Taking health inequity seriously requires direct engagement with increasing economic inequality and the underlying macro-scale economic processes. A remarkably thoughtful overview of those processes is provided by Zanny Minton Beddoes in a recent special report in The Economist. (At this writing, the special report is still open access; get it while you can.) Despite obligatory genuflection to the economic theology that economic inequality reduces ‘efficiency,’ Beddoes focuses on the destructive consequences of rising inequality (especially at the top of the economic pyramid) and on how public policy can and should respond. Everyone interested in the future of population health should read her report, which is especially scathing on how various US policies actually magnify inequality. Against the background of that country’s imminent money-driven elections it is worth quoting her concluding critique of the Obama government’s approach as “just a laundry list of small initiatives. [New Deal initiator Franklin] Roosevelt would have been appalled at the timidity. A subject of such importance requires something much bolder.”
Closer to home, on October 24 a commission that had been asked to review social assistance in Ontario released its report – with an almost total absence of media attention apart from the Toronto Star. (Readers and viewers to whom social assistance might actually matter are not highly valued by the managers of commercial media, but even the CBC missed this story.) Among other findings, the report recommended an immediate increase of $100 per month to “the lowest rate category, single adults receiving Ontario Works, as a down payment on adequacy while the system undergoes transformation.” This report should serve as an overdue starting point for moving public health advocacy beyond tanning beds, Red Bull and salt to consider underlying distributional issues such as income adequacy. We know, for example, that eating a healthy diet while keeping a roof over your head in much of Ontario is arithmetically impossible if you are paying market rents.
Will the various communities of researchers, practitioners and advocates concerned with health equity engage with these recommendations, taking advantage of the opportunity offered by the prospect of political change in Ontario? What kinds of followup will be initiated by Medical Officers of Health, and by university- and hospital-based researchers, who are far removed from having to choose between paying the rent and buying fruits and vegetables or paying their children’s dentist? We shall see.