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B.C.'s Doctor is Worried

Everyone in B.C. is his patient, and Dr. Perry Kendall's check-up includes the effects of poverty and homelessness on our collective health. Contrary to feel-good headlines, his report sounds alarms.

Barbara McLintock 15 Dec 2003TheTyee.ca

Barbara McLintock, a regular contributor to The Tyee, is a freelance writer and consultant based in Victoria and author of Anorexia’s Fallen Angel.

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When Provincial Health Officer Dr. Perry Kendall issued his annual report week before last, most of the stories in the media stressed the positive and stuck to sound bites. A sample headline, "We're Healthier, More Depressed."  In fact, Kendall notes some encouraging trends, ranging from B.C.'s low smoking rate to improving health among aboriginal peoples.

But delving more deeply into the 265-page update proves well worth the time involved, because not only does Kendall offer one of the last remaining independent check-ups on B.C. society from a government official, he also sounds an early alert to some worrisome trends that could lead to major health problems in years to come, if not dealt with now.

Kendall stresses that in the long run, government policies geared to dealing with issues like poverty and homelessness will save the taxpayer more dollars than will the health programs that simply provide treatment for diseases already occurring in the population. Indeed, when Kendall takes the pulse of the province, he strays far from the hospital wards to examine such factors as income, education, housing, the environment and even the economy. (For some of his general prescriptions, see this story Doctor's Orders for B.C. in today's Tyee)

As Kendall looks at each issue, he measures the progress British Columbia has made - or not made - with indicators that are both objective and measurable. The result is a lengthy and detailed snapshot of what is going right and what is going wrong in British Columbia from a wide range of perspectives - but all of them seen through the health lens.

Other health monitors silenced

The number of such evidence-based, independent reports has decreased substantially since the Gordon Campbell government took office. The position of the Child and Youth Advocate has been abolished and with it, her reports warning of problems caused by lack of services for young people. The Children's Commission has been abolished, and with it, the detailed analyses of the deaths of every child and youth who lost their life in the province. (The new Children's Officer is expected to eventually fill in some of these gaps, but so far has not made a public report.) Deep cutbacks in the budgets of the various independent officers of the Legislature have made it more difficult for them to provide the in-depth analyses previously expected from them.

Thus, Kendall's report takes on added importance. It should be noted that not all of the statistics that he uses are yet entirely up to date. For some measurements, the numbers for 2000-01 are the last available, meaning that changes since the Liberal government took office aren't yet recorded. Kendall himself takes special note of this in some cases, such as in the chapter on housing. "Housing need," he writes. "No recent data (likely worsening)."

With these provisos, he then proceeds to use 91 specific indicators to measure as well as possible everything from the direct health indicators, such as expected lifespan and infant deaths, to those determinants of health, such as poverty, air quality and housing.

The picture is far from all-black. Indeed of the 91 indicators, 41 show positive or improving trends. A total of 31 indicators have remained roughly the same for the past several years, and in only 14 cases is a negative trend yet visible.

Some good news

Those that have improved include over-all life expectancy which at the end of 2002 ranged between 77.7 years and 81.8 years, depending on what part of the province you live in. (Life expectancy is highest in Richmond, and lowest in the Northwest.) That's an increase of 0.8 years in just the past five years, statistically a significant improvement. The life expectancy of seniors has improved as well, and the number of people who are dying prematurely (before the age of 75) continues to decrease.

Many of the other indicators which are showing improvement are the result of interventions specifically targetted at high-risk groups in our communities. For example, after years of anti-tobacco campaigns, British Columbia now has the lowest proportion of smokers anywhere in Canada - only about 20 per cent of the population over the age of 12. The numbers are even better for those between the ages of 15 and 19 - the age when most smokers begin the habit. Only 16.5 per cent of B.C. teens smoke, fewer than half the number in Quebec (now at 33.6 per cent).

The number of cases of diseases that are preventable through vaccinations or immunizations has also been reduced in nearly all cases through such programs as the universal Hepatitis B vaccination program for all Grade 6 students and increased influenza immunization programs. The number of injuries is declining, although Kendall stresses it's still far too high. Targetted programs have helped reduce the number of injuries sustained in the workplace.

The numbers also show unquestionably that the health-care system itself has increased its efficiency significantly. The number of so-called "preventable admissions to hospital" is declining because of programs designed to treat people with such illnesses as diabetes, asthma and depression in the community. The length of time that people stay in hospital is going down slightly, and few are seen as staying in hospital longer than is absolutely necessary.

One area where significant improvement has been noted throughout is the health of B.C.'s aboriginal population. Not only are the life expectancy and objective health numbers improving for aboriginals, but so are the factors improving health. More aboriginals are becoming better educated, more are finding jobs and fewer are living in poverty.

