Chapter 4: The Chief Public Health Officer's report on the state of public health in Canada 2008 – Employment and working conditions
Social and Economic Factors that Influence Our Health and Contribute to Health Inequalities
Employment and working conditions
Employment provides Canadians with economic opportunities which can influence individual and family health. However, the working environment can also significantly impact physical and mental health through type of work and working conditions.2, 7
In 2006, Canada’s unemployment rate was at a 30-year low of 6.3%. Although most regions in Canada have seen a decline in the unemployment rate over time, regional differences range from 3.8% in the Prairies to 9.9% in Atlantic Canada.229 Additionally, recent immigrants (within 5 years of immigration) have a higher rate of unemployment (11.5%), despite being more likely than their Canadian-born counterparts to hold a university degree.230
In Canada, regulations and policies such as labour codes, workers’ compensation, leave and disability benefits, as well as job-site safety practices have worked to universally protect Canadian employees. However, workplace-related injury, disability and death still occur and some workers are more affected than others.
In 2003, 630,000 Canadians experienced at least one activity-limiting occupational injury. Blue collar workers (sales and service, transport, equipment operation, primary industry and manufacturing) experience over four times the injury rates experienced by white collar workers (business, administrative, management, and occupations in health, science, social science and arts). Men (5.2%) experience more work-related injuries than women (2.2%). Although the type of occupation is the key to determination of risk, higher-income men (over $60,000) and women (over $40,000) were less likely to experience injury compared to those men and women at lower income levels.231
Supporting Seniors Through Poverty Reduction
National Public Pensions
At the start of the last century, public pensions were non-existent. At that time, Canadian seniors were much more likely to be economically disadvantaged than the general population. Considering that income is an important health determinant, this meant that seniors were at greater risk of poor health because of their financial circumstances.226 When Old Age Security (OAS) was introduced in 1952, it was Canada’s first universal pension. It was followed in the mid-1960s by the employment-based Canada Pension Plan (CPP) and Quebec Pension Plan (QPP), and the income-tested Guaranteed Income Supplement (GIS). A Spouse’s Allowance (SPA) and Widowed Spouse’s Allowance – also income-tested – followed in 1975 and 1985, respectively.227 Provincial/territorial income supplements for seniors were also added along the way. Today, over 95% of seniors receive income from OAS, GIS or SPA. As well, 96% of senior men and 86% of senior women receive CPP/QPP benefits. As Canada’s public pension system matured, more seniors than ever became eligible for benefits and their after-tax income increased by 18% between 1980 and 2003.123 This maturation has been cited as a key factor in the major shift of Canada’s prevalence of low-income among seniors – from one of the highest among industrialized nations in the 1970s to one of the lowest today.8, 228
Stress related to employment in the form of job strain (work demand and control), satisfaction, perception of physical risk and issues of job security is a significant health concern for many Canadians.232 Overall, more women than men report feeling work-related stress. Perception of work stress also increases with levels of education and household income.117 However, those in the lowest income households also report experiencing high rates of stress coinciding with job insecurity and job dissatisfaction.232, 117
Over the last 20 years, the average workday for paid and unpaid work has steadily increased for Canadian adults aged 25 to 54 years, from 8.2 hours in 1986 to 8.8 hours in 2005. Like paid working hours, unpaid work can be a source of stress for some Canadians. Generally, women report feeling more time-stressed than men. While both women and men report participation in paid work has increased, women’s time involved in unpaid work has decreased (from 4.8 to 4.3 hours per day) and men’s has increased (from 2.1 to 2.5 hours per day) between 1986 and 2005.233
Longer hours and less predictable hours at work can also impact the home/family environment. An important aspect of healthy infant and child development is the role parents play in the lives of their children. In 2001, Canada’s employment insurance program extended parental-leave benefits up to one year. As a result, both the numbers of parents taking leave and the length of leave have increased.234 However, many mothers still do not take extended maternity leave – some mothers choose not to take leave, some are not eligible (e.g. self-employed) or some cannot afford to live on employment insurance benefits (55% of their salary) that are not supplemented by their employer.235
Healthy eating requires being ‘food secure’ (i.e. having physical and economic access to sufficient, safe and nutritious foods to meet the needs of a healthy and active life).236 In 2004, 9% of all Canadian households reported being food insecure at some point in the previous year as a result of financial challenges.237
