Health Care Blind Spot

By Jim Silver

Manitoba’s health care system is undergoing major changes. Many Manitobans fear that the changes are more about saving money than improving health, and that privatization of parts of the health care system may be a slippery slope towards the erosion of our treasured single-payer public health care system.
Completely absent from the health care discussion is any consideration of the social determinants of health. There is now a vast literature across the world about the social determinants of health. This literature provides evidence that our health is determined not only by bio-medical considerations, and our lifestyles—whether we smoke, or exercise, or are overweight, for example—but also by a range of socio-economic factors. The social determinants of health literature makes it clear that a population’s health is in large part a product of socio-economic factors related to people’s location on the income scale.
Those of us who have relatively high incomes are statistically much more likely to be healthy than those of us who live with low incomes. Another way of saying this is that being poor makes us sick. The poorer we are, the more likely we are to be sick.
Manitoba Centre for Health Policy data show that virtually all forms of health issues—cancers, heart disease, respiratory disease, kidney and liver disease, accidents, infant mortality, longevity, for example—are worse in the lower income areas of Winnipeg and Manitoba, than in the higher income areas.
It follows that if we were serious about wanting to improve Manitobans’ health—which would in turn lower the costs of health care—we would implement policies that improve the socio-economic circumstances of those at the bottom end of the income scale. Such policies would include, for example: building sufficient numbers of social housing units to meet the needs of the poorly housed; making enough childcare spaces available so that parents could improve their education or seek gainful employment; increasing the availability of adult education and literacy so that the very high numbers of Manitobans with low levels of education could make improvements in their lives; funding job creation strategies that have proved effective for marginalized, low-income people so that they can become self-supporting; increasing the minimum wage so that those who are working can earn a wage sufficient to support their families. There is overwhelming evidence that these policies, if implemented consistently over time, would make large numbers of people much healthier. But we are not implementing such policies. A large part of the reason is that such policies run counter to the ideology—the political belief system—of the current provincial government.
Instead of implementing such policies, the provincial government is limiting and even cutting funding to many such measures, while focusing almost all of its health care effort on re-organizing various parts of the health care system—the system that responds to peoples’ needs after they become sick.
No doubt the health care system needs improvements. Making improvements ought to be a constant in such a large and complex system, although such steps as allowing private diagnostic clinics to open in Manitoba can hardly be seen as an improvement, since they pull scarce resources from the public system and—consistent with that same ideology—eat away at the public system, adversely affecting those many who are sick but can’t afford to pay.
But to concentrate only on what happens after people become sick brings to mind the story of the person who sees someone drowning, and pulls her out of the river, and then sees another person drowning and pulls him out of the river, only to see another person drowning and then another and another. Finally, exhausted from responding to these emergencies, the person decides to go upstream to see who or what is pushing all these people into the river.
Poverty and its many adverse consequences, and the ever-widening gap between the rich and the rest of us, are pushing people into our hospitals and emergency rooms. If the provincial authorities spend all of their efforts re-organizing those hospitals and emergency rooms, and fail to deal with those socio-economic factors that we know are major causes of poor health, they are not acting on the basis of the evidence.
Ideological blinders appear to be preventing the current provincial government from seeing the overwhelming evidence that being poor makes people sick, and that to improve health outcomes requires policies that address the socio-economic circumstances of those at the lower end of the income scale.
The provincial government ought to take off those blinders, take a look upstream, and deal with the factors that are pushing people into emergency wards and hospitals.

Jim Silver is a professor in UW’s Department of Urban and Inner-City Studies, and a co-editor, along with Lynne Fernandez and Shauna MacKinnon, of The Social Determinants of Health in Manitoba, Second Edition (Winnipeg: Canadian Centre for Policy Alternatives-Mb, 2015).

