of democratically elected and accountable national governments.
Why you should care about the upcoming WTO negotiations in Seattle? Because the Seattle meetings are to begin the liberalizing of international trade in SERVICES. which include health and education. Until now Canada has been able to use a blanket exemption to protect these areas. But U.S. and European Union have served notice that they want health and education on the WTO negotiating table. This move could mean the dismantling of our public health, education and social services system."
Although it appears that the federal Minister of Health would not allow the above (health & education on negotiating table), Ms. Barlow says that it is really the Minister of Trade [Pierre Pettigrew ] that will have power in these talks.
See the Council of Canadians website - http://www.canadians.org
Nov. 15, 1999 press release: "Federal Trade Strategy Leaves Health Care And Education At Risk From Upcoming World Trade Talks"
The World Trade Organization - the Issues for Health Promotion
[edited] Letter Prepared For Canadian Consortium For Health Promotion Research - Ron Labonte Fri, 19 Nov 1999 (Click4HP list-serv)
To The Honorable Pierre Pettigrew Minister of International Trade
The Canadian Consortium for Health Promotion Research is comprised of 14 university-based centres across Canada, involving hundreds of researchers from a variety of disciplinary backgrounds.. Our Consortium members are deeply concerned that current trade and investment liberalization poses a number of direct and indirect health threats. We are not opposed to global trade per se. But we believe that decisions about trade and investment should not be made in isolation of decisions on social and environmental goals that ultimately create the conditions for public health.
The scientific knowledge base, shows that health status improves with increased economic growth but, this relationship flattens out at a fairly low level of GDP/capita (roughly US $5,000-$10,000). Beyond this level the most important determinant of health status is how equitably wealth is distributed within a population. Market forces may generate wealth, but they cannot and do not determine the equity of its distribution. This requires active government intervention through progressive tax/transfer programs and universal health, education and welfare programs and policies.
We are concerned that most WTO agreements, both past and proposed, will worsen, rather than improve, social equity and environmental sustainability outcomes.
.Our position is that all such trade and investment proposals should be examined, before agreements are made, on the basis of how such trade would improve equity in the distribution of material and financial resources (within and between nations), and sustainability in the use of natural resources.
. Canada, with its internationally respected history in innovative health care, health promotion and population health initiatives, is in a unique position to lead the rest of the world in re-framing trade and investment negotiations away from simple liberalization, and towards ensuring that such agreements incorporate common good goals enshrined in many UN agreements.
Ronald Labonte, Director
Saskatchewan Population Health and Evaluation Research Unit
College of Medicine, University of Saskatchewan
See Click4HP Archives http://community.opc.on.ca/exchange/root.asp?acs=anon p 3
See also in Click4HP on Nov 18, Dennis Raphael's forwarded article called:
GLOBALIZATION PROVES HAZARDOUS TO HEALTH OF WORLD POPULATION
"Is the WTO dangerous to our health?"
by Stephen Bezruchka MD, Op-Ed Seattle Post-Intelligencer, Nov 18, 1999
originally posted to the Spirit of 1848 list-serv that carries posting on social justice & public health (
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B. NATIONAL - CHILD POVERTY CALL TO ACTION NOV 24/99
The impact of poverty on health is well-known in the health promotion field - however, actions that could address this fundamental determinant of health seem out of our reach or control. On Wednesday November 24th there was a 'Wake Up Call' - a concerted effort to move from awareness to action, and to push for political commitment on countering child poverty.
[Toronto Star Nov 25] "Declaring the level of child poverty in Canada unacceptable, a coalition of more than 70 social policy groups is stepping up its pressure on the federal government.
Campaign 2000 yesterday called for an outlay of $15 billion to be spent on children and families over five years.
Its report, which coincided with the 10th anniversary of the House of Commons' unfulfilled pledge to end child poverty by 2000, also urges the government to bring in several new measures, including tax breaks for families with children, a higher minimum wage and high-quality child care."
The Campaign 2000 report card [see
What else has happened since 1989? The number of
Poor children up 49%
Children in families with incomes less than $20,000 (in constant 1997 dollars) up 48%
Children in families experiencing long-term unemployment up 16%
Children in working poor families up 44%
Children in families receiving social assistance up 51%
Poor children in 2-parent families up 45%
Poor children in lone-parent families up 61%
Note - 1.Poor children are those living in families whose total income before taxes falls below the Low Income Cut-Off (LICO) as defined by Statistics Canada.
[See the Campaign 2000 Report Cards at http://www.campaign2000.ca/national.htm
The Reaction in Ontario? Premier dismisses report as `hogwash'
[Toronto Star Nov 25/99]
"Ontario has had the biggest increase in child poverty of any province over the past 10 years. Nearly 20 per cent of Ontario children live in poverty. That's up from 11.6 per cent 10 years ago, when the country's richest province had the lowest rate. It's now fifth highest.
Premier Mike Harris did not hesitate to condemn those findings. `The report is hogwash,'' Harris told reporters. ``It's based on false data; even the U.N. doesn't agree with it.'' Harris said the United Nations calculates Canada's poverty rate at around 6 per cent.
Campaign 2000 alliance uses Statistics Canada's low-income cut-offs to define poverty, which in Toronto for a family of two was $21,760 in 1997.
