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Health as if everybody counted blog

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Housing, equity, and economic apartheid

Posted by Ted Schrecker
Ted Schrecker
Ted Schrecker is a clinical scientist at the Élisabeth Bruyère Research Institut
User is currently offline
on Tuesday, 15 January 2013
in CHNET-Works!

Maclaren

CBC News reported on January 9, 2013 that the residents of a high-rise Ottawa Community Housing building in Ottawa had been without hot water since November 30.  The people affected included a 77-year-old man in a wheelchair.  The revelation says a lot about the value of public broadcasting, and local CBC news bureaus in particular.  It also says a lot about the barriers to getting social determinants of health, like adequate housing, on the policy agenda.


It could be worse.  The residents of 415 MacLaren Street could have been stranded on upper floors by non-functioning elevators, which happened in 2010 to residents of a downtown Toronto Community Housing building.  But that’s not the point. 


A bit of background: public housing in Ontario used to be a responsibility shared among three levels of government.  However, the national government and most provincial governments have largely retreated from housing, content to leave it to the private market and to municipal governments that have limited revenue-raising options.  Canada is the only G7 country without a national housing strategy.


This might not be a problem if the market economy provided adequate incomes for all, or if Canadian social policy compensated for the failings of the market.  Neither is the case.  Market incomes at the bottom of the income scale have actually been dropping, and by the middle of the last decade it became clear that social policy had retreated from redistribution, big-time. Housing is only part of the equation.  For example, a hard-hitting report on social assistance in Ontario that recommended immediate increases in benefit rates and allowable labour market earnings for  “the lowest rate category, single adults receiving Ontario Works, as a down payment on adequacy” has vanished from the political landscape without a trace.  This is not only a Canadian problem.  In the United Kingdom, where the Conservative-Liberal Democratic coalition government is proposing to cap benefit rates while lowering the top income tax rate for the ultra-rich, a spokesman for the Labour Party – the Labour Party – won’t say anything more than that they “support the principle of a benefit cap, but with the important caveat that it should not render people homeless.”


For whatever reason, we tolerate a deepening form of economic apartheid, perhaps at least covertly buying the argument that those on limited incomes are the authors of their own misfortune.  The recent history of plant closings across Canada, briefly discussed in a previous posting and to be covered at greater length in a forthcoming one, is just one piece of evidence among many that undercut this belief.  But then, how often are such self-serving beliefs susceptible to refutation by evidence?


Historian and sociologist Margaret Somers describes the belief system that tolerates such economic apartheid as market fundamentalism – ironically borrowing the term from George Soros, one of the world’s richest men.  There are alternative perspectives.  One views the minimal material prerequisites for a healthy life, including adequate housing, as human rights – a position entrenched in international law by the International Covenant on Economic, Social and Cultural Rights, to which Canada is a party.  The current UN Special Rapporteur on the Right to Housing (be honest, now: did you know there was such a person?) is charismatic Brazilian architect Raquel Rolnik.  Her most recent annual report to the UN General Assembly is an important piece of historical scholarship and a stinging, carefully documented critique of the “financialization” of the housing sector, which has paid off handsomely for financial institutions and for many of the propertied, while marginalizing others.  In calling for “a paradigm shift from housing policies based on the financialization of housing to a human rights-based approach,” she is challenging market fundamentalism and asserting what Somers calls “the right to have rights” independent of the marketplace.


Unless professionals and advocates concerned with social determinants of health can get their heads around that simple message, as it applies to housing and many other policy fields, the future of the health equity agenda has to be reckoned as dim. 

Additional resources:
In an online video of an event at the City University of New York, Ms Rolnik delivers a powerful indictment of the financialization of housing (her presentation starts at about the one-hour mark in the video).  All her annual reports and reports of country visits, like those of her predecessor, are available on the Special Rapporteur’s official web page.

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Posted by Ted Schrecker
Ted Schrecker
Ted Schrecker is a clinical scientist at the Élisabeth Bruyère Research Institut
User is currently offline
on Tuesday, 06 November 2012
in CHNET-Works!

"The fog comes," Carl Sandburg famously wrote, "on little cat feet." With roughly the same amount of fanfare, in September a consortium led by Sir Michael Marmot published a summary of its findings on how to reduce health inequities in the 53 countries of the World Health Organization's European region. The region includes some of the wealthiest countries in the world, and some of those with the smallest disparities in health, but is hardly homogeneous. Mortality among children under 5 ranges from just over 2 per 1000 live births in Iceland to more than five times that figure in Bulgaria and Romania. Child poverty on a standardized cross-national measure is higher than 30 percent in Romania, three times as high as in the Nordic countries and a few others. And urban air pollution (concentration of particulate matter) is more than five times as high in the capitals of Turkey and Bulgaria as in those of Estonia and Iceland.

The consortium's argument will be familiar to readers of earlier reports in this vein, including the original Commission on Social Determinants of Health, but several points are worth mentioning because of their direct and immediate transferability to the Canadian context.

  • who euro-review-pic-1Air pollution remains a health hazard in many European cities.
    Photo: eifelyeti110’s photostream; reproduced under a Creative Commons 2.0 licence
    The consortium writes that "[h]uman rights are central in our approach to action on the social determinants of health". The fact that this was not true of the 2008 report has been identified as a significant omission by the distinguished human rights scholar Audrey Chapman, among others.
  • Social protection – including "a minimum standard of healthy living for all" that includes a nutritious and sustainable diet – is clearly and correctly identified as essential for reducing health inequity. Further, the consortium refers approvingly to the United Nations Social Protection Floor Initiative, a relatively low profile effort that is explicitly linked to a human rights approach. Could this be the start of an overdue convergence of concerns about health equity and social policy that often have been addressed by separate organizations and groups of professionals working in isolation from one another?
  • The effects of unemployment and exposure to hazardous work environments are foregrounded, at a time when youth unemployment is higher than 50 percent in two WHO Euro countries and a source of concern throughout the region.
  • Also foregrounded is the issue of health inequities among older Euro region residents – a concern with much broader applicability as populations age and social exclusion threatens to increase, especially in countries with high levels of economic inequality, a troubling trend that was evident even before the economic crisis.
  • Most importantly, both the economic crisis and many policy responses are identified as threats to health equity. In the consortium's words: "Recognition of the health and social consequences of economic austerity packages must be a priority in further shaping of economic and fiscal policy in European countries," with health and social affairs ministries and – at the transnational level – the World Health Organization, UNICEF, and the International Labour Organization given a voice.

who euro-review-pic-2Social exclusion threatens the European elderly, especially those with limited resources.
Photo: Zilverbat.’s photostream, reproduced under a Creative Commons 2.0 licence
Think, for a moment, about what institutionalizing this last recommendation would mean in a Canadian jurisdiction like Ontario.

My previous posting featured an important new report on redesigning social assistance in Ontario. Its arrival, too, could be described with reference to little cat feet. Ontario would do well to adopt both the consortium's insights about the inseparability of social protection and health and its view that "current economic difficulties are a reason for action on social determinants of health not inaction." But where will the necessary leadership come from? However well intentioned the proponents of taxes on 'junk food,' availability restrictions and warning labels on French fries may be, it may not come from them.

Related resource of interest

Video of Sir Michael Marmot's keynote speech at the Canadian Medical Association annual meeting in August 2012, which focused on health equity, is now available online.

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