Globalization and the health of Canadians: ‘Having a job is the most important thing’
Tóm tắt
Globalization describes processes of greater integration of the world economy through increased flows of goods, services, capital and people. Globalization has undergone significant transformation since the 1970s, entrenching neoliberal economics as the dominant model of global market integration. Although this transformation has generated some health gains, since the 1990s it has also increased health disparities. As part of a larger project examining how contemporary globalization was affecting the health of Canadians, we undertook semi-structured interviews with 147 families living in low-income neighbourhoods in Canada’s three largest cities (Montreal, Toronto and Vancouver). Many of the families were recent immigrants, which was another focus of the study. Drawing on research syntheses undertaken by the Globalization Knowledge Network of the World Health Organization’s Commission on Social Determinants of Health, we examined respondents’ experiences of three globalization-related pathways known to influence health: labour markets (and the rise of precarious employment), housing markets (speculative investments and affordability) and social protection measures (changes in scope and redistributive aspects of social spending and taxation). Interviews took place between April 2009 and November 2011. Families experienced an erosion of labour markets (employment) attributed to outsourcing, discrimination in employment experienced by new immigrants, increased precarious employment, and high levels of stress and poor mental health; costly and poor quality housing, especially for new immigrants; and, despite evidence of declining social protection spending, appreciation for state-provided benefits, notably for new immigrants arriving as refugees. Job insecurity was the greatest worry for respondents and their families. Questions concerning the impact of these experiences on health and living standards produced mixed results, with a majority expressing greater difficulty ‘making ends meet,’ some experiencing deterioration in health and yet many also reporting improved living standards. We speculate on reasons for these counter-intuitive results. Current trends in the three globalization-related pathways in Canada are likely to worsen the health of families similar to those who participated in our study.
Tài liệu tham khảo
Dollar D. Is globalization good for your health? Bull World Health Organ. 2001;79:827–33.
Deaton A. Health in an Age of globalization [internet]. Cambridge (MA): National Bureau of Economic Research; 2004. [cited on June 12 2014], Retrieved from: http://www.nber.org/papers/w10669.pdf?new_window=1.
Ottersen OP, Dasgupta J, Blouin C, Buss P, Chongsuvivatwong V, Frenk J, et al. The political origins of health inequity: prospects for change. Lancet. 2014;383(9917):630–67.
Labonté R, Schrecker T. Globalization and social determinants of health: Introduction and methodological background (part 1 of 3). Globalization Health. 2007;3:5.
Labonté R, Schrecker T. Globalization and social determinants of health: promoting health equity in global governance (part 3 of 3). Globalization Health. 2007;3:7.
Labonté R, Schrecker T. Globalization and social determinants of health: the role of the global marketplace (part 2 of 3). Globalization Health. 2007;3:6.
Lee K, World Health Organization, & Commission on Social Determinants of Health. Globalization, global governance and the social determinants of health: a review of linkages and agenda for action (CH). Geneva: World Health Organization; 2007.
Labonté R, Schrecker T, Packer C, Runnels V. Globalization and health: pathways, evidence and policy. London: Routledge; 2009.
Grant R, Short JR. Globalization and the margins. Palgrave Macmillan: London and New York; 2002.
Brown G, Labonté R. Globalization and its methodological discontents: contextualizing globalization through the study of HIV/AIDS. Globalization Health. 2011;7(29):1–12.
Stoebenau K, Nair RC, Rambeloson V, Rakotoarison PG, Razafintsalama V, Labonté R. Consuming sex: the association between modern goods, lifestyles and sexual behaviour among youth in Madagascar. Globalization Health. 2013;9:13.
Yalnizyan A, Schrecker T. The growing economic gap: what it means for Canadian families and the Canadian future. In: Globalization, health, and the future Canadian metropolis. Ottawa: Institute of Population Health, University of Ottawa; 2010. p. 112–28.
Citizens for Public Justice (CA). Poverty trends scorecard: Canada 2012 [internet]. 2012. [cited on June 12 2014]. Available from: http://www.cpj.ca/poverty-trends-scorecard-canada-2012.
Adamson P. Measuring child poverty: New league tables of child poverty in the world's rich countries. Innocenti report card 10. UNICEF Innocenti Research Centre: Florence (It); 2012.
Hyman I. Immigration and health: reviewing evidence of the healthy immigrant effect. CERIS working paper No. 55. Toronto: CERIS; 2007.
Ng E. The healthy immigrant effect and mortality rates. Health Rep. 2011;2(4):1–5.
Ng E, Wilkins R, Gendron F, Berthelot J-M. Dynamics of Immigrants’ health in Canada: evidence from the national population health survey. Statistics Canada: Ottawa (ON); 2005.
