The poverty disease

Alon Coret / Student Health Education Centre

During this past Reading Week, I participated in the Mac Serve Program, right here in Hamilton. The six days were densely packed with learning opportunities and exposure to some shocking realities.

Our group explored issues surrounding food (in)security and youth poverty, volunteering at places such as the Good Shepherd, Living Rock (youth center), community healthcare clinics, food drives and more.

One theme that seemed to thread throughout the week was the relationship between health and poverty, and how each affects the other. What I realized more than ever before was that poverty shapes our health in terms of our access to proper nutrition, sanitation and a safe place to live. At the same time, our health affects our financial situation; succumbing to disease and disability may prevent us from being able to work and integrate within society, and treatments can be costly.

A 2010 study known as the Code Red Series (Hamilton Spectator) shows the health-wealth connection better than any other. To determine the health status of different areas in the city, the average age of death was compared among Hamilton‘s neighborhoods. One West Mountain area had an average age at death of 86.3 years (2006-2008), while another near Wellington and Barton stood at 65.5 years. This staggering 21-year difference represents nearly a whole generation, and the main cause for the disparity is income. To put this in context, the West Mountain neighborhood’s life expectancy is five years higher than Canada’s national average. Meanwhile, the low-income North End neighborhood’s life expectancy is comparable to Nepal, Pakistan and Mongolia.

While visiting a community health center on Rebecca Street (Hamilton Urban Core), we learned about issues pertaining to medical services, specifically within the homeless and welfare-dependent demographic. It turns out, universal healthcare is not always so universal: most family physicians are paid on a fee-for-service basis, and often choose not to deal with more ‘problematic’ patients – the elderly, the homeless, the mentally ill or the severely handicapped. These groups mean more work for the physician, so it’s more efficient to take on young, healthy patients. Moreover, many Hamiltonians living in deep poverty do not have health cards. The majority of these are homeless individuals who could not replace a lost card, simply because they have no permanent address. To assist this demographic, the Hamilton Urban Core provides monthly health card replacement sessions (through the Ontario Health Ministry), and allows the homeless to use the center’s address as their own. Additionally, the staff working at the Urban Core are salaried, meaning they are paid the same amount irrespective of the number of patients they see. This is an important difference that separates them from other healthcare providers as there is no incentive to quickly ‘process’ as many patients as possible. Instead, the staff can tend to the complex problems of their target population. Common issues include mental illness, intellectual disability, physical handicaps, STIs, addictions or perhaps a combination of these.

Another key health-wealth connection was evident in the food banks we visited. Despite the immense quantities of food being donated, quality and variety appeared to be major issues: it’s always the same brands, the same foods and the obvious lack of fresh fruits and vegetables. Food banks house piles of Kraft Dinner and canned tuna, but these nonperishables do not meet our nutritional needs. It is not easy, of course, to supply fresh produce and dairy products given quick expiry and the need for refrigeration. Nevertheless, I could not stop thinking about the lack of quality food for populations in need. Even the hot meals served by food banks seem to play variations on a theme: pizza, pasta, tasteless salad, some meat and pastries (carbs, carbs, and a bit of protein). Clearly, living off the food bank diet is not good for long-term health.

Our minds, our bodies, and our social position are all intertwined; taking away from one can have serious ramifications on the others. The Romans were keenly aware of this connection – mens sana in corpore sano (a sound mind in a healthy body). When thinking about poverty, it is important to keep in mind its consequences beyond material well-being.