Monday, July 21, 2014

Visualizing reproductive choice

Last month saw the release of two important artistic projects that visualize reproductive choice: the American movie Obvious Child, and the Canadian book One Kind Word.

Half of pregnancies are unplanned, and 40% of these end in abortion. In the US more than a million women have abortions each year, but this is not reflected in mainstream film. As writer/director Jillian Robespierre explained, “We did write this script in response to a slew of movies that came out about unplanned pregnancy that always resulted in childbirth. It was frustrating, and instead of waiting for that movie to be made we decided to make it ourselves. I didn’t want to show the same film where the woman is struggling with the decision—I’ve seen that film before—and it’s not that this didn’t happen with this character, but we didn’t want to show the same story.”

Obvious Child
In 2009 she teamed up with comedian Jenny Slate to make a short film that went viral online. They then got funding to make a feature-length film that premiered at Sundance and was released in theaters last month. Obvious Child (the title of a Paul Simon song used in the film) is a romantic comedy about a stand-up comic who breaks up with her partner, loses her job, then has an unplanned pregnancy—and choses abortion. It has been falsely characterized as an “abortion comedy,” but as Slate said in an interview on CBC, “It's about this woman's journey from being passive to active, and learning how to stand by her decisions and still be herself, which means still be funny. Now that she's making a very adult decision, which is to have this safe procedure, can she still be irreverent and playful? Is her nature still hers when it's paired with this choice?”

The film follows the conventional story arc of a romantic comedy, is very irreverent and playful when it comes to the main character, but is very normalizing when portraying abortion. The filmmakers consulted Planned Parenthood to provide an accurate portrayal of a clinic experience—from counseling, to the procedure and recovery room. It shows the ongoing fear of stigma and importance of support. Refreshingly, the film doesn’t give a second of screen time to the anti-choice, though it does reference financial barriers and government restrictions.

It speaks volumes of mainstream film that this is one of the few to pass the Bechdel test—two female characters with names, who talk to each, about something other than a man—and rarer still that it be a positive portrayal of one of the million American women each year who chooses abortion. As Slate explained, “In the United States, women’s rights are very much under attack, and it’s enraging to some people to see a woman just make that decision. It’s good to me that the film is ground-breaking in a way, and in another way I look forward to a day when this is just part of a story…I get sent a lot of scripts that I read, and a lot of them have astounding and frankly irritating things that the women are doing—like women being traditionally catty to each other, often written by men. That to me is more shocking than a woman choosing what to do with her body.”

This is just one story—of a 30-year old urban white woman choosing abortion—but it’s an invitation to share others. As Robespierre said in an interview on Democracy Now on the anniversary of Roe v Wade, “Women’s rights are under attack, and there are many states that have put new restrictions on women being able to have safe, positive procedures. I think it’s a really good time for people to tell their stories.”

One Kind Word
While Robespierre and Slate were producing their short and feature-length film films on abortion, Martha Solomon and Kathryn Palmateer—founders of arts4choice—were gathering stories and portraits of women across Canada who have had abortions. Seven years of work culminated in the launch last month of One Kind Word: Women Share Their Abortion Stories. The title is from the personal story of Lori, a clinic counselor who reflected on her own abortion in 1972: “the support I would have appreciated: one kind word from anyone.”

In Canada there is no abortion law, but there are still multiple barriers to reproductive justice. As Solomon and Palmateer write in the introduction: “The iniquities of abortion access mirror the greater inequities in our society. Colonialism and racism can severely affect women’s abortion access and experiences. Low-income women face greater barriers than do affluent women, and access is even more tenuous for homeless, refugee and undocumented women. In many parts of the country, there are simply no providers available; in others, such as Prince Edward Island, provincial health authorities have refused to honour women’s basic reproductive health care needs and do not fund abortion services. Women from PEI who require an abortion must travel to another province and fund the costs of their abortion and travel expenses themselves. In New Brunswick, a woman must have the approval of two doctors before obtaining a provincially funded abortion. Sadly, the Fredericton Morgentaler clinic, the only other option for women seeking abortions in the maritimes, is scheduled to close in July 2014 after years of fighting the New Brunswick government, further limiting the already paltry options for east coast women. In no other area of health care would such an egregious disrespect for people’s basic health care needs be tolerated. Indeed, the problems with access in Canada point to a deep-seated misogyny within our country and our health care system.”

