Studying intra-metropolitan health disparities in Canada: How and why globalization matters

1. Studying intra-metropolitan health disparities in Canada: How and why globalization matters Ted Schrecker, Jennifer Cushon, Nazeem Muhajarine, Ronald Labonté Canadian Public Health Association Halifax, June 2008

2. Funded by Canadian Institutes of Health Research Research Team

3. Globalization and the Health of Canadians: Mission Statement To improve Canada’s ability to anticipate and respond to the effects of globalization on the health of low-income adults in Canadian metropolitan areas with children under 18. Key channels of influence include global reorganization of production and its effects on labour markets; financial markets; and migration flows. Analysis will include the spatial dimensions of globalization’s effects (both positive and negative), and on how globalization enhances or constrains the ability of governments to develop appropriate policy responses in areas including taxation, regulation, income support and provision of social infrastructure.

4. 1. Why focus on cities? • 80% of Canada’s population lives in metropolitan areas, one-third in our main study areas (Toronto, Montréal, Vancouver), which also • Receive ~80% of recent immigrants

5. 1. Why focus on cities? • Cities provide complex “mosaics of risk and protection” (Fitzpatrick & LaGory, 2003)

6. 1. Why focus on cities? … and are the stage on which the forces and pressures of globalization play out and affect people’s lives

7. 2. Why globalization? • Arguably the dominant element of today’s economic and political environment, in the form for instance of …

8. “Global supply-chains connecting cheap workers on one side of the world with rich consumers on the other” (The Economist, 2002)

9. 2. Why globalization? … with well docu-mented effects on metropolitan areas (UN Habitat, 2001). However, http://www.unhabitat.org/pmss/getPage.asp?page=bookView&book=1618

10. 2. Why globalization? • Few connections have been made between social scientific research on globalization and social determinants of health (SDH) and the similarly extensive literature on place and health

11. 3. Place, health, andeconomic inequality • Socioeconomic gradients in health status are ubiquitous, within Canada and within metropolitan areas. Here are just two illustrations:

12. Life expectancy at birth by neighbourhood income quintile, urban Canada Men Women Source: Statistics Canada data cited in Canadian Population Health Initiative, 2004

13. Poverty and health in Montréal http://www.santepub-mtl.qc.ca/Portrait/Les29/index.html

14. 3. Place, health, andeconomic inequality • Socioeconomic gradients in health status are ubiquitous, within Canada and within metropolitan areas • An expanding body of research shows that ‘place matters’ at both metropolitan and neighbourhood or small area level, even after compositional factors are controlled for. • Trends like increasing economic segregation and concentration of poverty are clearly evident in Canadian cities. Furthermore,

15. 3. Place, health, andeconomic inequality • “[C]urrent measures of simple universally applied ‘neighbourhood’ exposures may severely underestimate the total effect of ‘context’” (Cummins et al., 2007), as illustrated by the following example (Matthews et al., 2005; used with permission)

17. 4. Major channels of influence: globalization → SDH * • Polarization of labour market incomes and opportunities, e.g. deindustrialization, parallel rise of highly paid producer services and the low-wage, often precarious service sector jobs that meet the needs of the “working rich” * In major Canadian metropolitan areas

18. 4. Major channels of influence: globalization → SDH * • Changes in public policy landscape: emphasis on competition to attract investment, social policy retrenchment * In major Canadian metropolitan areas

19. “[R]edistribution grew enough in the 1980s to offset 130% of the growth in family market-income inequality -- more than enough to keep after-tax income inequality stable. However, in the 1990-to-2004 period, redistribution did not grow at the same pace as market-income inequality and offset only 19% of the increase in family market-income inequality” (Heisz, 2007)

20. 4. Major channels of influence: globalization → SDH * • Metropolitan housing markets and land uses, e.g. as gentrification is driven by globalization’s winners, cities become sites for consumption rather than production and governments subsidize that reinvention * In major Canadian metropolitan areas

21. 4. Major channels of influence: globalization → SDH * • Immigration: Immigrants concentrate in large cities; economic situation of recent immigrants is fragile relative to rest of population, with probable longer-term implications for health * In major Canadian metropolitan areas

22. 5. Key methodological challenges • Describing the macro-micro linkages between globalization and changes in SDH and globalization; deciding on the nature of evidence required to convincingly to assert a link with globalization; and establishing the relative contributions of globalization and other, unrelated influences

23. 5. Key methodological challenges • From among a huge universe of policies that have been adopted in multiple jurisdictions, developing an inventory of most effective policy responses, keeping in mind that they can either address the underlying dynamics of globalization or mitigate/magnify them

24. 5. Key methodological challenges • Effective and appropriate use and integration of a plurality of methods (quantitative and qualitative) and disciplinary perspectives, while keeping a transdisciplinary team focussed on key research questions

25. 6. Initial hypotheses • Global reorganization of production and social policy retrenchment are increasing economic polarization and undermining already tenuous social protection mechanisms in Canada

26. 6. Initial hypotheses • It may be less important to isolate the distinctive contributions of globalization and domestic public policy (and it may in practice be impossible to separate the two, because of how globalization affects distributions of income and wealth and therefore political allegiances) …

27. 6. Initial hypotheses …than to consider that current trends may signal the start of a longer period of polarization accompanied and reinforced by the dismantling of infrastructure, built up over two generations, that has been crucial to improving the health status of Canadians (cf. Siddiqi & Hertzman 2007) and, within limits, reducing health disparities

28. 6. Initial hypotheses • If this is the case, disparities in access to SDH within Canada’s major metropolitan areas are likely to increase in the absence of equity-oriented policy responses from all levels of government, but • A major mismatch in all likelihood exists between the fiscal and policy capacity of metropolitan governments and the scale of these challenges

29. References The Economist (2002, December 7). A moving story. The Economist, 65-66. Cummins, S., Curtis, S., Diez-Roux, A. V., & Macintyre, S. (2007). Understanding and representing 'place' in health research: A relational approach. Social Science & Medicine, 65, 1825-1838. Fitzpatrick, K. & LaGory, M. (2003). "Placing" Health in an Urban Sociology: Cities as Mosaics of Risk and Protection. City & Community, 2, 33-46. Heisz, A. (2007). Income Inequality and Redistribution in Canada: 1976 to 2004 (Analytical Studies Branch Research Paper 298). Ottawa: Statistics Canada. Matthews, S. A., Detwiler, J. E., & Burton, L. M. (2005). Geo-ethnography: Coupling Geographic Information Analysis Techniques with Ethnographic Methods in Urban Research. Cartographica: The International Journal for Geographic Information and Geovisualization, 40, 75-90. Siddiqi, A. & Hertzman, C. (2007). Towards an epidemiological understanding of the effects of long-term institutional changes on population health: A case study of Canada versus the USA. Social Science & Medicine, 64, 589-603. UN Habitat (2001). Cities in a Globalizing World: Global Report on Human Settlements 2001. London: Earthscan.