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When It Comes to Canadians' Health, Postal Code Matters

07/24/2013 05:09 EDT | Updated 09/23/2013 05:12 EDT

But the game is rigged. Let me tell you how I came here. I write for a major magazine and this is a privilege. I would say that it is earned, except that many people earn many things which they never receive. Privilege is like money -- when you have none it is impossible to get and when you have more people offer it to you at every turn. -Ta-Nehisi Coates, The Atlantic

In the early 19th century, the dictum that "all smell is disease" continued to hold weight with Royal Medical Societies. The thinking was that miasma -- bad air from decaying bodies -- would concentrate in certain neighbourhoods, and if inhaled, result in disease and death. Essentially, it was topography that would dictate health. Staying away from the masses or noxious neighbourhoods was heavily recommended, especially if you wanted to make it to the ripe old age of 40 back then.

In 1822, the French surgeon Louis-Rene Villerme wasn't completely sold on the miasma theory. He had given up on clinical work altogether, and as a young promising researcher, he set out in search of a relationship between poverty and death (this much before Victor Hugo's first print of Les Miserables). Gathering data from all Parisian arondissements and using the most elegant statistical techniques available, Villerme found 'economic privilege or misery' to wage large effects on mortality. People in poorer neighbourhoods lived less than those in richer ones, and he believed it wasn't just about foul air or views of the Seine. After two decades of wigged debate, the Société d'Observation Médicale concluded:

Villerme seems to have solved the question [of the influence of poverty on mortality] in its most general way.

The problem itself, however, is far from solved. Just last week, a new report from Statistics Canada underscored the importance of money on health. The authors bleakly noted that Canadians in the bottom rung of the income ladder were "more likely to die younger." Quite a lot younger. And after accounting for how those in the top rung fared, poverty seems to be shortchanging millions of Canadians on life expectancy each year.

While some will rightfully point to the "poverty rate" being the lowest it's ever been in Canada, there's also evidence that economic growth across the ladder hasn't looked quite the same. This time, it was Finance Canada, with a leaked report that pointed to a hollowing out of the middle class over the past 30 years. In the period of question (1976-2010), middle earners saw their income grow a paltry 7 per cent, while the top 1 per cent of earners saw theirs double. To be fair, there's still a lot left to be determined by the intellectual titans on income inequality (how do you even measure income?). But if the spread is as uneven as it seems on the surface, there are indications that such inequality can act as a social miasma affecting all members of the population, rich and poor alike.

While much has been made of its ill effects on democracy and public health, there is a growing concern that widening inequality also poisons equal opportunity. This would be damning for any semblance of a meritocracy, and for those in poverty, there's evidence to suggest that the odds of a climb are heavily stacked against their own children.

The #RoyalBirth couldn't have illustrated the benefit of being born right any better. As the media called Prince William's decision to drive his own Range Rover "progressive" (and public health experts collectively smacked their foreheads over the placing of the car seat), two important studies on low-income mothers and their babies received far less attention. One of them, a 25-year follow-up on "crack babies" in Philadelphia found:

Poverty to be a more powerful influence on the health outcome of inner-city children than gestational exposure to cocaine - Dr. Hallam Hurt

Almost 200 years since Vilerme's study, it's still primarily about postal code. The other, a Canadian study, reported:

New mothers with very low incomes were nearly 20 times more likely to face multiple health problems than new mothers with high incomes.

Most will acknowledge the nasty obstacles facing these families and kids from an early age. Yet on the flip side, there's also an incredibly successful and intelligent camp that doesn't think the investments in children of the wealthy amount to all that much (to them, it's a question of heritability and talent). Leaving Royals out of the debate by assuming their genetic superiority (yeah), here's where the Instagram Effect of Income may come into play.

Just like those flattering filters, financial resources can make everything in our lives look better: our surroundings, our health, maybe even the performance of our children. Except with income, those enhancements can be real. And so the pitfall lies in believing that you're a better photographer (or more 'deserving') than you actually are, wealthy liberals and conservatives alike.

The widening gap in income and privilege may distort a lot of things, one of which being a sense of solidarity. (In a packed auditorium, I'll always remember a classmate openly questioning a physician's obligation to those "who don't pay taxes" on the last day of medical school.) And that's important since any advances on poverty will require the political will to push different policy levers. It may be directing more income to the poor, or viewing housing as a form of health care. Neither is a panacea for poverty, but as one expert put it, "bringing a squirt gun to a forest fire" just won't cut it anymore.

The public's cooing of the Royal Baby will go on, that's for sure. It's just worth remembering that thousands of Canadian newborns aren't getting a fair shake. And their futures are banking on more being done about it.

10 Ways Inequality May Be Making Life Worse