This extends into medical schools, which have insufficient discussion of abortion except for students who actively pursue abortion training. Marginalizing one of the most common medical procedures, which one third of women will chose at some point in their lives, contributes to the lack of abortion providers—a problem that Medical Students For Choice seeks to correct, as Jillian Bardsley explains in the book’s forward.

Women sharing their abortion stories was part of the last great wave of reproductive justice struggles, and part of the new movement. As Judy Rebick writes in the book’s forward, “As part of the movement then, we organized testimonials from women who had desperately sought abortion when it was illegal, or later when it was legalized under such restrictive circumstances that only a small percentage of women who needed abortions got them in safe and supportive conditions. But since the legalization of abortion, there has been too much silence. The anti-choice organizations, who now have a supportive federal government, have continued their vile propaganda, the purpose of which is, at least in part, to make women with an unwanted pregnancy feel guilt if they chose abortion. That’s why I think a book where women go public about their abortions is so important today.”

As Solomon and Palmateer summarize, “In this book you will meet thirty-two Canadian women who have had abortions. They are courageous and brave; they are inspiring; they are our mothers, sisters, friends, lovers, neighbors, teachers, politicians, doctors, and grandmothers… Our participants come from a range of class backgrounds, ethnicities, abilities, and language groups. You will read stories from Latina women, French Canadians, and First Nations women, as well as women from Asian, Indo-Caribbean, and African Canadian communities. Our participants are young and old (and in-between), financially stable and just making ends meet, mothers and childless, in relationships and single, heterosexual and lesbian.”

These stories cover the history of abortion in Canada—from Linda who had a “terrifying experience” in 1968 when abortion was illegal, to Joyce whose experience with a Therapeutic Abortion Committee in 1988 shaped her life as a pro-choice activist, to Mika who had a clinic abortion four months before she participated in the book. The stories cover a variety of experiences in unplanned pregnancies, barriers to abortion, emotional reactions to the procedure, and level of support from family or friends. Regardless of their personal reactions to abortion—from grieving to ambivalence to empowerment—the women have a shared experience of facing barriers to choice and feeling the need to speak out. As Kaleigh says, about both her disability and her experience with abortion: “In having open conversations we actively annihilate shame.”

The format of written stories (30 in English, one in Spanish and one in French) combined with photos makes an instant human connection to the women and the importance of reproductive choice. As Sheila explains: “Photos complementing our written stories, particularly a collection of women’s photos and stories like arts4choice is producing (rather than an individual story like mine), is even more dramatic in its effect because the visual dimension will help people see and process more comprehensively that we are everywhere, and we are various ages from different racial, class, and cultural backgrounds. Through the photos, they will see people who look like their friends, coworkers, sisters, etcetera. This association of familiarity will help them feel some empathy, or possibly even a little compassion.”

As Solomon and Palmateer conclude: “It is time for women themselves to articulate what kind of abortion care this country requires. We need to ask ourselves: what is it about our experiences that we need to keep, and what do we need to change? We can only do that when we are open and vocal about our experiences, both positive and negative. In this way, we can expand our vision of what comprehensive, feminist, on-demand abortion care can and should look like in this country, and we can also work towards building a stronger, more inclusive, and more authentic conversation about reproductive justice in Canada.”

Obvious Child is in theatres now. One Kind Word was just launched in Toronto and will be launched in Halifax next week, with launch dates in Ottawa and Vancouver to be determined. You can get a copy from Another Story Bookshop in Toronto, or online from Three O’Clock Press or Amazon.


Friday, July 4, 2014

Federal Court rejects bogus cuts to refugee health

More than two years of mobilizing have pushed the Federal Court to reject the Conservatives’ cuts to refugee health. This should encourage further mobilizing to reverse the cuts and challenge the broader agenda.

In April 2012 then Immigration Minister Jason Kenney announced drastic cuts to the Interim Federal Health Program, beginning in June of that year. The government claimed that the cuts would promote fairness, save money and protect public health—but the cuts did the exact opposite.

Mobilizations
There was immediate condemnation by health providers—including an open letter, occupation, interruptions of Tory press conferences, and demonstrations across the country. These led the government to quietly reverse some of the cuts, but this only created more confusion.  

Health providers warned that these cuts would harm refugees and scapegoat them for other healthcare cuts. As Dr. Mark Tyndall said at an Ottawa press conference in 2012, "the government has used this issue to divide Canadians, pitting those who are dissatisfied with their own health coverage against refugees. Canadians are smarter than this. This is an attack on our entire healthcare system."