Health Services Minister Colin Hansen says that's one of the improvements he's most happy about. "The gap is still there between natives and non-natives," he said last week, "but at least we're seeing that gap beginning to narrow substantially."

Poverty a big factor

So much for the good news. More worrisome are the trends that are emerging in many of the other determinants of health, such as homelessness, unemployment and poverty - all factors that are extremely likely to lead to health problems for the individuals, and a corresponding increase in costs to the health care system, further down the road.

Kendall notes that the over-all unemployment rate rose in 2002, from less than 8 per cent to 8.5 per cent. The situation was much worse in some parts of the province, such as the North Coast, which saw its unemployment rate go up from 8.8 per cent in 1999 to 12.6 per cent in 2002. Equally worrisome was the high level of unemployment among youth. Those aged 15 to 24 in 2002 faced an unemployment rate of 14.3 per cent - above the Canadian average and higher than any of the prairie provinces.

According to the traditional measures of low income, the number of British Columbians living below the cutoff line has remained at about 12 per cent of the populace. However, Kendall notes that the federal government has developed a new measure which, instead of comparing incomes, looks at a family's ability to afford the basic necessities of life. Using that measure, the number of B.C. residents living in poverty rises to about 20 per cent, the second worst in the country after Newfoundland and Labrador. The main reasons for the increase are high housing and food costs in the Lower Mainland and Victoria areas. Vancouver is rates as the most expensive city in the country in which to live.

Equally disturbing is the growing gap between B.C.'s richest and poorest citizens. Research has consistently shown that over-all health is worse in provinces or countries where there is a large gap between rich, compared to ones in which the gap is smaller. The statistics show that in Canada, B.C. and Ontario had the largest gaps. Families in the top income bracket received almost 20 times more money each year than did families in the lowest income bracket. In Vancouver, where the gap is even worse than in the rest of the province, the bottom 10 per cent of families had an average annual income of $8,700, while the top 10 per cent averaged $205,200 a year.

Key health determinants declining

Kendall notes that there are no reliable indicators to measure accurately just how many British Columbians are homeless or at risk of becoming homeless. However, he notes that a "snapshot" taken in the Lower Mainland during one 24-hour period in 2001 found a total of 1,121 homeless individuals who were either staying in emergency shelters or transition houses or were actually on the street. Of that group, 71 were children. About two-thirds of them reported at least one health related problem - most often an addiction, a mental health issue and/or a disability. Research has also shown that the number of families spending more than half their income on shelter is steadily rising.

The great concerns about all these determinants of health is that these conditions appear to be worsening in B.C., not getting better. Although new jobs are being created, particularly in the urban areas, there remain significant concerns about job losses in the Interior and the North especially, as well as those caused by increasing downsizing and contracting-out within the public sector. 

Provincial tax policies continue to emphasize the gap between the rich and poor. The richer citizens continue to benefit from the 2001 tax cuts while the poorer citizens are finding the tax cut benefits being eaten away and more by increases in the sales tax, medicare premiums and other fees for government programs.

Further changes to the welfare rules that take effect in April will almost certainly further increase the number of citizens in poverty and those at risk of homelessness because they are forced to spend so much of their income on shelter. The average income of the lowest 10 per cent will almost surely shrink further when some individuals are removed from the welfare rolls altogether and thousands of others, mainly families with children, lose $100 from each month's cheque.

Anecdotal reports from around the province emphasize the increase in the number of homeless. One "hard to house" man died this week in Victoria when the recycling bin in which he was sleeping was dumped into a truck and then compacted - with him in his sleeping bag still inside.

Minister: Welfare cut-off won't harm health

Hansen is the first to admit that the health care system for which he is responsible is only one factor in the determination of a population's health. "Health is a much bigger thing than just our hospital system and doctors and so on," he stresses. "People have to realize that."

He stresses as well the importance of people making good decisions in their own lives, such as eating well, staying active and not smoking. As far as over-all government policy is concerned, he says he has talked to Human Resources Minister Murray Coell who is satisfied the welfare cuts can be made without harming the health of individuals or families.

Dr. Kendall plans to keep measuring the health of B.C.'s population to see if Hansen and Coell's optimism is justified. Unfortunately, by the time he makes public his next report, it may be too late for some British Columbians whose "determinants of health" have become the determinants of their illness, or even their death.


Readers who would like to read more details of Dr. Kendall's report can find it here (PDF file).


Barbara McLintock, a regular contributor to The Tyee, is a freelance writer and consultant based in Victoria and author of Anorexia's Fallen Angel.  [Tyee]

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