Poverty linked to multiple health problems in new mothers
Why social policy is health policy
A version of this commentary appeared in the Ottawa Citizen, Vancouver Sun and iPolitics.ca
As health equity researchers, it’s part of our job to measure therelationship between social conditions and health outcomes.Often, we try and link one social condition, like income, to onehealth outcome, like diabetes, low birth weight or mental illness— the list goes on. Using this approach, we are able todemonstrate when low income is associated with a higher risk of having a specific problem. What we don’t generally measure,however, is the overall impact of low income on physical andmental health.So what happens when we try? At the Centre for Research onInner City Health, we analyzed health survey data representativeof more than 75,000 Canadian women who had recently givenbirth. We looked at the relationship between low income and the risk of experiencing three to five of these healthconditions at the same time: adverse birth outcomes, postpartum depression, serious abuse, hospitalization duringpregnancy and frequent stressful life events.The results were staggering. We found that new mothers living on very low incomes were more than 20 times morelikely to experience multiple health problems than new mothers living on high incomes. Compare this to the “singledisease” method through which we often find that people living on low incomes are only twice as likely — if that — toexperience a specific health problem.Our evidence also suggests that if we were able to ensure all new mothers in Canada had household incomes of more than $50,000 a year, we could reduce the occurrence of multiple health problems in pregnancy by 60 per cent.These findings tell us that low income doesn’t just lead to one disease or another. Instead, it has wide-rangingimpacts on the health of individuals and communities. These findings also tell us that, as researchers, we’ve beenusing the wrong tools, and typically underestimating the full impact of income on health.So now that we have a more accurate assessment of the impact of low income on wellbeing, what kind of solutions dthese findings suggest? To some degree, the healthcare system is already recognizing that some populations facemultiple health problems. Recent responses have included a much-needed emphasis on case coordination and
collaboration between different parts of the system like primary care, hospitals, home care and long-term care. Theseare good things. Program responses like diabetes education centres and stress reduction classes can be good thingstoo.The healthcare system, however, is not the only place — or even necessarily the most important place — to focus our efforts to improve the health of the population.Instead, our evidence suggests the incredible potential of focusing our attention on low income itself. If we want toknow how to improve the health of Canadians on a large scale, programs and health system changes — while veryimportant — are not the answer. The answer is to institute policies that address the social determinants of health,such as education, housing and employment, and change the conditions themselves.