A year after the cuts there were already dozens of documented cases of refugees being denied essential medical care. Canadian Doctors for Refugee Care and the Canadian Association of Refugee Lawyers launched a constitutional challenge, and there was a second annual day of action across the country against the cuts.

The mobilizations pushed some provinces to say they would step in and provide care—throwing the new Immigration Minister Chris Alexander into a temper tantrum about making Canada “a magnet for bogus asylum seekers.” But the reality of the cuts has continued to emerge. According to the study “The Cost and Impact of the Interim Federal Health Program Cuts on Child Refugees in Canada”: “After the implementation of funding cuts, the admission rate of refugee children increased from 6.4% to 12.0%...Shifts in the levels of health care access (hospital to primary-based care or vice-versa) due to affordability and administrative hurdles may make the vulnerable refugee population sicker, eventually leading to overall increase in healthcare costs.”

Court decision
This June was the third annual day of action against cuts to refugee health, and now the Federal Court has reflected public opinion. The ruling by Justice Anne Mactavish found that the cuts threaten the health and lives of refugees: "The 2012 modifications to the [Interim Federal Health Program] potentially jeopardize the health, the safety and indeed the very lives, of these innocent and vulnerable children in a manner that shocks the conscience and outrages Canadian standards of decency…I have found as a fact that lives are being put at risk."

Furthermore, the ruling rejects the bogus rhetoric used to justify the cuts: “It puts their lives at risk, and perpetuates the stereotypical view that they are cheats, that their refugee claims are ‘bogus,’ and that they have come to Canada to abuse the generosity of Canadians. It undermines their dignity and serves to perpetuate the disadvantage suffered by members of an admittedly vulnerable, poor and disadvantaged group."

Keep up the pressure
Anti-migrant racism is a key component of the Conservatives’ austerity agenda: exploiting migrant workers while blaming them for jobs losses, and cutting refugee health while blaming them for healthcare cuts. This scapegoating provides a cover for the Conservatives’ own agenda—from eliminating jobs at Canada Post to cutting $36 billion from healthcare.

The recent Federal Court ruling reflects more than two years of mobilizing, and shows how this can challenge the Conservatives’ cuts and their racist justifications. But the court decision does not restore healthcare: the government has four months to respond, and they are planning on appealing the decision. That the Conservatives have ignored 10 court decisions and two votes in Parliament in support of US Iraq War resisters shows us that this important decision on refugee health is not the end of the fight. 


Continued mobilizations will be necessary to reverse the cuts, pressure provincial governments to follow their words and provide care in the meantime, and challenge the broader austerity agenda.

Friday, March 7, 2014

9 reasons to reject the NEB decision and continue opposing Line 9


Like the Joint Review Panel’s recent whitewash of the Northern Gateway pipeline, the National Energy Board has rubber stamped Enbridge’s Line 9 pipeline. Here are nine reasons to reject their 158-page decision and continue opposing Line 9.

1. allies of the Harper government
Even before reading the decision we need to consider the source. After Prime Minister Harper scrapped environmental legislation, handing over decision-making on pipelines to the NEB—which it has called an “ally.” As Keith Stewart from Greenpeace said, “Canadians should be concerned when a supposedly arms-length agency that is supposed to regulate the oil industry…is listed as an ‘ally.”

Who are the authors of the report? As Michael Toledano pointed out, “The government bureaucrats who made this decision were Lyne Mercier, a former oil and gas sector manager, Mike Richmond, a corporate energy lawyer, and Jacques Gauthier, a former energy sector CEO who has worked closely with Prime Minister Stephen Harper.”

Ontario’s so-called “social justice” premier Kathleen Wynne has also proved to be an ally of Harper’s environmental destruction. After first promising to address environmental concerns, Wynne refused to conduct an environmental assessment—leaving the decision to the NEB. As NDP MPP Peter Tabuns said, “I’m surprised to hear that this government has so much confidence in the Harper government’s approach to environmental protection.” Recently dozens of Indigenous, community and labour groups wrote an open letter demanding an environmental assessment, as part of a campaign that continues.

2. refused to consider tar sands production
The second page of the NEB decision gives insight into the content of the following 156 pages when it states that “some concerns were raised that are not within the Board’s mandate to regulate, such as oilsands development, energy policy, upstream greenhouse gasses (GHGs) and GHGs related to the end use of crude oil.”

