The idea of equity as the potential of every person to achieve the same quality of life regardless of their background appears to be the goal of human rights advocates. Among the aspects of this principle, health equity is considered as well; it is not a presence of equal rights, but an absence of differences in access between individuals. Nonetheless, the examination of the contemporary health status if people inside and outside of Canada reveals that the global society cannot claim that any level of equity has been reached in this field.
In turn, the idea of “health inequity” – the existence of differences in people’s ability to attain their best possible health potential, is widely discussed in the research. Here, the underlying reasons are at the center of attention, often being named social determinants of health. This paper examines the current political systems in Canada and compares the health status of the author as well as Indigenous peoples living in Canada and communities residing in “villa miseria” in Buenos Aires, Argentina. This analysis aims to show that the concept of health equity is strongly tied to such social determinants as race, education, nutrition, and environment, where race plays a dominant role in constructing unequal societies.
Institutions and Ideologies
First of all, it is vital to understand the system that is currently active in Canada. As noted by Ouedraogo and Jacobs (2017), Canadian politics are moving towards neoliberalism and away from Keynesian welfare-state ideas. The foundational principles of neoliberalism are that of laissez-faire economy and the free market. Here, the deregulation of processes between businesses is encouraged, believing that it will lead to more fruitful competition and merit-based achievements of entrepreneurs. Thus. The government is discouraged from participating and influencing the economy. As a result, one’s personal or corporate achievements become one of the primary factors of success.
Apart from the business-related activities moving toward neoliberalism, the Canadian government is also changing its view of social programs under the influence of this philosophy. The idea of personal freedom that permeates the ideology of neoliberalism argues that one’s choice to select which self-interest they will pursue is a necessary part of a person’s life (Ouedraogo & Jacobs, 2017). Although this idea seems beneficial to people in relation to their employment in the desired area, it dismisses the vital role of social programs that often rely on collaboration to cover all population groups. In this case, healthcare is the central topic of debate as it turns from a common problem and a universal right into a set of choices that each citizen has to make individually.
The idea that people should be able to make small choices in the delivery of healthcare is what differentiates neoliberalism from the concept of welfare. The latter, according to Keynesian notions, targets vulnerable communities that may not be able to make such decisions (Ouedraogo & Jacobs, 2017). Here, the issue of social determinants arises as it becomes unclear which people’s characteristics limit their ability to choose and which aspects align with the system’s view of individual achievement.
Social Determinants of Health
Throughout history, researchers have been uncovering many factors that influence one’s health. Ouedraogo and Jacobs (2017) offer twelve social determinants that are listed on the official website of Health Canada. These are “income and social status, social support networks, education and literacy, employment/working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender, culture” (Ouedraogo & Jacobs, 2017, pp. 40-41). However, the authors note that one significant factor, race, is missing. Race cannot be categorized as a biological or genetic aspect, as the perception of race differs from one location to another. Therefore, it is a separate determinant that also deserved increased attention.
In Canada, many of these social determinants play a role in achieving health equity. Neoliberal ideology highlights one’s education, employment, and income as the most impactful, arguing that people can overcome other issues if they work hard and educate themselves to become better at business. As a result, healthcare is tied to one’s workplace, although this connection is more apparent in the United States. Nevertheless, it is clear that the entrance to this competition presents systemic barriers that are not considered by neoliberalism. Instead, the focus is kept on individual achievement, which shifts the blame from the government and market to one person.
For example, neoliberalist ideology does not support the notion that inequity starts at birth under the influence of social determinants. In theory, income and education are factors that can be achieved regardless of one’s genetics, gender, or race. In practice, however, one can see that a person’s unchangeable characteristics strongly affect their opportunities for advancement in society. Ouedraogo and Jacobs (2017) provide an example of economic struggles leading to malnutrition of a pregnant woman and her child that leads to worse health status as an example of this issue. Here, disability, race, and gender can be included as well, highlighting the problem of structural inequality. Thus, such factors as education and income cannot be viewed in separation from the determinants that have an impact on them.
