CONTRIBUTION: Hospitals are great, but they won’t keep you out of the hospital

Canada has free, high-quality healthcare for everyone.  So why do the richest 10% of people live seven years longer than the poorest?  Deep poverty can be associated with a drop in life expectancy of 20 years or more.  If we look at both life expectancy and years lived with disability, the rich are 39% healthier than the pHomelessoor.

Income affects health in several ways, including the direct impact on the resources needed for healthy living, access to healthy physical environments and access to healthy social environments.

Poverty limits access to nutritious food, recreation opportunities, adequate housing, and the education needed to pull oneself out of poverty.  Each year, the Middlesex-London Health Unit issues a report that compares the cost of nutritious food to income received from minimum or welfare wage.  This Nutritious Food Basket Report consistently shows that it is impossible for people on low income in London and Middlesex County to afford healthy food once basic costs such as rent and utilities are paid.

Approaches like the  Housing First Model, which firsts secures housing then provides other necessary supports and services, show how housing impacts health.  London CAReS offers free housing, with in-home support, to over 70 individuals who have experienced chronic homelessness. Initiated by the City of London with primary funding from the Province of Ontario and United Way London Middlesex, this collaborative service keeps people healthy and prevents over 1,000 emergency department visits and police calls each year.

In addition to where we live, the social circles we move in also shape our health.  Smoking, which remains the #1 killer in Ontario, is just one example that is strongly associated with poverty.  When friends, family, co-workers and neighbours smoke, it can be very difficult to avoid this addiction, or to break it once formed.

The benefits of policies that address poverty go far beyond simply helping the poor. Research has consistently shown that everyone is better off in societies that are more equal.  Comparisons of countries which are part of the Organization for Economic Cooperation and Development (OECD) consistently show that in societies that are most equal, even the poor are healthier than the rich in societies that are the least equal.  In other words, greater income equality means better health for everyone – including the rich.

This paradox – that my income is linked with my health, but that my society’s income equality is also linked with my health – is not fully understood.  One theory is that it is linked with the social environments we live in.  More unequal societies tend to be more competitive, with fewer opportunities for upward mobility.  This can be associated with stress and hopelessness.  Stress is linked with a number of health problems from heart disease to cancer.  Hopelessness can be devastating, reducing motivation to seek employment and leading a person to neglect their health or even engage in self-harming behaviours like addiction to alcohol and drugs.

In more equal societies, a feeling that friends, neighbours and fellow citizens will offer help when needed can be motivational, even leading to an increased sense of self-worth.  Reduced stress can allow us to see past day-to-day challenges and make better decisions for the long term.

Under the Ontario Public Health Standards, public health units in this province are required to raise these issues and help policy-makers knit solutions together at all levels of government.

Part of the challenge is overcoming the value judgments we sometimes make: that the wealthy are inherently different from the poor; that healthy people are somehow better those who are sick; and those who are homeless have chosen to live that way.

It is easier, perhaps too easy, to draw lines between “us” and “them” than to see the common ground that unites us as one community. It is easier to dismiss someone who lives in poverty than it is to ask what we can do as a society.

Let’s change how we see others and reassess the roles we can all play. If we narrow the gap between the wealthy and the poor, we will all live healthier, happier lives.

Dr. Christopher Mackie
Dr. Christopher Mackie

Dr. Chris Mackie is a contributor to the London Institute, the Medical Officer of Health and CEO for the Middlesex London Health Unit (MLHU) and is an Assistant Professor, Part Time at McMaster University. Before coming to London, Dr. Mackie was Associate Medical Officer Health for the City of Hamilton for four years. He also worked as a Public Health Physician with Public Health Ontario. Dr. Mackie has published peer-reviewed papers and abstracts on a number of public health related issues, including vaccination policy, emergency planning, environmental health and child and youth mental health. He is particularly passionate about ensuring that public health programs address both health and health equity, aligning with public and stakeholder values in order to ensure the long-term sustainability of public health organizations, and supporting the development of evidence-informed public policy, particularly to address the major gaps in support for early childhood development.

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  • Ashley Thomas

    This touches on what are called the “Social Determinants of Health”, which is a hot topic in pubic health and the medical world in general at the moment. The determinants are listed at: and there’s a downloadable guide book available that looks at the issue from a Canadian perspective.
    The federal public health agency addresses it briefly here: and the link at the bottom leads to a list of “successful public health programs, interventions and policies that have been evaluated and have the potential to be adapted and used”, which could be helpful to those currently working to address these issues in London.
    Thanks for the post, this is a crucial issue!

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