Monday, January 13, 2014

Doctors’ orders: raise the minimum wage

Minimum wage in Ontario has been frozen at $10.25 for three years, which is now 19% below the poverty line. Inspired by fast food and retail workers in the US, there is a growing campaign across Ontario to raise the minimum wage to $14/hr. January 14 will be a province-wide call-in day to Ontario Premier Kathleen Wynne, to demand a $14 minimum wage for health reasons.

The health impacts of inequality
There is a growing rediscovery of the ways in which poverty and inequality undermine health. As an article in The New England Journal of Medicine explained in 2004: "On the whole, people in lower classes die earlier than do people at higher socioeconomic levels, a pattern that holds true in a progressive fashion from the poorest to the richest... Unhealthy behavior and lifestyles alone do not explain the poor health of those in lower classes. Even when behavior is held as constant as possible, people of lower socioeconomic status are more likely to die prematurely."

The same is true in Canada, as the Ontario Medical Review explained in a series of articles last year: “Income is a well-recognized social determinant of health, and people living with low incomes experience higher burdens of illness, decreased life-expectancy, and higher rates of mortality than high-income earners. Health declines as one moves down the income gradient, with differential health outcomes at every level of income. A recent Statistics Canada report on cause-specific mortality rates by income quintile highlighted these health disparities. Each successively lower income quintile was associated with an increase in age-standardized mortality rates for almost all causes of mortality.” This has a disproportionate impact on indigenous communities and racialized groups, women, people with disabilities and others groups whose oppression concentrates them in lower incomes.

Capitalism makes us sick
Social and economic inequality and its health impacts do not abstractly exist, they are actively maintained. In The Conditions of the Working Class in England, Friedrich Engels wrote in 1845 that when society places hundreds of workers in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live – forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence – knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual.”

Instead of challenging this economic model, mainstream medicine came to reflect it—reducing people to isolated individuals removed from their environment and society. This biological reductionism has provided ideological justifications for colonization in Canada and around the world, and for a rise in fat-phobia that attributes declines in health to people’s body size instead of their social and economic conditions. 

The social model of medicine is reasserting itself. In 2008 the World Health Organization raised the alarm that “social injustice is killing people on a grand scale”, and we need to “tackle the inequitable distribution of power, money, and resources.” But austerity measures have done the opposite: prescribing massive bailouts for banks and corporations while taking a scalpel to jobs, wages and services. There are claims that recent job numbers show this is leading us to prosperity, but as economist Joseph Stiglitz recently wrote this month, “we should curb our euphoria. A disproportionate share of the jobs now being created are low-paying – so much so that median incomes (those in the middle) continue to decline. For most Americans, there is no recovery, with 95% of the gains going to the top 1%.”

Prescription for health: tax the rich, raise wages, and support unions
Physicians are starting to follow the advice of Rudolph Virchow, one of the founders of social medicine: “if medicine is really to accomplish its great task, it must intervene in political and social life.” Last year the Canadian Medical Association held a public consultation process about the social determinants of health. Their findings: “poverty is the most important issue and must be addressed” and “governments need to be pressured to take action.”

Doctors for Fair Taxation has called on the Ontario government to increase taxes on the wealthy: “Ontario physicians see the adverse health impacts of growing inequality in our patients and our communities. As the government grapples with its financial difficulties, we urge all political parties to spare the province’s poor, sick, and vulnerable residents. We think high earning Ontarians are prepared to pay higher taxes for a fairer society. We say to Premier Wynne and Finance Minister Sousa: Tax us, Ontario is worth it!”

Health Providers Against Poverty have developed a clinical tool kit to factor poverty into clinical decision-making, considering the evidence of how poverty predisposes to cardiovascular disease, diabetes, depression, suicide, cancer, hypertension, arthritis, COPD and asthma. As Dr. Gary Bloch explained, “Treating people at low income with a higher income will have at least as big an impact on their health as any other drugs that I could prescribe them.”

Unions are another mechanism to prescribe equality, which is why they are under such sustained attack—from Ontario Tory leader Tim Hudak’s threat of “right to work” to the federal Conservatives’ recent party convention. As The National Post wrote recently, “Forget Duffy. Harper’s war is with unions.” Unions defend wages and conditions, and support broader social justice causes—all of which promote health. Which is why fast food and retail workers in the US—part of the 99% who are suffering from austerity—are combining demands for a higher minimum wage with unionization to provide them with democratic structures to resist austerity.

Take action for your health
The campaign to raise the minimum wage is part of a broader struggle to change the world and through the process change ourselves. As psychologists studying protesters found, social justice is good for our health: “The take-home message from this research therefore might be that people should get more involved in campaigns, struggles and social movements, not only in the wider interest of social change, but also for their own personal good."

*Health Providers Against Poverty will hold a press conference at 10:30am at the Queen’s Park Media Studio at the Ontario Legislature
* Join the phone-in day on January 14th to tell Premier Kathleen Wynne we need a raise, by calling her office at (416) 425-6777 and then your local MPP.  Find your MPP contact info here.
* Tweet @Kathleen_Wynne: Raise minimum wage to $14/hr in 2014 #14now #OnPoli
*On January 24 the Campaign to Raise the Minimum Wage is holding a public forum with organizers leading the fight for fair wages in the US.