As the decision goes onto explain, “The NEB does not have jurisdiction over energy exploration and production within provincial boundaries, Alberta’s oils sands, for example.” Not only does it refuse to consider the giga-project that Line 9 will be promoting, which has been termed “slow industrial genocide” by Indigenous groups, but it makes the bizarre comment separating the tar sands from Line 9: “the Project and oil sands production, or other Canadian oil production potentially supplying the Project, are sufficiently geographically separated that there is not likely to be any meaningful or measurable interactions between the likely residual environmental effects of the Project and those activities.”

3. Dismissed climate change effects
The NEB refused to consider what goes into Line 9, and what comes out of it—admitting that “The Board did not consider the environmental and socioeconomic effects of downstream consumption (ie end use) of oil transported by Line 9 within the cumulative effects assessment for the Project.”

But the decision goes further, dismissing climate change effects as speculative and hypothetical: “Any examination of potential environmental effects from such speculative impacts on the downstream mix or patterns of energy use in destination markets would be hypothetical and of no meaningful utility to the Board’s ESA or public interest determination. The Board finds that the potential for effects of downstream use of oil to act cumulatively with any potential effects of the Project is too speculative to merit consideration.”

Those who witnessed the floods in Alberta and Toronto, or the typhoon in the Philippines, know that climate change is not “speculative” but real—as are the deaths associated with air pollution. According to the Canadian Association of Physicians for the Environment, “air pollution kills about 20,000 Canadians a year and with tar sands expansion, it will only get worse. If we can about our health we need to leave tar sands oil in the ground.” Otherwise, according to climate scientist James Hansen, “If Canada proceeds, and we do nothing, it will be game over for the climate.”

4. Restricted consultation
After thousands of people intervened in public consultations against the Northern Gateway pipeline, and Natural Resources Minister Joe Oliver threw a temper antrum over people “stacking public hearings with bodies,” the NEB restricted democracy—requiring people to submit a 10-page application explaining why they personally are affected and why they should be granted to right to intervene. Those who passed this hurdle and were able to intervene had complaints against Enbridge—including some public consultation that happened after the deadline to intervene.

Enbridge simply rejected these concerns (“these comments are submitted to the Board without proof and should be rejected.”) and NEB agreed: “The Board is comfortable concluding that the design of he consultation program in general was adequate for the nature of the Project.”

5. Denied indigenous sovereignty
The lack of consultation was the most extreme concerning the 18 First Nations whose territories lies within 50km of Line 9. The decision provides sugar-coating, stating, “the Board takes the interests and concerns of Aboriginal groups into consideration before it makes a decision that could have an impact on those interests.” In other words, the NEB usurps all authority to make the decision that will affect Indigenous communities and their territories, and after denying their sovereignty it patronizingly claims it will take their concerns “into consideration.”

The NEB did write down these concerns, including: “Aboriginal Participants in this proceeding were critical of Enbridge’s efforts to engage them concerning the Project and also expressed concerns regarding Crown consultation. Aboriginal Participants argued that because these efforts were insufficient the potential impacts of the Project on Aboriginal interests are not fully understood or addressed… Chief Chris Plain stated that Enbridge’s efforts to engage Aamjiwnaang First Nation about the Project have been insufficient and did not meaningfully address its concerns about potential health impacts and impacts on its Aboriginal and treaty rights…Mohawk Council of Kahnawà:ke asserted that no meaningful engagement or information exchange occurred between MCK and Enbridge during the period reported in Enbridge’s summary. MCK also cautioned the Board not to interpret each meeting or exchange between Enbridge and a First Nation as qualifying as a meaningful engagement…Chippewas of the Thames First Nation submitted in their written evidence that Enbridge’s efforts to engage its members about the Project have not meaningfully addressed their concerns about potential health impacts and impacts on COTTFN’s Aboriginal and treaty rights…Mississaugas of the New Credit First Nation stated in their evidence that Enbridge does not actively consult with or address MNCFN concerns regarding the ongoing operation and management of Line 9…Mohawk Council of Kanesatake submitted that Enbridge failed to engage with them meaningfully about Line 9…Grand River Indigenous Solidarity expressed concerns in its written evidence about Enbridge’s consultation activities, stating that Enbridge only notified affected Aboriginal groups of the Project rather than undertaking a process of meaningful consultation…Rising Tide Toronto stated in its oral final argument that Enbridge had not engaged in sufficient consultation processes within indigenous communities and, as a result, Enbridge was not aware of several sacred burial sites, outstanding land claims, and treaty violations.”

