Social Determinants of Health: Ontario’s Minimum Wage Increase
Savannah Black
N1070a, Section 001
University of Western Ontario
Social Determinants of Health: Ontario’s Minimum Wage Increase
For decades, poverty has been a widespread epidemic that continues to dramatically increase. Poverty is a multifaceted concept involving economic, political, and social factors (Laurie, 2008). It is defined as the deprivation of basic necessities such a money, food, and shelter, to sustain long-term health and well-being (Lammam & MacIntyre, 2016). In Canada, approximately five million people are currently living in poverty (Laurie, 2008). Canadian’s experiencing poverty are at an extremely high risk of developing chronic diseases (heart disease, and diabetes) and mental illnesses (depression, anxiety)(Laurie, 2008). Vulnerable groups such as elderly, immigrants, those living with disabilities, Aboriginals, single parents, and youth are particularly more susceptible to the effects of poverty.
In efforts to eliminate poverty, a public health policy known as the “Poverty Protection Strategy” has been developed by increasing minimum wage in Ontario to promote equity and equality (CBC News, 2017). On the surface, this may be an appropriate solution to alleviate the long-term effects of poverty. However, further investigation and evidence indicates the short-term consequences are detrimental to society outweighing the long-term outcome. The effects of poverty can be expressed through the social determinants of health. The social determinants of health are conditions in which people are born, live, grow, and work that primarily shape an individuals health and well-being (Shim et al., 2014). From a nursing perspective, this article will apply social determinants of health to the current event and implicate health promotion strategies to understand the relevance to health and well-being. In relation to the article, the most relevant determinants of health are income, social exclusion, and unemployment and job security (CBC News, 2017).
Income
Income is the greatest determinant of health and influences the quality of nearly all social determinants of health (Kushner & Jackson, 2019). Income is defined as the amount of money an individual or family receives annually. Research indicates a lower income is linked to higher levels of physiological and psychological stress leading to chronic health illnesses and shorter life expectancies (Compton, & Shim, 2014). Additionally, the distribution of income across the population is also strongly correlated with physiological, psychological, social, and environmental well-being (Mikkonen, & Raphael, 2010).
In the article, Ontario's Financial Accountability Office (FAO) predicts only a small portion (~27%) of the total gain in labor income would actually benefit low-income families. The remainder would be going to families above the low-income threshold (CBC News, 2017). Additionally, Statistics Canada (2018) states the majority of workers receiving minimum wage are under the age of 25 years and are currently living in a household with a primary or sole-earner (Lammam, & MacIntyre, 2018). Approximately all Ontario’s minimum wage earners are not living with low-income families pushing those who are further into poverty. Therefore, the policy is not targeted toward those experiencing poverty and will create an even larger income gap between middle and lower class citizens. Despite the provincial government’s belief that the policy will alleviate the effects of poverty, it is not an effective strategy as the consequences will be more detrimental to society.
Furthermore, by increasing minimum wage, pricing for food, housing, clothing, and medications are predicted to increase to higher amounts then ever seen before (Macurdy, 2015). This creates a barrier for low-income individuals and families making quality living conditions unattainable. Due to higher consumer rates, poor communities will be unable to afford basic prerequisites of health such as adequate housing, healthy foods and clothing. This could potentially force more members of society into poverty. Without affordable living conditions, individuals are predisposed to negative health outcomes including chronic diseases such as cardiovascular diseases and diabetes, and even death (Mikkonen, & Raphael, 2010). Therefore, increasing minimum wage has a negative effect on the economy and the overall health of society. An individual’s level of income is often determined by education level and employment. Raising the minimum wage causes several economic consequences to young inexperienced workers.
Unemployment and Job Security
Employment is the condition of having paid work to aid in the structure of one’s life. A sense of identity is often achieved through one’s employment condition and income (Mikkonen, & Raphael, 2010). A lack of employment may lower one’s self-esteem. In Ontario, approximately 65% of the population are currently employed or actively seeking employment (Statistics Canada, 2018). However, within the last year, the rates of unemployment are exponentially rising. Due to the higher minimum wage in Ontario, government officials have predicted 50,000 job losses predominantly in teens, young adults, and immigrants (CBC News, 2017). Losing a job can be extremely stressful by lowering one’s self esteem and causing harmful effects to physical and mental health.
Lack of employment often leads to unhealthy coping behaviors (smoking, alcohol consumption), psychological stress, and material and social deprivation (Mikkonen, & Raphael, 2010.) In addition, mental illnesses are highly associated with unemployment frequently triggering symptoms of anxiety, depression and may even lead to suicide. Therefore, the poverty protection strategy is increasing rates of unemployment and putting the health of 50,000 individuals at risk for poor health outcomes.
Job insecurity is a major work-related stressor that usually involves a reduction of employees. Several small and large businesses are beginning to eliminate positions, benefits, and job security due to the raising minimum wage. This generates significant conflict between long-term employees and employers. Long-term employees are insisting on higher wages considering the fact the minimum wage will be 15$/hour in 2019 (CBC News, 2017). However, despite the demand for higher wages, employers are more likely to reduce the number of workers and hire inexperienced employees that will work for minimum wage. Therefore, raising the minimum wage effects the job security of many employees. Insecure employment is associated with unfavorable working conditions which could potentially lead to high blood pressure, sleep deprivation, injuries, and cardiovascular disease (Mikkonen, & Raphael, 2010). Therefore, the reduction of job opportunities and fewer benefits, less hours of work available, and higher consumer prices negatively effect the working poor (Lamman & MacIntrye 2018). Furthermore, there are particularly vulnerable groups that are more susceptible to unemployment and job insecurity which could lead to further social exclusion.