There is a large difference in reported food insecurity between households in the lowest and highest income levels (48.3% vs. 1.3%). And there is evidence that individuals with higher social and economic status more regularly consume nutritious foods (fruits and vegetables, dairy products, lean meats, whole grains) than individuals with lower social and economic status. Research shows that there is also an education gradient associated with food insecurity, as 13.8% of households with the lowest education attainment level (less than high school) reported some form of income-related food insecurity compared to 6.9% of households with the highest education attained (completion of post-secondary education).237
One in ten households with children, particularly young children, experience food insecurity.237 When children go to school hungry or poorly nourished, their energy levels, memory, problem-solving skills, creativity, concentration and behaviour are all negatively impacted. Studies have shown that 31% of elementary students and 62% of secondary school students do not eat a nutritious breakfast before school.238 Almost one quarter of Canadian children in Grade 4 do not eat breakfast daily and, by Grade 8, that number jumps to almost half of all girls.239 The reasons for this vary – from a lack of available food or nutritious options in low-income homes, to poor eating choices made by children and/or their caregivers. As a result of being hungry at school, these children may not reach their full developmental potential – an outcome that can have a health impact throughout their entire lives.
The growth in the number of food banks and school breakfast programs in Canada reflects the fact that food insecurity is increasingly being recognized as a problem in Canada (see text box). The importance of these types of programs cannot be overstated. At the same time, however, it is crucial to address the underlying causes of food insecurity: lack of income; education; knowledge; employment and other barriers to accessing affordable and nutritious food. In 1996, Canada joined 186 other nations at the World Food Summit in endorsing its goal to reduce the number of undernourished people worldwide by half no later than 2015. Canada’s Action Plan for Food Security, launched in 1998, is a response to this commitment and builds on a number of other existing international and domestic commitments affecting food security that Canada has made.240
As part of the plan, Canada agreed to report on these actions to Canadians every two years. To date, these reports demonstrate the extensive network of participants, both directly and indirectly, supporting food security issues and how – in many cases – gaps are being filled indirectly through general safety net activities with no specific mandate in regards to food security.241 Activities and commitments within Canada include: meal programs for schools and shelters; food banks; subsidized air transportation of nutritious and perishable foods; food safety regulation and surveillance (i.e. contaminants); emergency requirements – safety and access; and research and reporting on nutrition, the extent of food security problems and the underlying socio-economic factors of these problems.
Breakfast for Learning
Since 1992, a non-profit organization called Breakfast for Learning has been providing funding, nutrition education and other resources to community-based student nutrition programs across the country with a goal to ensuring that every child in Canada attends school without hunger.242 Since its inception, Breakfast for Learning has moved from initial funding for 20 programs to an investment in over 3,000 programs in every province and territory in the country. With a network of over 30,000 volunteers, it has served healthy breakfasts, lunches and snacks to over 1.5 million Canadian school children to date.243, 244, 245 Although there is a lack of data on breakfast programs meeting goals, school staff have reported improvements in scholastic performance, improved behaviour and attentiveness among some students. Also, volunteers in this program report high satisfaction rates and a feeling of sense of community.246 The success of Breakfast for Learning in terms of reaching so many school children is largely attributed to the community-level involvement and management of each program. The needs of each area are determined by the combined efforts of governments, private businesses, community agencies, volunteers, food banks, parents and educators.
In 2006, the Canadian Association of Food Banks (CAFB) moved over 8.5 million pounds of food-industry donations (worth $18 million) to its members through the National Food Sharing System.247 In addition to food received from the CAFB, community-run food banks collect and distribute an estimated 150 million pounds of food per year.248 Canada’s first food bank opened in Edmonton, Alberta in 1981.249 As of March 2007, there were 673 food banks and 2,867 affiliated agencies operating across the country in every province and territory. That same month, those food banks and agencies served over 2 million meals and provided groceries to more than 720,000 individuals. Over the last 18 years, reliance on food banks has increased 91% and, until food security is better addressed in Canada, those numbers will likely remain high.250
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