But the NEB cynically used these concerns as substitute for informed consent, agreeing with Enbridge that “all Aboriginal groups potentially affected by the Project were provided with sufficient information about the Project…potential affected Aboriginal groups and individuals had an opportunity to make their views known to Enbridge and to the Board.” The NEB then dismissed the content of these concerns, claiming that “any potential Project impacts on the rights and interests of Aboriginal groups are likely to be minimal and will be appropriately mitigated.”

6. Minimized risk of spill
The spill from Enbridge’s Line 6B caused water pollution that continues after a billion dollars in clean up fees. Enbridge not only refused to provide $1 billion in insurance but also stated that “if drinking water is affected Enbridge would provide a safe, temporary supply of drinking water.” What a reassuring thought, to be given a temporary supply of bottled water after Enbridge has ruined the natural water source for us and other living creatures.

For a comprehensive assessment of the risks of Line 9, which synthesizes information from intervenors, read the new report “Not Worth the Risk.”

7. Admitted negligible jobs
There is a common myth that we need tar sands and pipelines to provide jobs, but Enbridge inadvertently debunked that myth: “Enbridge submitted that for the majority of stakeholders, the reversal would have no noticeable impact since it involves reversing the flow on an existing pipeline, and that any impacts arising from construction are expected to be temporary and minor in nature…The project is expected to create a total of 3 permanent positions and may require up to 40 temporary construction workers at each of the existing station the terminal Project sites.” Three permanent jobs per site, at the cost of destroying the planet on which all our jobs depend!

8. Ignored green jobs alternatives
There is growing labour opposition to tar sands pipelines across the country. On the West coast, Unifor and the BC Teacher’s Association have signed the Solidarity Accord in support of First Nations resisting the Northern Gateway pipeline. As Gavin McGarrigle, Unifor Area Director of BC said, “it’s time for a new vision for Canada’s energy industries –one that addresses the reality of aboriginal title and rights, respects our social and environmental commitments, and generates lasting wealth for all who live here.” According to a report by Blue Green Canada, the $1.3 billion of federal subsidies to the oil and gas industry could create 18,000 more jobs in the clean energy sectors.

What alternatives did Enbridge consider in its application? “No other alternatives to the Project were investigated” other that “an assessment of the feasibility of using rail, barge, waterborne tanker, other existing pipelines or trucks, in isolation or in combination, to deliver western Canadian and/or US produced crude oil to Quebec area refineries.”

And you can guess the response of the NEB: “The Board stated that making use of existing underused pipeline capacity, such as the capacity on Line 9, is a sound idea. The Board concludes that the Project represents the most economically feasible alternatives.”

9. Uses conditions to shift the debate
Having monopolized and restricted decision-making, refused to consider tar sands or climate change, denied Indigenous sovereignty, minimized risk of spills and ignored green jobs alternatives, the NEB decision has used conditions to shift the debate from “No Line 9” to “Line 9 if…”. This is designed to undermine the unconditional opposition to Line 9 and to shift the debate onto pipeline technicalities. But the unconditional opposition to Line 9 and the reasons for it—opposition to tar sands and climate change, and support for Indigenous sovereignty and green jobs—will continue.

Tuesday, February 4, 2014

Obituary: Dr. Romalis, abortion provider


On January 31, Vancouver abortion provider Dr. Garson Romalis passed away at the age of 76, after providing reproductive choice for four decades and surviving two anti-choice attacks. His life is best summarized in his own words, in a 2008 address he gave to mark the 20th anniversary of the Morgentaler decision that struck down legal barriers to abortion in Canada.

Criminalizing abortion kills women
A graduate of UBC medical school, it was his experience at Cook County hospital in Chicago where he witnessed the magnitude of barriers to choice, which disproportionately affected women living in poverty.

“Cook County had about 3,000 beds, and served mainly an indigent population. If you were really sick, or really poor, or both, Cook County was where you went. The first month of my internship was spent on Ward 41, the septic obstetrics ward. Yes, it’s hard to believe now, but in those days, they had one ward dedicated exclusively to septic complications of pregnancy. About 90% of the patients were there with complications of septic abortion. The ward had about 40 beds, in addition to extra beds which lined the halls. Each day we admitted between 10-30 septic abortion patients. We had about one death a month, usually from septic shock associated with hemorrhage. I will never forget the 17-year-old girl lying on a stretcher with 6 feet of small bowel protruding from her vagina… Today, in Canada and the US, septic shock from illegal abortion is virtually never seen. Like smallpox, it is a ‘disappeared disease.’”

