A triage nurse I know once stated that you could perfectly track a patient’s health outcomes if you simply collected their income when they entered the ER; Supposedly, income directly determines your health and whether you will have a positive outcome. This is an interesting concept to me, because while you hear these things from people who are “in the know,” the research seems to tiptoe around the issue. We often look at the type of job a person has, their ethnicity, their marital status, and then determine from that what their health outcomes are more likely to lean towards. Public policy then acts on these ideas that widowers, or racial minorities, are more likely to suffer from adverse health outcomes and determines that health teaching and better screening is what we need to solve major health crises in our society like diabetes and hypertension. What if we are looking at the wrong variables? Perhaps the thing that links widowers, racial minorities, and single parents is not a personal disregard for health or poor dietary choices, but actually their income. This would fundamentally change the way we approach health in Canada. Currently, health teaching, education, and empowering Canadians to improve their health is our public health focus (Government of Canada, 2020, para. 1). Healthcare in Canada is universal, and therefore should have universal outcomes, unaffected by a person’s socioeconomic status (Government of Canada, 2017, p. 10). If it came to light that people’s personal choices are less relevant than their income then we would need to move our focus to economic equality for the good of the population. This topic is broad, and the solutions are complicated. In this paper, I will determine that income and health outcomes are directly related, as demonstrated through the connections between chronic, preventable diseases, life expectancy, and income.
To begin, I will explain some common terms used in healthcare. A health outcome is the impact that a healthcare intervention has on the individual seeking care (CIHI, 2020, para. 1). A positive health outcome could be staying alive, better quality of life, and functioning well, while negative health outcomes could be loss of life or function, decreased quality of life, or lack of wellbeing socially, mentally, or physically (Gibson Parrish, 2020, para. 1). Health related behaviours would be defined as actions that an individual takes in order to influence their physical and mental well being (Hassan & Tibret, 2016, p. 2). Chronic disease and health conditions would be diabetes, hypertension, COPD, depression, stroke, obesity, and any other long lasting health issue that requires consistent management, such as asthma or cancer (Oates et al, 2017, para. 2).
The concern with lower income individuals and health outcomes is centred on lower quality of life, due to chronic illness and loss of function. One study found that health disparities between higher and lower income Americans were most pronounced between income and chronic health conditions (Oates et al, 2017, para. 3). While there was a link between health related behaviours and education, it was income that determined the rate of chronic disease (Oates et al, 2017, para. 3). The concern with chronic health issues would be the impact they have on an individual’s quality of life, and the progression of the disease. Obesity, diabetes, and hypertension are chronic health issues that put individuals at risk of stroke and heart attack, health events that could significantly lower their quality of life if they survive. They are also largely manageable and preventable, which is why it is important to note that it is not an individuals health behaviours that determines their risk for these diseases but their income. A person’s education may impact their health behaviour, but it does not provide protection against chronic illness. This means that public health initiatives focusing on individual health behaviours and education, such as “move more, eat less” campaigns, are likely ineffective at protecting low income groups from chronic disease. Poor health also leads to reduced income, as does disability and age, putting those already at risk in a more compromising position (Kullar & Chokshi, 2018, para. 1).
As income disparity grows, as does health disparity. In the 1970s a man in the top half of the income spectrum could expect to live 1.2 years longer than his counterpart in the lower half of the spectrum, but as of 2000, he could expect to live 5.8 years longer (Kullar & Chokshi, 2018, para. 3). The difference in life expectancy between the top 1% and the bottom 1% of the income distribution is 10-15 years dependent on gender (Kullar & Chokshi, 2018, para. 4). Middle-aged Americans in the lowest quintile for wealth had a 48% chance of becoming disabled in the next decade, versus their wealthiest counterparts who only had a 17% chance. While there are endless reasons why this could be the case, a lack of income is what underpins it.
In this paper, I determined that while research focuses on many different variables, income underpins each of these things. Therefore, income is a strong factor for health outcomes and quality of life. In Canada, we are all supposed to be equal under the law and in government. Income inequality should not determine whether we end up with a chronic preventable disease, lowered quality of life, and early death. I consider the wealth of information available to be one of the things that prevents us from taking action against the link between poverty and poor health outcomes. The more research is done, the deeper the links and the more overwhelming the scale of this issue becomes. Genetics, marital status, mental health, income, childhood experiences, access to a grocery store, and health behaviours are just a few examples of the many ways that Canadians differ from one another. All of these issues can be separately linked to income, and maybe it is time that we moved our focus to resolving the underpinning issues in our society. Public economic policy needs to change to support all Canadians and their health.
The Avery Spectacle 