Social Exclusion
Social exclusion refers to specific groups in society that have unequal access to resources and lack power (Mikkonen, & Raphael, 2010.) Vulnerable groups such as elderly, immigrants, living with disabilities, Aboriginals, single parents, and youth are particularly more susceptible to social exclusion. Underprivileged groups are especially excluded with limited access to health services, resources, and education. Excluded groups lack power and are unable to contribute to social, economical, and political activities. The higher minimum wage is problematic for the excluded groups as there is higher likelihood of unemployment, low incomes, and social problems leading to increased poverty rates. Consistent in the literature, the exclusion from mainstream society is the primary factor in the development of chronic diseases and mental illnesses (Compton, & Shim, 2014).
Minimum wage increase is an attempt to increase equity, a fair and just distribution of resources and services (Pinto, et al., 2016). However, this public policy is flawed and does enable all Ontarian’s to equal access of resources. Macurdy (2015) predicts the pricing for basic necessities (food, housing, clothing) will continue to increase sufficient amounts. Consequently, excluded groups and low-income families are predisposed to material and social deprivation. The greater the deprivation the more challenging to participate in mainstream activities involving political, economical, and cultural decisions (Shim et al., 2014). Excluded members of society are often faced with discrimination and underrepresented in high-income occupations. Overall, the strategy to alleviate the effects of poverty are forcing more members of society into poverty.
Building a Healthy Public Policy
Health promotion involves the population as whole and is directed towards the determinants of health (Kushner & Jackson, 2019). Health professionals have a significant role in empowering individuals to control and improve one’s overall health. Raising the minimum wage is an ineffective strategy and negatively effects the determinants of health. An alternative solution is for public health nurses to build a public policy that is directly benefiting those in need with less negative consequences. In a past study, Gunderson (2007) first introduced a program known as a work-based subsidy which became enhanced recently by the federal government to be titled Canada’s Worker Benefit (2018). A work-based subsidy is a cash transfer from the government to low-income workers (Gunderson, 2007). For example, low-wage earners making less than a specific amount will receive an additional grant from the government. Minimum wage increase leads to a reduction of employees, positions, and pay-roll preceding to job insecurity. On the contrary, a work based subsidy program would increase employment rates by encouraging poor individuals to find work (Lammam & MacIntyre, 2018). The government requires a low-income in order to receive the benefits of the program. Health professionals can advocate for a basic income to assist the poor communities. Therefore, a work-based subsidy would promote employment and provide a more effective solution to decreasing poverty.
Strengthening Community Action
Many people believe the answer to poverty is for the poor to get a job and receive a basic income (The London Free Press, 2016). However, the underprivileged are uneducated and without the the appropriate resources and tools individuals living in poverty will continue down the same path. Health professionals need to focus on the individuals and communities to understand the root causes of poverty. In a research study, nursing education incorporated a poverty simulation for students to influence attitudes towards individuals experiencing poverty (Noone, Sideras, Gubrud-Howe, Voss, & Mathews 2012). The poverty simulation provided new insight and experience to the nursing students. It was an engaging learning opportunity to gain sensitivity when working with the poor population (Noone et al., 2012). Therefore, the improvement of the education curriculum is enhancing nursing students knowledge and awareness of poverty. Nurses need to participate in community-based placements in underprivileged neighborhoods. It is important to be placed in the context to completely understand those living in poverty and to provide adequate care. Consistent throughout the literature, health professionals constantly emphasize the importance of educating student nurses appropriately for preparation in clinical settings (Andermann, 2016.). This will strengthen community action, help develop personal and skills and raise the awareness of poverty.
Reorienting Health Services
A alternative solution is to reorient health services for socially excluded groups specifically for underprivileged communities. Consistent throughout the literature, individuals experiencing poverty are lacking access to resources (Schomus, 2013). The poor communities are suffering from physical and mental health problems with limited services and support. Public health nurses could provide free therapy sessions for the poor to combat the high rate of mental illnesses prevalent for that group. Additionally, this would create safe and supportive environments for the poor to help eliminate the negative effects associated with poverty. Therefore, if higher precedence is targeted towards mental and emotional health it could potentially solve several existing problems. Mental health is effected by absolutely everything similarly the way income affects every social determinant of health (Andermann, 2016). To reorient health services by focusing on the underprivileged that lack access would be the most effective strategy to help alleviate the effects of poverty. This strategy is currently available in some larger cities in Ontario. In London, there are counselling sessions based on income that can be as low as zero (The London Free Press, 2016). However, there is a three-five months wait time period unless considered in severe crisis mode. Nurses can advocate for shorter wait times and make more supportive environments available for the poor (Andermann, 2016). Therefore, increasing physical, mental, and emotional health would lead to a better quality of life.
Conclusion
Research indicates the “Poverty Protection Strategy” is flawed and is predicted to be detrimental to society. Raising minimum wage is an ineffective strategy against poverty. When addressing the determinants of health, income, unemployment, and social exclusion are especially problematic for the poor communities. The government policy fails to target the underprivileged groups in need of assistance and produces several economic consequences for young inexperienced workers (Lammam & MacIntyre, 2018). From a nursing perspective, there are health promotion strategies that may be more effective in alleviating the effects of poverty without the negative consequences. Health professionals can influence political policies by advocating for basic income, providing support groups, and incorporating poverty simulation into education systems to reduce health disparities.