Reproductive justice
In 1969 the Canadian government liberalized the abortion law, and Dr. Romalis began providing abortions as part of his practice as an obstetrician and gynecologist in 1972. But the law still maintained strict control of the procedure and denied abortion access to women. It took a mass movement—concentrating opposition to the abortion law based on a broad understanding of reproductive justice—to strike down the law in 1988.

As Carolyn Egan from the Ontario Coalition for Abortion Clinics wrote, “OCAC tried to ensure that the demand for abortion access was never seen in isolation, but as one of a number of interdependent struggles. We tried to make this concrete by challenging the coerced sterilization that Aboriginal women, women with disabilities and Black women were facing. We held joint forums on the issues with women speaking about the injustices that they were experiencing. Healthcare workers told us that therapeutic abortion committees sometimes refused abortions unless a woman agreed to be sterilized. We fought for childcare as a woman’s right and campaigned against extra billing by doctors. OCAC worked with Dr. Henry Morgentaler and in 1983 he opened a clinic challenging the federal criminal code. The clinic became a symbol of women’s resistance to an unjust law. A long campaign against two levels of government and an organized anti-choice movement began.”

Anti-choice backlash
This campaign continued to challenge the anti-choice backlash after the 1988 Supreme Court decision—from the Tories trying to re-criminalize abortion through Parliament, to “Operation rescue” swarming the Morgentaler clinic in Toronto, and anti-choice violence against abortion providers.

Dr. Romalis was shot in 1994 and stabbed in 2000: “I had been a medical doctor for 32 years when I was shot at 7:10am, Nov 8, 1994. For over half my life, I had been providing obstetrical and gynecological care, including abortions. It is still hard for me to understand how someone could think I should be killed for helping women get safe abortions. I had a very severe gun shot wound to my left thigh. My thigh bone was fractured, large blood vessels severed, and a large amount of my thigh muscles destroyed. I almost died several times from blood loss and multiple other complications…These acts of terrorist violence have affected virtually every aspect of me and of my family’s life. Our lives have changed forever. I must live with security measures that I never dreamed about when I was learning how to deliver babies.”

The movement continues
But the anti-choice failed to stop Dr. Romalis and the movement. He continued to provide abortions and to inspire future generations of providers, like Medical Students for Choice: “My life had changed, but my views on choice remained unchanged, and I was continuing to enjoy practicing medicine…I love my work. I get enormous personal and professional satisfaction out of helping people, and that includes providing safe, comfortable, abortions. The people that I work with are extraordinary, and we all feel that we are doing important work, making a real difference in peoples’ lives. I can take an anxious woman, who is in the biggest trouble she has ever experienced in her life, and by performing a five-minute operation, in comfort and dignity, I can give her back her life.”

Dr. Romalis was very courageous and risked his life to provide the life-saving procedure of abortion. Through the process he inspired a new generation of reproductive freedom fighters—who continue to challenge the Tory attacks on choice, and to connect access to abortion with the broader struggle for reproductive justice.

On February 11, join a screening of Young Lakota, about indigenous youth fighting for reproductive justice. 7pm at Innis Town Hall, 2 Sussex ave, Toronto. Screening followed by a speaker from the Native Youth Sexual Health Network (NYSHN). Presented by Medical Students for Choice, the Ontario Coalition for Abortion Clinics, and NYSHN. Facebook event here.

Monday, January 13, 2014

Doctors’ orders: raise the minimum wage


Minimum wage in Ontario has been frozen at $10.25 for three years, which is now 19% below the poverty line. Inspired by fast food and retail workers in the US, there is a growing campaign across Ontario to raise the minimum wage to $14/hr. January 14 will be a province-wide call-in day to Ontario Premier Kathleen Wynne, to demand a $14 minimum wage for health reasons.

The health impacts of inequality
There is a growing rediscovery of the ways in which poverty and inequality undermine health. As an article in The New England Journal of Medicine explained in 2004: "On the whole, people in lower classes die earlier than do people at higher socioeconomic levels, a pattern that holds true in a progressive fashion from the poorest to the richest... Unhealthy behavior and lifestyles alone do not explain the poor health of those in lower classes. Even when behavior is held as constant as possible, people of lower socioeconomic status are more likely to die prematurely."