New CED Documentary Screening Tuesday Jan 23

CCEDNET-MB, CCPA-MB, The Manitoba Research Alliance and Rebel Sky Media present:

The Inclusive Economy

Stories of Community Economic Development in Manitoba

Tuesday, Jan 23 at Cinematheque, 100 Arthur St. Winnipeg

Doors open at 6:30, movie at 7 pm

Discussion at 7:30

Free event

Watch movie trailer

Low income Manitoban’s falling behind in 2018

By Josh Brandon

As we roll into 2018, low income Manitobans are falling further behind. While minimum wage in Ontario went up on January 1 to $14 per hour, in Manitoba it is stuck at a poverty level of $11.15 per hour. This leaves minimum wage workers up to $5,700 per year behind their Ontario counterparts. Here, a single parent with one child earns as much as $7,000 below the poverty line. Manitoba has now fallen to 8th among provinces and territories in minimum wage. Read More

Call for Papers 1919 Winnipeg General Strike Centenary Conference May 9 – 11, 2019

1. Presentation Title
2. A 100-150-word outline of the presentation.
3. A 100-150-word biography. These must include (if applicable) a list of publications, activities, and a list of
positions (paid and/or voluntary) relevant to this event. This information is essential to assisting the
organizers in soliciting funding to support travel and other workshop costs.
Please email these materials as an attachment in Word format to the program committee at:
For more information about conference themes and to keep up with our ongoing plans, please visit:

THE WINNIPEG GENERAL STRIKE OF 1919 was a landmark moment in North American working-class history. In May and June that year, over 30,000 workers ceased work for six weeks. Provoked by the inequities of industrial capitalism, the authoritarianism of their workplaces, the brutal experiences of the First World War, rising prices and stagnating wages, an insecure economic outlook, intransigent employers, and a federal state that responded to their demands with growing repression, the city’s workers stood together in an astounding display of unity. This was also an era filled with hope; the horrors of industrialization and militarism encouraged many to think of ways of constructing a better world. The combination of anger and hope was infectious. In 1919, Winnipeg workers displayed an inspiring unity, facing hunger, threats of permanent dismissal and blacklisting, and violence at the hands of authorities, most notably in the vicious assault they unleashed on “Bloody Saturday,” killing two workers and injuring many more.

Just as workers in 1919 sought to lift themselves and their communities out of poverty and win a fairer share of the fruits of economic growth, 21st-century workers are facing worsening material conditions: stagnating wages and increasing precarious employment, along with cuts to social services that increase demands upon working-class families. The “Fight for 15,” struggles for family supports such as child care, and the rise of antipoverty movements are at the forefront of today’s organizing, reflecting the ways in which neoliberalism has forced the fight for a living wage and a working-class economic security onto centre stage.
A century ago, Winnipeg was a divided city – not only along the lines of class, but workers were, themselves, divided along lines of race and ethnicity. A capitalist labour market pitted “British Canadian” and “immigrant” workers against each other; the First World War heightened fears of the “foreigners,” and the economic insecurity that faced returning soldiers at the end of the war led, on occasion, to confrontations on the streets of Winnipeg. Amazingly, attempts by employers to use bigotry to divide the city’s strikers failed. Today, governments and businesses use international borders, an exclusionary “citizenship” which often denies workers from abroad a range of social and labour rights, and post 9/11 xenophobia, to ensure their control over labour. The lessons of overcoming these divisions and fighting for common, expanded rights, are as central today as they were then, and include a growing understanding of the rights of Indigenous people as First Peoples and as workers.
The Winnipeg General Strike was part of a continent-wide, even an international, labour revolt that saw unions, mass strikes and working-class parties act in their own name. In Winnipeg, despite the defeat of the strike, socialist and labour parties continued the fight by other means. This was an era in which labour was the voice of the dispossessed; if there was a solution to the problems that capitalism brought, it was represented by labour. In the 21st century, a wide range of social movements address issues that were often unimagined a century ago. Building an effective response to a wide range of assaults on the environment, and in defence of Indigenous rights, gender rights, on the rights of the disabled, and so much more, requires education, organizing, and mobilization. To what extent are these class issues that labour needs to centrally address? Can labour lead in building a better world in which all forms of oppression and exploitation are fought?
These are all broad themes, but the Winnipeg General Strike, although provoked by specific issues of collective bargaining, exploded into a broader revolt because it spoke to much broader issues, provided a voice to the dispossessed, and raised the question of whether labour had the answers. This conference hopes to tie the past and the present together by examining these three themes in their historical and contemporary context.
We invite a range of scholars, trade unionists, and social activists to share their knowledge and experiences. We envisage presentations and discussions by historians, labour studies scholars, and unionists about the General Strike, the subsequent history of labour’s attempts to address these themes, as well as contemporary struggles. We invite public historians to engage in discussions of the manner in which this history has been shared, how to best engage with a wider audience. What part can teachers play in including an understanding of workers’ history, including the Strike, at all levels of education? Finally, the conference will include roundtable discussions, led by activists, of the three themes listed above.
We call, then, for proposals for individual presentations, panels, and roundtables that address the themes of the conference. The organizers are presently exploring funding opportunities to help offset travel costs and other costs associated with conference attendance. It is hoped – though not guaranteed – that some of the costs of participation may be covered.

