The Missing Piece in Health and Education

By Jim Silver

Previously published in the Winnipeg Free Press May 1, 2023

Although recent media coverage of our healthcare and education problems here in Manitoba has been very good and quite wide-ranging, one particularly important piece of the puzzle has been consistently missing. That missing piece is the social determinants of health.

There is strong scientific evidence, going back decades and covering most countries in the world, that socio-economic factors play a particularly important role in determining people’s health and level of educational attainment.

Consider health. What the social determinants of health tell us is that people get sick not only for bio-medical reasons, and for lifestyle reasons—they smoke or drink a lot; they are overweight; they don’t get enough exercise—but also for reasons having to do with their socio-economic circumstances. The evidence is overwhelming that being poor, for example, makes it more likely that a person will experience a wide variety of health problems and suffer a shortened life span. Living in poor housing will have the same effect. Homelessness accentuates health risks. Absorbing the stress related to low incomes or poor housing or living in dangerous neighbourhoods has negative health impacts.

The incidence of virtually every type of health care problem is highest in Manitoba’s lowest income areas and Winnipeg’s lowest income neighbourhoods. Longevity—how long people live—is dramatically lower in Manitoba’s lowest income areas and Winnipeg’s lowest income neighbourhoods.
Hospital beds, including and perhaps especially emergency and intensive care beds, are disproportionately occupied by people who are poor, and/or are struggling with poor housing or stressful neighbourhoods or the damage that continues to be caused by colonialism. In other words, these poverty-related factors are driving up health costs and adding to the length of wait lists.

It is by now obvious to everyone who is paying attention that poverty, lack of adequate housing, homelessness and a range of poverty-related problems are almost epidemic in Winnipeg and Manitoba. In 2020, 64,670 children in Winnipeg were growing up in families living in poverty. Manitoba is the province with the worst record for child poverty in Canada. Churchill-Keewatinook is the federal constituency suffering Canada’s second highest incidence of children growing up in families that are poor. We have a serious poverty problem in Manitoba, and it’s affecting our health care costs.

The evidence is equally clear that educational outcomes correlate directly with socio-economic status. Being poor not only makes you sick; it also increases the likelihood that children raised in a family living in poverty won’t graduate high school. Many will, of course, but it’s clear and well known that children and youth who grow up in families that are poor have reduced chances of graduating high school.

Not graduating high school, in turn, reduces the likelihood of finding a decently paid job and thus increases the likelihood of being poor. In this way poverty is reproduced. The result is adverse effects on health care costs and educational outcomes. Everyone in Manitoba suffers.

Health care and education are provincial responsibilities. It follows that our provincial governments have a responsibility to attend to those factors that damage our health and education systems and drive up those costs. That means the social determinants of health—poverty, low wages, poor housing among others.

Yet most governments and especially our current provincial government fail rather dramatically in this regard. They seriously underinvest in strategies to drive down poverty. They underinvest in the building of good quality affordable housing for low-income people. They don’t do enough to establish liveable wage levels, to enable adults with low levels of education to benefit from adult education, and to enable parents who want to work to benefit from affordable and available childcare. They don’t invest enough in the poverty-related factors that drive up health costs and drive down levels of educational attainment.

Instead, Manitobans get a steady diet of austerity in public spending and intermittent cheques in the mail. This is profoundly short-sighted. It is not meeting Manitobans’ real needs. The overwhelming evidence from the vast literature on the social determinants of health makes it fully clear that to improve health and education we need to attend to the poverty and homelessness and related problems that have been allowed to grow for decades.

If provincial governments continue to fail in these respects, health care problems will worsen, educational attainment will not be what it could and should be, and we will all pay the price for that short-sightedness.

Jim Silver is Professor Emeritus at the University of Winnipeg, and a Research Associate with the Canadian Centre for Policy Alternatives-Manitoba.