Sherrie Tingley noted in Click4HP, on a related discussion:
"Right now in Canada there is a debate about the definition of poverty. The anti-poverty movement is struggling to hold on to the 'Low-income cut offs' and Human Resources Development Canada is working hard to develop a "market basket approach" to measuring poverty. For more information about this debate visit:
Historically Canada has not set its welfare rates at an absolute poverty level and because of this we have very little intergenerational welfare use and have very high mobility out of welfare. As we set benefit and asset rates lower we make it harder for people to leave welfare. And harder for people who turn to social assistance to participate in their communities."
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C. PROVINCIAL The Poverty Situation Worse in Ontario
The average poor family in Canada now lives $8,265 below Statistics Canada's low-income cut-off - a depth of poverty that has steadily grown since 1989, Campaign 2000 says.
In Ontario, it is even worse. Since welfare rates were cut by 22 per cent in 1995, the number of poor children has risen by 32,000 or 6.3 per cent, while across Canada, the rate declined by 5 per cent.
On November 18th - another blow - "Tories promise still more cuts: Welfare, students hardest hit as spending slashed by $309 million" Toronto Star November 19, 1999
The Conservative government announced $309 million in spending cuts, with a large part hitting students, welfare recipients and municipalities. Cuts include reducing the amount of time welfare recipients are allowed to hold part-time jobs to supplement their income, an immediate lien on the homes of any welfare recipients; reducing subsidization to municipalities for childcare spaces, and less support for students.
With housing, health care, education, work (and work-fare) pressures affecting families in Ontario - knowing where to start to 'promote health' in this province is a challenge. One of the frequent contributors to Click4HP, Sherrie Tingley asked on Nov. 12th about public health units' experiences in monitoring the costs of a nutritious food basket, and how they felt about it. The responses were fascinating and raised concerns about how any family on social assistance, or earning minimum wage, could possibly eat reasonably well, and still be able to pay rent, have minimal transportation or clothing. The Simcoe County Health Unit was the first to respond noting:
"we completed two of these surveys in Simcoe County - one last fall and the second in June 1999. The results have been interesting. For a reference family of 4 - we found that they would have $4.60 per person per week left after paying rent/utilities and food. This would have to cover everything from toilet paper to school supplies, transportation etc.. "
Within the hour, the Thunder Bay District Health Unit sent copies of their press release and a worksheet for budgeting for food. From their press release:
"Recently, the Thunder Bay District Health Unit calculated that it costs approximately $527.48 a month to feed a family of four (2 adults; boy 13-15 years; girl 7-9). For many families, however, other living expenses must take priority over food. The following scenario shows how it can be a real struggle for families to afford to eat nutritiously:
M. is the single parent of 2 children living in Thunder Bay. M. works full-time for minimum wage ($964.48/month). To feed themselves properly, this family needs at least $101.89 per week or $441.19 per month. After paying for rent and hydro ($647), telephone ($14.87) and a bus pass to get to work ($55), there is only $247.61 left over for food. This is $193.58 less than what this family needs to eat properly following Canada's Food Guide to Healthy Eating. Rent, utilities and telephone are all constant monthly expenses; food is the only flexible item on their list. M. tries hard to buy basic nutritious foods for the family. By the end of the month it's just not possible to make ends meet. M. is not alone. Many people who work for minimum wage, or receive social assistance, must use their food money to pay for their other day-to-day living expenses.
These are alarming situations that the public health units are discovering. Unfortunately, figuring out what to DO about families not having enough money for basic necessities, is a difficult task. Sherrie Tingley had an insightful comment and question after reading about the food basket surveys - a call for comments that has not yet been answered:
"I am totally impressed with how far health units have managed to take this tool but very concerned that the figures might be used to teach budgeting, set welfare rates locally, change what we believe about how we support people. Thoughts [about how to use these tools, what to do]??"
A week later, another frequent contributor to Click4HP posted a thoughtful article about Toronto, poverty and the implications for health promoters and healthy city advocates. A short excerpt from this message is reprinted below.
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D. TORONTO AND POVERTY
"Paradigms, Politics, and Principles - A Cautionary Tale from Toronto, Canada"
By Dennis Raphael [firstname.lastname@example.org] Nov. 24/99
"The City of Toronto is in crisis. The percentage of children living below the Statistics Canada low-income cut-offs is now 38%. Homelessness is at levels not seen since the 1930's and food banks are used on an ongoing basis by 135,000 Toronto residents, a doubling in number since 1990. This is occurring even as the Canadian economy is in the midst of an economic recovery. As a health promoter trying to make sense of this, I have been forced to consider the economic and social forces within Canada contributing to these developments.
Healthy Cities work is also committed to the concept of the "common good" -- an idea that is essential to the practice of health promotion in these difficult times:
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, A. (1999). Health promotion and the common good: Theoretical considerations. Critical Public Health, 9, p.130]
It is therefore, essential that Healthy Cities adherents recognize that powerful economic interests associated with economic globalization will resist this vision of the common good...
[To Appear in Issue #13 of Research for Healthy Cities Newsletter World Health Organization Collaborating Centre for Research on Healthy Cities, Universiteit Maastricht. - posted to a variety of list-servs on November 24, 1999 including Click4HP, Health-Promotion, and Spirit of 1848] Please see the Click4HP archives for a full copy of this posting http://listserv.yorku.ca/archives/click4hp.html
The next message of resources puts together some of the references and places referred to in the Click4HP messages and provides a few more links for follow-up.