Applying a Rural and Remote Lens to the KPMG Review

By Lonnie Patterson

There has been much discussion and analysis of the KPMG Manitoba Fiscal Performance Review recently released by the provincial government. However, the potential impacts that will occur in rural and remote Manitoba communities, if some of the review’s recommendations are implemented, have not yet been part of the dialogue. The review itself fails to recognize the realities of delivering public services across our province’s vast geography and into places with low population densities. As the review characterizes it, there are “areas of opportunity to bend the cost curve” across government, some of them directly related to delivering services to rural and remote Manitobans. In this piece, I will highlight some policy recommendations that require much more analysis, with a specific focus on how rural and remote Manitoba could be impacted. Read More

Contracting Out the Enhanced Home Care Program

By Pete Hudson

Among the many recent changes by the Pallister government to health care was a contract with two private companies to operate the Enhanced Home Care Program (EHCP). This will provide community care to patients who can no longer benefit from acute hospital care, at an estimated total cost of $10.5M. Each eligible patient will receive up to 90 days of intensive service prior to “transitioning” to their own home or to a Long Term Care (LTC) facility. Read More

No Poverty Reduction Strategy in Speech from the Throne

By Josh Brandon

Tuesday morning, I received a phone call from a Make Poverty History Manitoba member. He lives on a disability benefit that provides him only $180 per month for food and other basic necessities. He wanted to know if he can expect any change soon. I told him we would see in the Speech from the Throne that afternoon what, if anything, the Province has planned for its long-promised poverty reduction strategy. Read More

KPMG: Reasons to be skeptical of the advice they offer

By Jim Silver

It is curious that the Pallister government would have hired consulting firm KPMG to provide advice on how to manage the Province’s affairs. KPMG’s actions across the world and in Canada—some illegal; many promoting the interests of the exceptionally rich at the expense of the rest of us—suggest that we should be very wary of any advice they might offer. Read More

Income Security to End Poverty in Manitoba

By Andrew Clark

Income security programs in Manitoba and Canada are not keeping pace with the growing problem of poverty. Change is needed to ensure low income and vulnerable people and families do not become entrapped in a lifetime of poverty.
Canada’s Income Assistance (IA) and Manitoba’s Employment and Income Assistance (EIA) programs provide support to 115,000 Manitobans. These programs were started in the 1960s for people whose incomes were insufficient to meet their basic needs. During the 1990s, IA and EIA benefits were cut and have largely been frozen ever since. Make Poverty History Manitoba (MPHM) estimates that benefit levels for all categories of recipients are below the poverty line – as much as 44% and 33% for single individuals and people with disabilities respectively. It is no surprise that over 60,000 Manitobans accessed foodbanks in 2016. Read More

Will SIB’s Deliver Less for More in Manitoba?

By Jesse Hajer

On Wednesday October 18th, the Province of Manitoba announced that it had hired the MaRS Centre for Impact Investing to design a “made-in-Manitoba” Social Impact Bond strategy. Social Impact Bonds (SIBs) are a relatively new type of contract between governments and the private sector to enable the delivery of social services in areas such as health, education, job training, early childhood development, child welfare, housing and crime prevention. SIBs focus on preventing undesirable social outcomes from occurring in the first place and can in theory end up saving the government money, although this has been downplayed more recently by proponents.
Evidence supports the idea that many social services interventions can ‘pay for themselves’. The Washington State Institute for Public Policy, for example, as of May 2017, had analyzed 343 social policy intervention models that were subject to rigorous experimental study, and found that 57 percent saved government more then they cost to deliver, and 76 percent produced a quantifiable benefit to citizens greater than their cost. Read More