Llácer A, Zunsunegui M, del Amo J, Mazarrasa L, Bolumar F. The contribution of a gender perspective to the understanding of migrants’ health. J Epidemiol Community Health. 2007;61 Suppl 3:ii4–10.
Spitzer DL. Work, worries and weariness: towards an embodied and engendered migrant health. In: Spitzer DL, editor. Engendering migrant health in Canada. Toronto: University of Toronto Press; 2011. p. 3–20.
Vissandjee B, Desmeules M, Cao Z, Abdool S, Kazanjian A. Integrating ethnicity and migration as determinants of Canadian Women's health. BMC Womens Health. 2004;4 Suppl 1:S32.
Bond P. Trends in global political economy and geopolitics post-1980 [Internet]. Globalization Knowledge Network: World Health Organization Commission on the Social Determinants of Health; 2008. [cited on June 13 2014], Available from: http://www.globalhealthequity.ca/projects/proj_WHO/index.shtml.
Babb S. The social consequences of structural adjustment: recent evidence and current debates. Annu Rev Sociol. 2005;31:199–222.
Pfeiffer J, Chapman R. Anthropological perspectives on structural adjustment and public health. Annu Rev Anthropol. 2010;39:149–65.
Gallagher KP. Losing control: policy space to prevent and mitigate financial crises in trade and investment agreements. Dev Pol Rev. 2011;29:387–413.
Koivusalo M, Schrecker T, Labonté R. Globalization and policy space for health and social determinants of health. In: Labonté R, Schrecker T, Packer C, Runnels V, editors. Globalization and health: pathways, evidence and policy. New York: Routledge; 2009. p. 105–30.
Thrasher RD, Gallagher KP. 21st century trade agreements: implications for long-Run development policy, pardee papers No. 2. Boston: Frederick S. Pardee Center for the Study of the Longer-Range Fugure, Boston University; 2008. Retrieved from: http://ase.tufts.edu/gdae/Pubs/rp/KGPardeePolSpaceSep08.pdf.
Labonté R. The austerity agenda: how did we get here and where do we go next? Crit Publ Health. 2012;22(3):257–65.
Harvey D. A brief history of neoliberalism. Oxford: Oxford University Press; 2007.
Aihwa O. Neoliberalism as exception: mutations in citizenship and sovereignty. Durham: Duke University Press; 2006.
Peck J. Constructions of neoliberal reason. Oxford: Oxford University Press; 2010.
Bello W. The anti-development state: the political economy of permanent crisis in the Philippines. Pasig City, the Philippines: Anvil Press; 2009.
Delgado Wise R, Covarrubias H, Puentes R. Reframing the debate on migration, development and human rights. Popul Space Place. 2013;19:430–43.
Jenkins R. Globalization, production, employment and poverty: debates and evidence. J Int Dev. 2004;16:1–12.
Barrett C, Little B, Lafleur B, Beckman C, Hodgson G, Hoover G, et al. The world and Canada: trends reshaping our future [internet]. Ottawa: Conference Board of Canada; 2005. [cited on June 12 2014], Available from: http://www.gci.org.uk/Documents/CBOC.pdf.
Bank W. World development report 1995: workers in an integrating world. New York: Oxford University Press; 1995.
Dicken P. Global shift: reshaping the global economic Map in the 21st century. 4th ed. New York: Guilford Press; 2003.
International Labour Office (ILO). Economic security for a better world. Geneva: International Labour Organization; 2004.
Labonté R, Blouin C, Chopra M, Lee K, Packer C, Rowson M, et al. Towards health-equitable globalization: rights, regulation and redistribution, globalization knowledge network final report to the commission on social determinants of health. Ottawa: Institute of Population Health, University of Ottawa; 2007. [cited on June 12 2014]. Available from: http://www.who.int/social_determinants/resources/gkn_final_report_042008.pdf.
Polanyi M, Tompa E, Foley J. Labor market flexibility and worker insecurity. In: Raphael D, editor. Social determinants of health Canadian perspectives. Toronto: Canadian Scholars’ Press; 2004. p. 67–77.
Subramanian S, Kawachi I. Wage poverty, earned income inequality, and health. In: Heymann SJ, editor. Global inequalities at work: Work's impact on the health of individuals, families and societies. Oxford: Oxford University Press; 2003. p. 165–87.
Schrecker T. Labor markets, equity, and social determinants of health. In: Labonté R, Schrecker T, Packer C, Runnels V, editors. Globalization and health: pathways, evidence and policy. New York: Routledge; 2009. p. 81–104.
United Nations Centre for Human Settlements. Cities in a globalizing world: global report on human settlements 2001. London: Earthscan; 2001.
Castells M. The rise of the network society. Oxford: Blackwell; 1996.
