Here's what we should be doing.
Classifying Toronto as the capital city of child poverty, as was done in last week’s report, Divided City: Life in Canada’s Child Poverty Capital [PDF], is bold, but undeniably true.
Judging from the way the report is written and constructed, the allegation is meant to shame government officials who claim to uphold values of equal opportunity into spending some money in honour of these values.
Good luck with that.
In my view, it would make more sense to shame government officials by exposing what disgraceful managers they are of the public’s taxes and the city’s economic future. Child poverty is something that everyone, including the well-to-do, pays for many times over.
Leave aside the economic potential that is forfeited by policies that under-invest in nurturing the talent base of all children across the city, not just the lucky two-thirds born outside of poor neighbourhoods.
More dramatically, the bottom line of today’s public expenditures are being wasted on high-cost medical treatments that could easily have been avoided by prudent and modest investments in health promotion and disease prevention.
Had the report’s authors highlighted this hidden cost of City Hall’s penny-wise, pound-foolish dogma, they might not have concluded by calling for an unwelcome increase in city taxes to cover the costs of treating children more equitably.
Instead, they could have insisted that the money being wasted, now and into the future, on high-priced medical treatment be invested instead in improving food access—perhaps the wisest investment any government can make.
Food and its health implications receive cursory treatment in the Divided City report. It follows lead sections on substandard education, recreation, and housing, is only two pages in length, and is very thinly footnoted, with only one citation on the health impacts of hunger.
The footnote problem could have been solved by attending last week’s PROOF conference, sponsored by nutrition and public health leaders at University of Toronto. Two of the lead presenters were U.S. scholars, Craig Gundersen and James Ziliak.
In one of their studies on health impacts of food insecurity on health outcomes in the U.S. (where food insecurity is slightly worse than in Canada), they refer to food insecurity as a leading health and nutrition issue.
In another study, they identify childhood food security, in and of itself, as linked to “a host of health problems, including but not limited to anemia, lower nutrient intake, cognitive problems, higher levels of aggression and anxiety, poorer general health, poorer oral health, and a higher risk of being hospitalized, having asthma, having some birth defects, or experiencing behavioral problems.”
These are all painful for children, and expensive for medical (and educational) systems, but embarrassingly simple and low-cost to avoid through food.
Causing the thick skin of neoliberal city officials to blush is not as productive as going to doctors who don’t make a profession of making excuses, but who can actually take care of people who are literally sick of poverty.
One of these is Dr. Gary Bloch at St Michael’s Hospital, a few blocks from City Hall bean counters. He proactively helps his patients overcome difficulties imposed by low incomes, and also provides poverty-screening tools for Ontario doctors on behalf of the Ontario College of Family Physicians.
“The bottom line for me is that we can either pay up front or we can pay down the line,” Bloch told the CBC last year.
“But if we want to pay up front to keep people healthy, to keep them productive, to keep them away from their social deprivation, the terrible social situations that make them unhealthy, then we can probably prevent a lot of these health expenditures.”
Another doctor who doesn’t prescribe excuses is Dr. Kimberly Wintemute, with the North York Family Health Team. She uses Bloch’s screen to assess when poverty might be the cause of the causes of her patients’ problems.
When appropriate, she treats patients proactively by helping them access prescriptions for free or fill out complex forms that entitle them to government assistance. She hopes to engage all 76 of her North York colleagues in this kind of work, she said to the CBC.
As soon as we realize that many diseases are expensive symptoms of poverty, the veil comes off the stupidity of forcing people to “economize” by skimping on food.
This is what Laura Rosella at the Dalla Lana School of Public Health in Toronto does with her several studies of what are called “high-cost users” (HCU) of medical services (one of which is under wraps until next week).
Her statistical specialty is establishing, without the use of any personal or private information, what’s called the “strong relationship” between living on low income and being a high-cost user of the medical system.
In the technical language of one of her reports: “HCU status was most strongly associated with food insecurity, personal income, and non-homeownership.”
Canadians established medicare partially to avoid irrational spending patterns of people who avoided a doctor’s visit and thereby ended up with an expensive disease. Why can’t today’s medicare funding be used again to counter the economic irrationality of depriving children of their basic needs?
The Shame of it All
What accounts for savvy and accomplished social-policy researchers overlooking the food-based economics of child poverty?
The report’s authors are in the centuries-old tradition of Anglo-Saxon countries, where exposing the shameful suffering of children played a crucial role in the establishment of the “social welfare state.” That’s how government intervention in the economy was justified in countries where something akin to the divine right of unregulated markets is thought to distribute wealth based on how hard and meritoriously individuals work.
The most embarrassing exceptions to the justice and efficacy of markets are widows and children, blameless for being unable to pull themselves up by the bootstraps.
This is why child and family welfare programs are the cornerstone of “welfare state” policies in countries with an Anglo-Saxon heritage of dogmatic market liberalism. By contrast, across continental Europe, more far-reaching welfare state policies are inspired by a desire for order, effectiveness, sound planning, and even democracy.
This unique Anglo tradition, first brought to light by the sociological classic on The Three Worlds of Welfare Capitalism [PDF], is apparently alive and well, living embarrassedly in Toronto.
Who Should Pay and How?
It does make sense, as the Divided City report suggests, to raise taxes to cover some city-specific expenses that address the needs of people in neighbourhoods that have inexcusably been under-served in terms of transit, parks, and recreation services.
But the cost of paying for better food should be charged to the province, which will end up saving from its investment. Instead of paying for the cost of proper diet by increasing taxes, the province simply has to take current tax revenue from a place where it’s being spent stupidly and put it into a smart investment that costs less.
I believe a good portion of that food money should go into child care and school breakfast and lunch programs. First, the bulk purchasing of school food supplies allows schools to support local and sustainable farmers, so we can add that bonus to the beneficial return on investment.
Second, it protects children from some maladapted survival strategies of people who endure poverty.
The spending patterns of people on low incomes have a brutal logic. In stage one of an impoverishment cycle, parents, usually moms, go without food before they let their kids go without, thereby unwittingly creating a situation where they are likely to get sick. In stage two, the children go without food, rather than spend the rent money, and thereby land the whole family on the street.
The instinct of poor people is to treat their body as a bank account they borrow from in order to hold onto prized assets they will need for a long time—such as an apartment in Toronto, or a goat or seeds in sub-Saharan Africa. That is why food deprivation is so common among the poor; they trade their body’s well-being for the life-giving asset they must protect with their lives.
School meals are one way of both sparing low-income families the expense of meals for their children and also ensuring that children are not forced to pay an exorbitant health and educational cost for the tax deductions given to the rich.
The growing pattern of neglecting child welfare in affluent countries of the Global North is a classic case of unsustainability—instead of sharing the real costs of living responsibly today, elites and governments pass on true life cycle costs to the future.
When that accounting trick is done to the environment, the unsustainability process is faceless. When it is done to kids, it has a face.
The old rule about children being seen, and not heard—just like the natural environment—has protected politicians who pass on the true costs of their policies to youth.
That may now change with the recent formation of Children First Canada.
“The children are not alright,” Children First Canada founder Sara Austin told the Economic Club of Canada meeting launching the organization last week. The launch took place at the Marriott Hotel, a block from City Hall.