The first time I met Raj, I remember feeling completely helpless in what to offer him. A middle-aged South Asian man with a wife and two kids, Raj had moved to Canada looking for a better life 7 years ago. He came to the clinic looking for help, but what ailed him was more complicated than a headache or a twisted ankle.
Raj told me that although he had previously held a "good job" in his home country, he was unable to find similar work in Canada. Instead, he took work wherever he could find it but his paycheque just wasn't cutting it. Raj found himself stuck between his family in Canada that needed to survive, and extended family back home expecting him to send them money.
Soon after arriving, Raj started having difficulty coping with the stress of it all. As a result, the relationship with his wife slowly started to break down. Eventually his wife asked for a divorce, telling him that he had failed in his role to provide for the family. With nowhere to go, Raj turned to a shelter, where he stayed for almost a year, while continuing to work full time making poverty level wages. The stigma of poverty, homelessness and the breakdown of his marriage was so great that Raj felt unable to reach out to family members back home for support. He avoided socializing with community members in Canada who may have had links to his relatives, in the event that they would learn of his situation.
Raj was having difficulty sleeping, carrying intense feelings of hopelessness and worrying constantly. He came to me to find answers, to feel better, to be cured. By all definitions of the term, Raj was experiencing clinical depression. It would have been easy to give him this diagnosis, prescribe him an antidepressant, and hope that his problems would be solved. But having heard Raj's story, I knew that his feelings were a consequence of his social situation, and anything I could offer would be a band-aid solution. The underlying problem was that he was living in poverty.
This story is unfortunately a common one. In 2008, 400,000 Canadian adults found themselves below the poverty line, even while working full-time, because they made less than $10/hour. For the past three years, the minimum wage in Ontario has been frozen at $10.25/hour, putting full time minimum wage workers 19% below the poverty line. Recently, rising income inequality has become a mainstream topic of discussion. Since the 1980s, workers' wages have stayed almost the same while incomes in the top 1% have grown by 71%. When it comes to income inequality, Canada is ranked 12th out of the 17th richest countries of the world. We have a long way to go.
We also know that living in poverty is not just an economic and political issue, but fundamentally an issue of human health. Income is the strongest determinant of health. How much you make is more important than what you eat, how much you exercise, or even your genetic make-up. A recent series of articles in the Ontario Medical Review highlights the fact that poverty is a medical problem, and healthcare providers are seeing the impacts on the front lines. We know that people on social assistance have a suicide rate 18 times higher than those in the highest income bracket. We know that people living in poverty have higher rates of diabetes, heart disease, arthritis, and even cancers. Worst of all, we know that the rate of death among infants is 60% higher in our lowest income neighbourhoods.
Do we want to live in a society where we accept that people living in poverty will have a higher risk of losing their children, getting cancer and taking their own lives than those who have more? It seems to me, when thinking of Raj and so many others I have met just like him, that raising the minimum wage enough so that no one working full time would have to live below the poverty line is a basic first step. Perhaps in this situation, Raj would have been able to better support his family and avoid slipping into depression. We know that with a higher income, he would be healthier overall.
People are coming together all across Ontario to raise the minimum wage to $14/hour, with actions happening on the 14th of each month. Try as I might, I know that what I have to offer as a doctor is a small piece of the puzzle. Comforting words and prescriptions might help, but at the end of the day, what we need is systemic change. It's time to prescribe something that we know works: an increase in the minimum wage.
