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Income inequality: A matter of life and death

A new Conference Boardf of Canada report suggests that income inequality has serious impacts on health and life expectancy - and the divergence starts early in life.

Alexander Raths/

Most Canadians would agree that all citizens should be able to develop their individual talents and capacities and to meet at least their basic needs. We may differ on just how much economic inequality we are prepared to tolerate, but we generally agree on the importance of equalizing opportunities for all of us to live meaningful and healthy lives.

There is probably no single better indicator of how we are doing as a society than life expectancy. This varies a lot among countries at different levels of development – and differs to a surprising degree among the rich advanced industrial countries.

A book by health experts Richard Wilkinson and Kate Pickett, The Spirit Level, demonstrates that there is no relationship between gross domestic product, or health spending per person, and life expectancy in rich countries. There is, however, a significant link between average life expectancy and income inequality: Citizens of more equal countries tend to live longer.

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The recent Conference Board of Canada report "How Canada Performs" awarded us a "B" grade for life expectancy. The life expectancy of the average Canadian at birth is now 81.2 years, a bit below 83.0 years in top-ranked Japan, but three years more than 78.2 years in the United States.

Canada fares reasonably well in these kinds of international comparisons. Indeed, average life expectancy is a bit higher than one would expect, given our relatively high level of income inequality.

The fact that we live significantly longer on average than do U.S. citizens likely reflects the fact that our Medicare system covers all citizens and delivers generally high-quality care, while many Americans lack coverage.

Average life expectancy in the United States is also reduced by especially low life expectancy for racial minorities. For example, American black men die more than five years earlier than do white men.

All that said, differences in life expectancy between Canadians are also shockingly high.

Statistics Canada estimates life expectancy of persons age 25, and finds that 48 per cent of men who are Registered Indians will live to age 75, compared with 64.6 per cent of all other men. (The figures for women are 57.4 per cent and 78.1 per cent, respectively.)

There are very large differences in life expectancy based on the income group someone belongs to at age 25. The life expectancy of a man in the top 20 per cent is more than seven years longer than a man in the bottom 20 per cent; the life expectancy of a woman in the top 20 per cent is almost five years longer than a woman in the bottom 20 per cent.

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The fact that the most affluent Canadians live significantly longer than the least affluent suggests that poverty and material deprivation – such as lack of decent housing and inability to afford a nutritious diet – may be a factor.

But the figures show that relative well-being counts as well.

The middle 20 per cent of Canadian men aged 25 can expect to live for another 52.9 years, almost five years longer than the 48.2 years of remaining life for those in the bottom 20 per cent. But this is still more than two years less than the 55.3 years of remaining life for men in the top 20 per cent.

The middle 20 per cent of Canadian women age 25 can expect to live for another 58.5 years, more than three years longer than the 55.0 years of remaining life for those in the bottom 20 per cent. But this is still one year less than the 59.9 years of remaining life for women in the top 20 per cent.

How do we account for the fact that life expectancy is clearly linked to income inequality, and not just to poverty?

There is no clear answer to this question. Wilkinson and Pickett argue that a person's position in the economic and social hierarchy is closely linked to stress and anxiety, which have a strong influence on health.

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Our position on the income spectrum also influences other significant determinants of health, such as the kinds of jobs we hold in terms of their physical and mental demands; how much stress we experience from economic insecurity; the kinds of communities in which we live; and our access to recreation and a non-polluting environment.

One big thing we do know, and should act upon, is that economic inequality undermines the chance of all Canadians to live long and healthy lives.

Andrew Jackson is the Packer Professor of Social Justice at York University and senior policy adviser to the Broadbent Institute.

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