
                          HEALTH CARE AND POVERTY

                      By SHARON KIRKEY and JOAN RAMSAY
                                Southam News

     OTTAWA - Tommy Douglas learned early about health care for the
     poor. It almost cost him a leg.

     ``I lay in a Winnipeg hospital off and on for three years,''
     Saskatchewan's CCF premier told his legislature as he fought to
     pass Canada's first medicare bill in 1961.

     ``My parents couldn't afford the services of an outstanding
     surgeon. I had my leg hacked and cut again and again, without any
     success. The only reason I can walk today, Mr. Speaker, is because
     a doctor doing charity work, one of the great bone surgeons of
     Winnipeg . . . took an interest in my case and took it over.''

     His Medical Care Insurance Act was instituted in 1966, setting off
     a chain reaction that led to a national system of universal health
     care considered one of the best in the world.

        See <03health> for a discussion of Canada's health care system
        See <13health> for a discussion of the U.S. heath care system

     But while Canada's poor are no longer dependent on chance and
     charity for decent medical attention, universal health care has not
     meant universal health.

     This is true especially among the poor, who lack much of what
     contributes to health - affordable housing, good food, social
     support and community services.

     According to a Statistics Canada report released in March, infant
     mortality among the poor is almost twice that of the rich, or 11
     per 1,000 births. Life expectancy is also lower, with rich men
     living an average 5.5 years longer than their low-income
     counterparts, and rich women about two years longer than poor
     women.

     As well, the suicide rate for the poorest Canadians is double that
     for the rich and accidental deaths are higher.

     The problem, says Statistics Canada analyst Russell Wilkins, begins
     before birth.

     ``The babies of poor women are lighter, their birth weight is
     lower, which is greater risk of death, they're more apt to be
     premature, more apt to die in the first year of life from a variety
     of causes.''

     Adds Wayne Millar, a senior health analyst for the Canadian Centre
     for Health Information: ``If you really work at reducing low birth
     weight within income groups you could go a long way to reduce the
     life expectancy differences between income groups.''

     But prenatal courses are still not reaching those most in need, he
     says.

     Meanwhile, poor children who survive to adolescence face a higher
     proportion of accidental deaths, Wilkins says, ``and certainly in
     young adulthood, where accidents are the major cause of death,
     they're also more elevated for the poor than the rich.''

     For adults across Canada, cancers and cardiovascular diseases are
     the biggest killers. But lung cancer and cardiovascular diseases
     are much more common in the poor than their rich counterparts,
     Wilkins says.

     No one knows exactly why, but some of the reasons are obvious:
     Smoking rates are higher among the poor now, they do less leisure-
     time exercise, their diets are not as healthy.

     Experts are beginning to insist the only way to significantly
     improve  Canada's overall health status is to divert some of the
     money spent on  sickness to improve the lifestyle of the poor.

     ``Health is not just a physical thing that is treated in an
     emergency department,'' says Prof. Jane Fulton, a health economist
     at the University of Ottawa and author of the book Health Care in
     Canada.

     ``Health is emotional, social, family and environmental. So it's
     important to have cops understand domestic violence just as it's
     important to have somebody to vaccinate your kids against polio.
     They're equivalent.''

     For Fulton, affordable housing is a key issue, as is licenced
     subsidized day care for women and men at work.

     Even sewage disposal is a health issue, she says, adding: ``We have
     to start thinking about Canada as part of a global village.''

     In early April, Ontario Premier Bob Rae backed a series of reports
     from his council on health strategy that recommended programs to
     improve prenatal care and raise birth weight and end childhood
     poverty.

     ``What's happening now is a realization that you can't get people
     to change their habits without trying to create positive, health-
     enhancing environments,'' adds Irving Rootman, director of the
     health promotion centre at the University of Toronto.

     Health for all, the official goal of the World Health Organization,
     was enthusiastically embraced by Ottawa in 1986, with the release
     of former health minister Jake Epp's Achieving Health for All: A
     Framework for Health Promotion.

     ``The first challenge we face is to find ways of reducing
     inequities in the health of low- versus high-income groups in
     Canada,'' the paper said.

     Little has been done, critics say.

     In fact, Canadian programs are doing more to widen the health gap
     than narrow it, says Barry George, a statistical analyst with the
     Canadian Council on Social Development. He points to tax reform,
     partial de-indexation of child benefits, limitations on the Canada
     Assistance Plan and cuts in transfer payments to the provinces for
     health and social services.

     ``The sad association of sickness and early death with lower income
     remains a reality,'' George said.

     The most extreme example of poverty and illness can be found among
     natives, which a recent federal report on health care labelled
     ``depressing.''

     In the past decade, native people were still dying from Third World
     illnesses such as tuberculosis, gastroenteritis and pneumonia -
     diseases that rarely cause death in non-natives.

     Tommy Douglas knew how lucky he had been when the Winnipeg doctor
     chose to help him fight his osteomeilitis.

     ``But there were thousands of children who were not so lucky,'' he
     told his legislature 30 years ago.

     ``And from that day on I have been convinced in my heart that if I
     were ever given the authority and the power to do so, I would try
     to help usher in the day when in this country no boy would be lame,
     no child would be without health services, merely because the
     parents could not pay for it.''

     Now, Canadians have to decide if they will usher in a day when no
     child will be without health, just because the parents are poor.

     (Sharon Kirkey is a reporter with the Ottawa Citizen.)