Labonté R, Torgerson R. Frameworks for analyzing the links between globalization and health. Geneva: Switzerland: Globalization, Trade and Health Group, World Health Organization; 2003. [cited on June 12 2014]. Available from: http://www.globalhealthequity.ca/electronic%20library/Framework%20for%20analysing%20links%20between%20Globalization%20&%20Health%20-%20WHO%201-71%20Dec%2031%202003.pdf.
Labonté R, Torgerson R. Interrogating globalization, health and development: towards a comprehensive framework for research, policy and political action. Crit Publ Health. 2005;15(2):157–79.
Chang H-J. Policy space in historical perspective - with special reference to trade and industrial policies. Paper presented at queen Elizabeth house 50th anniversary conference. Cambridge: Faculty of Economics, University of Cambridge; 2005.
Cerny PG. Paradoxes of the competition state: the dynamics of political globalization. Govern Opposition. 1997;32(2):251–74.
Murdie R. Diversity and concentration in Canadian immigration. Toronto (ON): Centre for Urban & Community Studies, University of Toronto; 2009.
Way U. Vertical poverty: declining income, housing quality and community life in Toronto’s inner suburban high-rise apartments. Toronto: United Way Toronto; 2011.
Agence de la santé et des services sociaux de montréal. Report of the Director of Public Health: Social Inequalities in Health in Montréal. Montreal (QC); Direction de santé publique: Agence de la santé et des services sociaux de Montréal; 2011. Available from: http://publications.santemontreal.qc.ca/uploads/tx_asssmpublications/978-2-89673-131-2.pdf
Hulchanski D. Three cities within Toronto: income polarization among Toronto’s neighbourhoods, 1970–2005. Toronto: University of Toronto Cities Centre; 2010. [cited June 12 2014], Available from: http://3cities.neighbourhoodchange.ca/wp-content/themes/3-Cities/pdfs/three-cities-in-toronto.pdf.
Ley D, Lynch N. Divisions and disparities in lotus-land: socio-spatial income polarization in greater Vancouver, 1970–2005. Toronto: University of Toronto Cities Centre [Internet]; 2012. [cited on June 12 2014]. Retrieved from: http://neighbourhoodchange.ca/wp-content/uploads/2012/08/d5c3c1b62f243959bac02c874c633852.pdf.
Epstein G. Employment oriented macroeconomic policy and the challenge of outsourcing. Prepared for the New global division of labor: winners and losers from offshore outsourcing. South Hadley (MA): Mount Holyoke College; 2006. [cited on June 12 2014]. Available from: http://www.peri.umass.edu/fileadmin/pdf/Epstein_Mt.Holyoke_2006.pdf.
Milberg W. The changing structure of trade linked to global production systems: What are the policy implications? Int Labour Rev. 2004;143:45–90.
Rosen EI. Making sweatshops: the globalization of the US apparel industry. Berkeley: University of California Press; 2008.
Thun E. The globalization of production. In: Ravenhill J, editor. Global political economy. New York: Oxford University Press; 2008. p. 346–72.
Toronto Workforce Innovation Group. Innovative approaches to prosperity: shaping Toronto’s labour market, background paper. Toronto: MaRS Centre; 2010.
Ministry of Advanced Education, & Labour Market Development and BC Stats: A regional perspective on the BC economy – Mainland/Southwest. In A Guide to the BC Economy and Labour Market 2010. Vancouver: Ministry of Advanced Education, & Labour Market Development and BC Stats; 2010.
Stinson J, Pollack N, Cohen M. The pains of privatization: How contracting Out hurts health support workers, their families, and health care [internet]. Vancouver (BC): Canadian Centre for Policy Alternatives; 2005. [cited on June 13 2014], Retrieved from: http://www.policyalternatives.ca/sites/default/files/uploads/publications/BC_Office_Pubs/bc_2005/pains_privatization.pdf.
Slater T. Gentrification of the city. In: Bridge G, Watson S, editors. The New Blackwell companion to the city. Oxford: Blackwell; 2011. p. 571–85.
RBC Economics (CA). Housing Trends and Affordability [Internet]: Royal Bank of Canada (CA); 2011 [cited on June 13 2014]. Available from: http://www.rbc.com/newsroom/pdf/HA-1125-2011.pdf
Bryant T, Raphael D, Schrecker T, Labonté R. Canada: a land of missed opportunity for addressing the social determinants of health. Health Policy. 2011;101(1):44–58.
