Upstream.PRS.Submission (PDF)

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Submission to the Canadian Poverty Reduction Strategy Consultation

Cody Sharpe, Policy Coordinator
28 June 2017

To provide context on the state of poverty in Canada, and recommendations on what measures
ought to be included in a Canada Poverty Reduction Strategy to build a healthy society.
While overall poverty rates are largely unchanged at the national level since the late 1980s, the
real story is that poverty is disproportionately experienced by specific populations. The diversity
of these populations, and the reality that poverty is a social condition with multiple facets (food
insecurity, income insecurity, systemic racism, etc.) suggests that a whole-of-government
approach ought to be embedded in the CPRS. Specifically, Upstream recommends adopting the
Health in All Policies framework of decision-making, along with new legislation mandating
implementation of the CPRS and a suite of supportive policy measures.
Upstream is a social movement committed to creating a healthy society by developing solutions
to health inequities. Collectively, social determinants of health (SDoH) like education, housing,
income, gender, ethnicity, and early childhood are primarily responsible for the health quality of
Canadians. These factors are not equally available to all, and inequities based on structural
factors are unacceptable in a just society. Upstream promotes this understanding of the factors
responsible for our collective health through social and traditional media1, 2, conferences3,
community campaigns4, podcasts5, and original reports to government6, 27, 28.
Action on poverty has occasionally received concentrated attention from the federal government,
with administrations in 1989, 2009, and 2015 all pledging to reduce or eliminate poverty within
certain populations. However, there has been a consistent implementation gap between these
pledges and the policies that would reduce the material experience of poverty. Consequently,
there has been little movement in the national poverty rate since the late 1980s, the first time a
federal government made a direct promise to eliminate poverty7, 8. Given that poverty, and being
lower-income in general, is a factor that has a profound effect on the health and wellbeing of
individuals, it is essential that this policy area be addressed.
National poverty rates hide the real story. In Canada, poverty is disproportionately felt by
identifiable populations. Children are particularly vulnerable, with Canada ranking 26th out of
35th wealth countries on a comparison of child poverty rates9. More than one-third of food bank
users are children, with food insecurity among children a severe problem in Canada’s north10, 11,
. First Nations are also over-represented in poverty statistics, with more than 60% of on-reserve
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Indigenous children living in poverty13. Other over-represented populations include seniors who
live alone, single parent families, and new Canadians14.
A legislative approach to poverty reduction would be an appropriate response to the
implementation gap, and there is Canadian precedent for such; Québec passed Bill 112, the Act
to combat poverty and social exclusion the early 2000s, in doing so committing the National
Assembly to develop a provincial poverty reduction strategy, establishing a provincial research
authority to monitor progress, and creating an annual reporting obligation for the Minister
responsible for the Act15. Similar bills have been developed for Manitoba and Canada, but neither
passed into law16, 17. Upstream is also involved with a group of non-profits in Saskatchewan who
are drafting a similar piece of legislation for the provincial government. Legislation would
demonstrate the gravity of the federal pledge to reduce poverty, recognize that pledges alone are
insufficient to sustain action over time, and provide an opportunity to formalize goals, timelines,
and evaluation methods.
Emphasizing poverty’s ill effects on health may also assist with closing the implementation gap,
in that improving health outcomes is an existing governmental priority. Poverty is related to
many other social determinants of health, such as working conditions, housing status and food
security. Poor quality housing increases exposure to biological, chemical and physical risks, with
children and Indigenous peoples in poorer households experiencing a disproportionate share of
these risks18, 19. Certain health conditions, particularly mental illness, may increase the likeliness
of living in poor quality housing or experiencing homelessness, making treatment more difficult
and costly20. Employment is no guarantee of food security, with seasonal, shift, and precarious
workers all experiencing higher rates of food insecurity and related chronic health conditions21.
The breadth of ways in which poverty affects the lives and health of Canadians suggests a wholeof-government approach is required to tackle the issue. Departmental boundaries inhibit the
implementation of holistic solutions, particularly in the absence of sustained, high-level
leadership and the creation of new structures and processes22, 23. Health in All Policies (HiAP) is
a promising approach to incorporating a health lens across government, a problem orientation
which emphasises the role of the SDoH in producing health24. As improving health outcomes is
already an objective of government, the challenge here is about providing education on how the
SDoH affect health, not justifying the pursuit of health through policy altogether. The World
Health Organization has produced an extensive array of tools and processes to facilitate the
spread of HiAP across government, including case studies on examples of successful
implementation25, 26. Upstream has produced similar materials for several Canadian provinces27,
Decision makers also need to be aware of how popular constructions of ‘deservingness’ can
shape policy outputs. For example, while children as a deserving population often emerge in
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formal discussions around food security, their parents receive less emphasis as a deserving target
of policy intervention; the same holds for other groups who experience health inequities29, 30.
Building a broad understanding of deservingness can be facilitated by early inclusion of
individuals with lived experience of poverty into formal decision-making processes. Going
beyond tokenism requires accommodations be made, specifically in terms of arranging
transportation, child care, and honorariums to compensate for lost working hours.
The prospective Canada Poverty Reduction Strategy is an opportunity to close the
implementation gap by establishing clear goals, timelines, policy tools and evaluation methods.
The CPRS will be valuable only to the extent that it commits this government – as well as its
successors – to these concrete actions. Upstream is eager to review the final strategy and find
ways to contribute to its success.