Personal Health Status
Analyzing my health status, I can see that various factors played a role in my experience. I am a resident of Ontario, a populous province with vast resources and a highly-developed infrastructure. My personal access to healthcare can be considered good; nonetheless, it does not mean that the region or the country exists in the state of health equity. First, it is clear that I have access to education, which means that my experience and professional development are valued highly in a society based on neoliberal values. It is an important social determinant of health in Canada, and it provides me with vast opportunities to receive high-quality services.
Second, I have a sound support system that includes my immediate family and other relatives. Resources accumulated by our group are viewed as one individual cluster, thus increasing my access to improving my wellbeing. Third, the fact that I live in Ontario and have enough resources to receive an education also implies that I have access to a health system that has health providers and medication to support my health in case of illness or emergency.
These aspects of my personal experience can be explored to show that they support Canada’s increasing inequity of health. To begin with, education in Canada requires sufficient financial support, which goes toward courses, fees, textbooks, and other payments. Therefore, one has to possess enough money before acquiring an education and getting a job – elements that are necessary for success in a neoliberal framework. In this case, one has to rely on either having these resources due to their family status or obtaining them through unqualified labor. In turn, such determinants as status reveal a generational divide between people with and without a support network and family wealth.
A significant part of the health status is one’s access to safe living conditions and health services. As noted above, I have both of these elements, which means that my environment does not pose an immediate threat to my health. Moreover, all problems that I may encounter in regards to my well-being are resolved without substantial financial loss or considerable time constraints. These social determinants are vital because they provide a protective surrounding and allow one to address problems quickly, avoiding complications. The comparison between my personal experience and those of people from developing areas uncovers a stark distinction of how these determinants affect one’s health.
Developing Areas: Indigenous Peoples in Canada
Before considering populations from other countries, it is crucial to look at the issue of inequity that exists inside Canada – the health status of Indigenous peoples. Indigenous Canadians comprise a rather small portion of the population. Their unique situation and the combination of such determinants as race, place of residence, and culture make them highly vulnerable to the decisions of the majority and the institutional shift in privatization. One can take the same health determinants that were reviewed in the previous segment and see how they affect the wellbeing of Indigenous populations.
First of all, in contrast to my experience living in a well-developed area of Ontario, many Indigenous Canadians reside in regions historically occupied by their communities. These territories were found to be lacking the same level of infrastructure development as major cities, which means that their environment is not as safe for people’s health (Ouedraogo & Jacobs, 2017). Regardless of Canada’s laws about the recognition of multiculturalism and the protection of the Indigenous peoples, researchers continuously find new data that reveals poor living conditions.
For example, many Indigenous Canadians do not have access to safe drinking water – one of the essential requirements for healthy living. Contaminated water is not suitable for drinking and cooking, and it requires filtration that may not be available to all residents. As a result, people in areas without clean water have to either use it and face health risks or constantly buy bottled water. The latter choice requires additional funds and creates an unhealthy relationship between the community and companies setting prices for one of the living essentials.
Second, First Nations may also face barriers in acquiring education and raising their income (two major factors in improving one’s health status). This issue arises from systemic racism, harassment, and prejudiced treatment during the hiring process and in other stages of employment. According to Ouedraogo and Jacobs (2017), racism is a significant factor in reducing the potential of achieving equity as it prescribes negative characteristics to people on the basis of socially constructed norms. As Indigenous Canadians cannot control the conversation about race, the impact of the societal changes remains unaddressed.
As a result, Indigenous peoples live in environments that damage their physical and mental health. Furthermore, they are exposed to environmental hazards, and they have no institutional support that would be provided to them in a Keynesian state. As they cannot rely on the principles of neoliberalism in the same way as White, prosperous Canadians, Indigenous peoples are not helped by the system or by other people’s individual choices.
