07/19/2012 07:51 EDT | Updated 09/18/2012 05:12 EDT

Is There Really a 1% Group for Canadian Healthcare?


At our country's most visible cultural event last week, Prime Minister Stephen Harper chose to describe Canada as a "great country rising." With the economic indicators of his choice, he is certainly not wrong. Yet the rising tide has not been lifting all boats, and the political will for landlocked citizens also appears to be waning in Ottawa.

While some may dismiss talk of income inequality as strictly for the bleeding hearts in Zuccotti Park, it becomes a little trickier when Nobel economists start to lead the chorus. The Harper government's cuts to the benefits provided to refugees and the unemployed compound inequalities and attempt to polarize the country. But this great divergence in income is no longer between the rich and the poor: The health of all Canadians hangs in the balance.

For years, we've enjoyed any comparison of fairness to the United States as our neighbours were straddled with a morally bankrupt health system. In many respects, our gut instinct was right. Something dubbed the Great Gatsby curve will be played out on center stage in this November's American presidential election. Essentially, not since the Gilded Age of the 1920s has so much wealth been in the hands of so few. And as American society has become more unequal, it is no longer become about the dreams of one's father, but the harsh reality that one's future income is tightly tied to that of his or her parents.

How has Canada fared in comparison? A more progressive taxation and transfer system preserved a greater sense of social mobility over the years, but it is now believed that less than five per cent of the population controls over two-thirds of total financial wealth. Serious concern about the concentration of wealth, however, is not localized to any one region or party. Canadians sense it, and understand that social programs and economic growth do not have to run in opposite directions.

Unlike Americans however, Canada never waged a full-blown "war on poverty." It could be said that we have had a much more holistic understanding of health in our pursuit of "a just society." No matter your political stripes, there is a fundamental belief in the equality of opportunity that shouldn't be undermined by poor health. Income inequality jeopardizes this vision as a social epidemic. There is growing evidence that the loss of life from income inequality rivals the loss from lung cancer, diabetes, motor vehicle crashes, HIV infections, suicide and homicide in any given year.

The jury in the academic world is still out as to how exactly inequality levies its toll on health. It's important to remember that we are not dealing with absolute poverty alone, but a hallowing out of the middle class.

Theories involving lower social position and chronic psychosocial stress have gained traction as culprits in the public health community. In the late 1970s, an expert commission in the United Kingdom was tasked with the wicked problem of unequal health outcomes. Cruel in that the rich have always lived longer since the time they were able to do something about it (medical technologies, sanitation, etc.), and wicked in that teasing out the reasons for differences across health measures can be quite tough.

With the introduction of universal health coverage after World War II, there was reason to believe that equal access to medicines and physicians could level the playing field when it came to the health of the rich and poor in England. To some surprise, their report stressed economic inequality as the primary driver of health outcomes and drew the ire of the Thatcher government. In an effort to suppress the findings, only 200 odd copies of the landmark study were published at Her Royal Majesty's print shop.

The intellectual arguments can get real fancy when it comes to income inequality and health, but it's hard to dispute income inequality's real threat to health acts through its corrosion of democracy. As more and more work is showing that political institutions are disproportionately responsive to the interests of the wealthy, it shouldn't be much of a surprise to see public investment shift away from Canadians. The gap is only worsened in a parliamentary system that knows few checks and balances on power, and is in the midst of a slow phase-out of public subsidies to political parties.

A raucous debate surrounds the public or private financing of health care, while Canada has quietly fallen off as the world's leader in per capita public investment in education. The consequence is costly on two fronts, as each year of additional education for an individual is believed to reduce mortality by 10 per cent. We are left to question not only the values, but the returns of building prisons over schools.

In a recent commentary by the former president of the Canadian Medical Association, Dr. Jeff Turnbull, poignantly noted that "a balancing act on the backs of some of our poorest citizens" is not the Canadian way. This is not the way to avoid a fiscal cliff, or the way to ensure a sense of fairness that embodies social cohesion. What is particularly disturbing are Ottawa's cuts to our ability and statistics in even measuring such an income gap. While we may never want to hold our government to the same evidence-based mantra that dominates medicine, having legislation informed by evidence is a modern democratic virtue.

Prime Minister Harper seems to follow Buckley's approach to prescribing economic policies. It will hurt some of us, but in the end, it's good for you. Canada has fared better than other nations in the global economic crisis, but success stories have not followed those who prescribed austerity.

When it comes to playing favorite Nobel economists and the importance of evidence, we may wish to sing him the tune that graced Milton Friedman's 90th birthday:

"A fact without a theory is like a ship without a sail. Is like a boat without a rudder. Is like a kite without a tail. A fact without a theory is as sad as sad can be. But if there's one thing worse in this universe, it's a theory...without a fact."

The Harper government may choose to believe that a divided society is not bad for the economy, or that wealth will trickle down. Canadians from across the country may have to assure him that health will surely not.