Social determinants like education, employment, early childhood development, housing, food security are critical to children’s health
When parents bring a child into a clinic, they seek help for an acute illness or a longer-term problem. They expect the child can get a prescription from their health-care provider that will improve their immediate and lifelong health.
It might be something as simple as an ear infection, a chronic illness like asthma, or something more socially and psychologically complex such as attention deficit hyperactivity disorder (ADHD).
In all cases, the best prescription, however, may not be something for the child to take. The most effective way to improve a child’s health may be to give their parents a raise.
Living in crowded, unsafe housing. Unable to afford a diabetic diet. Not filling a necessary prescription. Missing out on opportunities for early childhood learning and higher education. These and many other challenges related to poverty and low wages can result in poor health for kids now and into adulthood.
As physicians, we see patients struggling with the resulting health problems in clinic, but we are not equipped to deal with the real problem – poverty. The sources of the problem originate outside of health care. So do the solutions.
Income, education, employment, early childhood development, housing, food security – these social determinants of health are far more influential than health care on the quality and length of our lives. Chief among these is income, often referred to as the determinant of the determinants, given its direct influence on health and factors such as where people can afford to live and how far they can go in school.
In June, the Alberta government announced it was standing firm on its intention to increase the minimum wage from $11.20 to $15 per hour by 2018. While Alberta has the lowest percentage of workers earning less than $15, it is still home to nearly 300,000 people employed at a rate far below what is necessary to afford the basic necessities of life.
Alberta will be the first province to move to a $15 minimum. The move could be one of the most significant public health interventions in the country this decade. The link between low wages and chronic illness has been well established, as has the connection with mental health issues such as anxiety and depression.
A report looking at U.S. birth data for the last 25 years showed a link between increases in minimum wage and birth weight – an important indicator for future health – along with increases in prenatal care and decreases in smoking.
While not associated with wage increases directly, a study of the Manitoba Health Prenatal Benefit Program showed that giving low-income expectant mothers an extra $81 a month resulted in significant decreases in low birth weight (21 per cent) and preterm birth (17.5 per cent).
Better income through a higher minimum wage means healthier workers and families.
Bringing minimum wage closer to a living wage is a simple way to help low-income Albertans live healthier, by accessing better housing, more nutritious food and participating more fully in their community and the economy.
There are benefits to the economy as well. As the living wage movement has demonstrated, paying people enough to make ends meet leads to less costly employee turnover. It also means more reinvestment in local businesses, as those most marginalized in our communities are able to participate more in the economy and are more likely to spend their earnings locally.
The 2015 Poverty Costs report from Vibrant Communities estimated the cost of poverty to the Alberta economy at between $7.1 billion and $9.5 billion a year. Much of this is through decreased economic activity, but a significant proportion is due to increased health and social spending.
Difficult economic times have tightened provincial budgets. The promised increase to Alberta’s minimum wage will go a long way to help bend the curve on growing health-care costs.
Alberta’s leadership on increasing minimum wage is a promising prescription for the health of its children. It’s also a bold experiment in economic governance that other provinces would do well to watch closely – and hopefully many will follow suit.
By Ryan Meili and Christine Gibson
Ryan Meili is a family physician in Saskatoon, an expert advisor with Evidence Network and founder of Upstream. Christine Gibson is a family physician in Calgary who has been involved in global health and medical education in Canada and overseas.