Developing Areas: Villa Miseria, Buenos Aires
Outside of Canada, many nations face the same problem of differences in people’s access to income, education, and health. One of the examples is the territorial segregation in Buenos Aires, Argentina. So-called “villa miseria” are towns located around large urban cities, including Buenos Aires. These small settlements do not have the same quality of life as the urban centers they surround. In contrast to technologically developed Buenos Aires, Villa Flammable is filled with single-story houses made from toxic or unsafe materials. A lack of pavements or clean water supply are distinctive characteristics for such towns, and people living in them usually do not have a store with fresh produce in close proximity. These factors greatly contribute to people’s health status and have long-term effects on their health.
Here, the social determinant of one’s environment and surroundings is apparent, but it also has an impact on other factors of one’s wellbeing. Toxic materials and contaminated water do not just poison adults – they also lead to congenital disabilities of the following generations. Therefore, disabilities arise as another social health determinant – they have a significant impact on one’s ability to participate in education and work (Ouedraogo & Jacobs, 2017). The lack of proper medical assessment in these areas may further contribute to this issue, as underlying reasons behind such disabilities may go unaddressed for decades. Thus, while people spend money and time trying to alleviate symptoms, more significant systemic problems are not resolved.
Apart from that, health problems acquired before birth or during one’s exposure to toxic materials affect one’s ability to work and earn money for upward social mobility. Although higher education, in comparison to Canada, is free in Argentina, it is not exempt from hidden costs such as transportation, materials, and rent. Therefore, persons from low-income families still face financial barriers that can be made impossible to overcome with the increased negative impact on the environment.
Similar to Canada, Argentina’s territorializing is based on racial prejudice. As Torres notes, such towns (villa miseria) are mostly filled with non-White citizens and immigrants (Jacobs & Visano, 2015). This is a stark contrast to urban cities that are prevalently occupied by White Argentinians and affluent immigrants from prosperous countries. This divide further contributes to the disparity in health access and inequity based on the social determinants of race, education, and income.
Systemic Racism and Health Equity
The comparison of the three examples presented above shows how different elements in one’s life can impact not just one’s immediate health concerns but also the risks of future health problems and generational barriers to better health status. Notably, the latter examples are strongly influenced by systemic racism – the inequality ingrained into or unchallenged by governmental and societal institutions.
This line of thinking shows that racism experienced by people in the described cases is not limited to the prejudiced hiring process or negative opinions expressed by other residents. Instead, systemic racism penetrates people’s access to utilities and infrastructure, including healthcare services. In both cases, minority groups are separated territorially, being placed in environments that put their health at risk and curb opportunities for moving out or improving their health status.
The lack of infrastructure in the cases of Indigenous peoples in Canada and citizens of villa miseria in Argentina is especially notable. It creates health problems by itself, also contributing to congenital disabilities and increased fiscal spending. Both situations are united by their restricted access to safe water, which shows that there exists a direct correlation between water quality and residents’ health. Moreover, there may be another problem – the incentive of creating a community reliant on bottled water to keep the competitive nature of neoliberal markets growing. Thus, one can argue that systemic racism continues to be part of many societies because it serves a specific purpose and benefit to a select group of people. In turn, the idea of health equity becomes unreachable if one fails to address the root of the issue.
The connection between one’s health status and governmental and societal institutions lies in the ideologies that form the system and influence the population as a result. Various social determinants of health are highlighted by research; some are more influential than others, but all of them are interconnected. Income, for example, greatly depends on one’s education, which may be affected by disabilities, financial support, and living environment. In Canada, the neoliberal ideology currently dominates the economic sphere, which affects people’s access to healthcare and safe living arrangements.
My personal experience living in Ontario reveals that I have a good health status supported by my family, education, and developed infrastructure. The examples of Indigenous Canadians and people living in villa miseria in Argentina are starkly different. These communities do not have access to the same utilities (such as safe and clean water), which leads to a worse quality of life and contributes to chronic diseases and congenital disabilities. In turn, these issues lower one’s health status and create a barrier for improving other social determinants of health.
Jacobs, M., & Visano, L. A. (Eds.). (2015). “Righting” humanity: “In my OUR time?” APF Press.
Ouedraogo, A., & Jacobs, M. A. (Eds.). (2017). Race in-equity: Intersectionality, social determinants of health, and universal rights. APF Press.