The same is true in Canada, as the Ontario Medical Review explained in a series of articles last year: “Income is a well-recognized social determinant of health, and people living with low incomes experience higher burdens of illness, decreased life-expectancy, and higher rates of mortality than high-income earners. Health declines as one moves down the income gradient, with differential health outcomes at every level of income. A recent Statistics Canada report on cause-specific mortality rates by income quintile highlighted these health disparities. Each successively lower income quintile was associated with an increase in age-standardized mortality rates for almost all causes of mortality.” This has a disproportionate impact on indigenous communities and racialized groups, women, people with disabilities and others groups whose oppression concentrates them in lower incomes.

Capitalism makes us sick
Social and economic inequality and its health impacts do not abstractly exist, they are actively maintained. In The Conditions of the Working Class in England, Friedrich Engels wrote in 1845 that when society places hundreds of workers in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live – forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence – knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual.”

Instead of challenging this economic model, mainstream medicine came to reflect it—reducing people to isolated individuals removed from their environment and society. This biological reductionism has provided ideological justifications for colonization in Canada and around the world, and for a rise in fat-phobia that attributes declines in health to people’s body size instead of their social and economic conditions. 

The social model of medicine is reasserting itself. In 2008 the World Health Organization raised the alarm that “social injustice is killing people on a grand scale”, and we need to “tackle the inequitable distribution of power, money, and resources.” But austerity measures have done the opposite: prescribing massive bailouts for banks and corporations while taking a scalpel to jobs, wages and services. There are claims that recent job numbers show this is leading us to prosperity, but as economist Joseph Stiglitz recently wrote this month, “we should curb our euphoria. A disproportionate share of the jobs now being created are low-paying – so much so that median incomes (those in the middle) continue to decline. For most Americans, there is no recovery, with 95% of the gains going to the top 1%.”

Prescription for health: tax the rich, raise wages, and support unions
Physicians are starting to follow the advice of Rudolph Virchow, one of the founders of social medicine: “if medicine is really to accomplish its great task, it must intervene in political and social life.” Last year the Canadian Medical Association held a public consultation process about the social determinants of health. Their findings: “poverty is the most important issue and must be addressed” and “governments need to be pressured to take action.”

Doctors for Fair Taxation has called on the Ontario government to increase taxes on the wealthy: “Ontario physicians see the adverse health impacts of growing inequality in our patients and our communities. As the government grapples with its financial difficulties, we urge all political parties to spare the province’s poor, sick, and vulnerable residents. We think high earning Ontarians are prepared to pay higher taxes for a fairer society. We say to Premier Wynne and Finance Minister Sousa: Tax us, Ontario is worth it!”

Health Providers Against Poverty have developed a clinical tool kit to factor poverty into clinical decision-making, considering the evidence of how poverty predisposes to cardiovascular disease, diabetes, depression, suicide, cancer, hypertension, arthritis, COPD and asthma. As Dr. Gary Bloch explained, “Treating people at low income with a higher income will have at least as big an impact on their health as any other drugs that I could prescribe them.”

Unions are another mechanism to prescribe equality, which is why they are under such sustained attack—from Ontario Tory leader Tim Hudak’s threat of “right to work” to the federal Conservatives’ recent party convention. As The National Post wrote recently, “Forget Duffy. Harper’s war is with unions.” Unions defend wages and conditions, and support broader social justice causes—all of which promote health. Which is why fast food and retail workers in the US—part of the 99% who are suffering from austerity—are combining demands for a higher minimum wage with unionization to provide them with democratic structures to resist austerity.

Take action for your health
The campaign to raise the minimum wage is part of a broader struggle to change the world and through the process change ourselves. As psychologists studying protesters found, social justice is good for our health: “The take-home message from this research therefore might be that people should get more involved in campaigns, struggles and social movements, not only in the wider interest of social change, but also for their own personal good."

*Health Providers Against Poverty will hold a press conference at 10:30am at the Queen’s Park Media Studio at the Ontario Legislature
* Join the phone-in day on January 14th to tell Premier Kathleen Wynne we need a raise, by calling her office at (416) 425-6777 and then your local MPP.  Find your MPP contact info here.
* Tweet @Kathleen_Wynne: Raise minimum wage to $14/hr in 2014 #14now #OnPoli
*On January 24 the Campaign to Raise the Minimum Wage is holding a public forum with organizers leading the fight for fair wages in the US.