Poverty, Politics and Leadership

Andrew Lynk MD MSc FRCPC D.Litt. (Hons)
Past President, Canadian Paediatric Society

I recently saw an infant in my office, with young, poor and troubled parents. After my history and physical, and a plan to address the baby’s health issue, I asked the mother and father what they hoped for their child’s future? “A better life than ours,” they said. So I asked myself, how can we make that happen?

The current federal election campaign is all about the middle class. The three major parties are in a race to prove they are the true champions of middle Canadians. Rarely do we hear them discuss growing income inequality or poverty. Despite their numbers, low-income people are less likely to vote, and have little powers of influence and persuasion. Twenty percent of Canadian children are poor, some deeply so, especially among Indigenous, newly immigrant and single parent families. Child poverty is associated with immediate negative health and social outcomes, and long-term, possibly mediated through toxic stress and social exclusion pathways, negative adult health and social outcomes.

We hear much election talk about infrastructure “deficits”, and calls for long-term investments, which all agree are essential for a well-functioning economy. Although social investments for poor children and their families reflect both social justice and wise economic policy (a $7 return on each dollar invested), they are not likely to sway a majority of voters. The fruits of such policies, however just, are too distant in the future to resonate in a four-year electoral cycles.

As paediatricians, we are trusted and well regarded members of “The Establishment”. We have a voice and influence if we choose to use it. We also have both the experience and a duty to fight for those who have no voice, namely poor children and their families.

This is the “middle class” question I would suggest we ask the federal parties, their candidates and their leaders:

“If elected, what new measures would your government introduce to help lift poor children and families into the middle class?”

Based on the experience of high-income countries with low child poverty rates and income inequality (e.g., Nordic countries), here is an abbreviated list of proven national policies that truly address the essential social determinants of health (income, education, employment, housing and food security):

1. A nationally led poverty reduction strategy, which is multi-disciplinary, multilevel and comprehensive.
2. A nationally agreed upon poverty metric that includes both an income measure and a deprivation index (encompassing food and housing security, social inclusion and life satisfaction). Ireland has such a measure, which is also useful in measuring the depth of poverty, and those at risk for poverty.
3. Basic income-guarantee pilot programs, which may be a smart, more efficient alternative to costly social assistance programs, overcoming disincentives that trap people behind the “welfare walls”.
4. Enriched, means-tested national child benefits.
5. Progressive, fair income tax systems.
6. High quality national early childhood education and care programs.
7. A national housing strategy.
8. National programs for adult education and training.
9. Enriched housing, education and training investments for Indigenous Canadians.
10.  Setting the minimum wage to a living wage.
11.  A national pharmacare program.
12.  Nationally supported childhood dental and vision screening programs.

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