Hadi A, Labonté R. Housing and Health of Recent Immigrants in Canada: A Narrative Review. E/Exchange Working Paper Series, Public Health Improvement Research Network; 2011 [cited June 12 2014]. Available from: http://www.rrasp-phirn.ca/images/stories/docs/workingpaperseries/housing_and_health_of_immigrants_lcdraft_2_.pdf
Mason G. Confirmed losses on B.C,’s Olympic Village $230 million and rising. Globe and Mail [Internet]. 2011 Apr 12 [cited on June 12 2014]. British Columbia:[1 screen]. Available from: http://www.theglobeandmail.com/news/national/british-columbia/gary_mason/confirmed-losses-on-bcs-olympic-village-230-million-and-rising/article1981177/
Bula F. Property taxes won’t rise to cover Village losses, city says. Globe and Mail. [Online]. 2011 August 12 [Cited on June 12, 2014]; News:[1 screen]. Available from: http://www.theglobeandmail.com/news/national/british-columbia/property-taxes-wont-rise-to-cover-village-losses-city-says/article1981209/
Stuckler D, Basu S. The body economic: Why austerity kills. London: Allen Lane; 2013.
Fuentes-Nieva R, Galasso N. Working for the Few: Political Capture and Economic Inequality [Internet]. OXFAM International; 2014 [cited on June 12 2014]. Available from: http://www.oxfam.org/sites/www.oxfam.org/files/bp-working-for-few-political-capture-economic-inequality-200114-en.pdf
Ruckert A, Labonté R. The global financial crisis and health equity: early experiences from Canada. Global Health. 2014;10:2.
Standing G. The precariat: the New dangerous class. London: Bloomsbury; 2014. revised.
International Labour Office (ILO). Global employment trends 2014: the risks of a jobless recovery. Geneva: International Labour Organization; 2014. Available from: http://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---publ/documents/publication/wcms_233953.pdf.
Lewchuk W, Clarke M, de Wolff A. Working without commitments: precarious employment and health. Work Employ Soc. 2008;22:387–406.
Virtanen M, Kivimaki M, Joensuu M, Virtanen P, Elovainio M, Vahtera J. Temporary employment and health: a review. Int J Epidemiol. 2005;34:610–22.
Lewchuk W, de Wolff A, King A, Polanyi M. From job strain to employment strain: health effects of precarious employment. Just Labour. 2003;3:23–35.
Canadian Labour Congress (CA). Recession watch bulletin issue 5 spring 2011 [internet]. 2011. Available from: http://beta.images.theglobeandmail.com/archive/01262/Recession_Watch_1262159a.pdf.
Stanford J. The myth of Canadian exceptionalism: crisis, Non-recovery, and austerity. Alternate Routes. 2013;24:19–32.
Harvey D. The New imperialism. Oxford: Oxford University Press; 2003.
Schrecker T, Barten F, Mohindra KS. Metropolitan health in a globalizing world. In: Schrecker T, editor. Ashgate research companion to the globalization of health. Farnham, Surrey: Ashgate; 2012. p. 191–204.
Schrecker T, Labonté R. Globalization and urban health. In: Boufford J, Vlahov D, editors. Urban health: global perspectives. New York: Jossey-Bass/John Wiley & Sons; 2010. p. 13–26.
Goering P, Veldhuizen S, Watson A, Adair C, Kopp B, Latimer E, Aubry T, Nelson G, MacNaughton E, Streiner D, Rabouin D, Ly A, Powell G. National at Home/Chez Soi Final Report. Calgary (AB): Mental Health Commission [Online]. 2014 [cited on June 12 2014]. Available from: http://www.mentalhealthcommission.ca/English/node/24376
Jones C. Austerity should not be abandoned says Canada's Finance Minister. Financial Times [internet]. 2013 May 9 [cited June 12 2014]. Retrieved from: http://www.ft.com/intl/cms/s/3c92ceae-b8c6-11e2-869f-00144feabdc0,Authorised=false.html?_i_location=http%3A%2F%2Fwww.ft.com%2Fcms%2Fs%2F0%2F3c92ceae-b8c6-11e2-869f-00144feabdc0.html%3Fsiteedition%3Dintl&siteedition=intl&_i_referer=#axzz32S4qzMFU
Simpson J. A very scary PM:'I don't believe that any taxes are good taxes’. The Globe and Mail [Internet]. 2009 Jul 13 [cited on June 13 2014]; Globe Debate:[1 screen]. Available from: http://www.theglobeandmail.com/globe-debate/a-very-scary-pm-i-dont-believe-that-any-taxes-are-good-taxes/article787808/
McParland K. Thomas Mulcair learns only half the lesson of lower taxes. National Post [Internet]. 2014 May 20 [cited on June 12 2014]. Full Comment:[about 3 screens]. Available from: http://fullcomment.nationalpost.com/2014/05/20/kelly-mcparland-thomas-mulcair-learns-only-half-the-lesson-of-lower-taxes/
Commission on the Reform of Ontario's Public Services. Public services for Ontarians: a path to sustainability and excellence. Toronto: Ontario Ministry of Finance; 2012. [cited on June 12 2014]. Available from: http://www.fin.gov.on.ca/en/reformcommission/chapters/report.pdf.