Adopt a Health in All Policies approach to decision-making across the Government of

Pass legislation committing the Government of Canada to reducing poverty by a specific
amount – according to a clear and commonly accepted indicator of poverty – and to
reporting annually on actions taken to achieve this goal.

Create opportunities for people with lived experience of poverty to participate in
decision-making processes around poverty reduction initiatives, and put in place the
infrastructure required to facilitate their participation.

Design, implement, and evaluate for broader implementation a national basic income
pilot, using similar program criteria as Ontario’s basic income pilot to facilitate cross-site
evaluations of impact on reducing poverty.

Work with provinces and territories to support existing evidence-based poverty reduction
initiatives, such as Newfoundland and Labrador’s Poverty Reduction Strategy.

Incorporate a clear focus on eliminating food insecurity into the upcoming National Food
Policy, along with targets, timelines, and concrete measures which will move Canada
away from relying on the charity model of emergency food distribution, ie. food banks.

Implement the calls to action of the Truth and Reconciliation Commission, specifically
those recommendations that will reduce poverty among Indigenous peoples, and adopt
Joradan’s Principle as a whole-of-government practice .

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1. Upstream. @UpstreamAction. Facebook page. Accessed online 28 June 2017:
2. Martin, Danielle; Meili, Ryan. “Basic income: just what the doctor ordered.” Toronto Star. 26
August 2015.
3. Upstream. Closing the Gap ’17: Better Health for All. YouTube playlist. Accessed online 28
June 2017:
4. LivingWage YXE. Home. Website. Accessed online 28 June 2017:
5. Upstream. UpstreamRadio. Website. Accessed online 28 June 2017:
6.Upstream; Saskatoon Health Region. Saskatoon Health Equity Impact Assessment. 4
November 2016. Accessed online 28 June 2017:
7. Campaign 2000. Federal Action Plan to Eradicate Poverty. 12 June 2007. Accessed online 28
June 2017:
8. Campaign 2000. A Road Map to Eradicate Child & Family Poverty. 24 November 2016.
Accessed online 28 June 2017:
9. UNICEF. UNICEF Report Card 13: Fairness for Children. 14 April 2016. Accessed online 28
June 2017:
10. Food Banks Canada. Hunger Count 2016. March 2016. Accessed online 28 June 2017:
11. PROOF. Children in Food Insecure Households. 2017. Accessed online 28 June 2017:
12. Achtemichuk, Lauren. Nunavut needs a sustainable food system. Upstream. 21 March 2016.
Accessed online 28 June 2017:
13. Macdonald, David; Wilson, Daniel. Shameful neglect: Indigenous child poverty in Canada.
Canadian Centre for Policy Alternatives. 17 May 2016. Accessed online 28 June 2017:
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14. Citizens for Public Justice; Canada Without Poverty. Dignity for All: A National AntiPoverty Plan for Canada. 3 February 2015. Accessed online 28 June 2017:
15. National Assembly of Quebec. Act to combat poverty and social exclusion. Légis Québec. 1
April 2017:
16. Legislature of Manitoba. Bill 204 – The social and anti-poverty act. 3rd Session, 39th
Legislature. 2008.
17. Parliament of Canada. C-545 – Act to Eliminate Poverty in Canada. 3rd Session, 40th
Parliament. 2010.
18. Breysse, Patrick; Farr, Nick; Galke, Warren; Lanphear, Bruce; Morley, Rebecca; Bergofsky,
Linda. "The relationship between housing and health: Children at risk." Environmental Health
Perspectives (vol. 112 no. 15). 2004: p. 1583-1588.
19. Dunn, James R.; Hayes, Michael V.; Hulchanski, J. David; Hwang, Stephen W.; Potvin,
Louise. "Housing as a socio-economic determinant of health." Canadian Journal of Public
Health (vol. 97, supplement 3). 2006: S11-S15.
20. Frankish, C. James; Hwang, Stephen W.; Quantz, Darryl. "Homelessness and health in
Canada: Research lessons and priorities." Canadian Journal of Public Health (vol. 96,
supplement 2). 2005: S23-S29.
21. McIntyre, Lynn; Bartoo, Aaron C.; Emery, JC Herbert. "When working is not enough: food
insecurity in the Canadian labour force." Public Health Nutrition (vol. 17, no. 1). 2012: p. 49-57.
22. Greaves, Lorraine J.; Bialystok, Lauren R. "Health in All Policies - All talk and little action?"
Canadian Journal of Public Health (vol. 102, no. 6). 2011: p. 407-409.
23. Greer, Scott L.; Lillvis, Denise F. "Beyond leadership: Political strategies for coordination in
health policies." Health Policy (vol. 116, no. 1). 2014: p. 12-17.
24. De Leeuw, Evelyne; Peters, Dorothee. "Nine questions to guide development and
implementation of Health in All Policies." Health Promotion International (vol. 30, no 4). 2014:
p. 987-997.
25. World Health Organization. Adelaide Statement on Health in All Policies. Adelaide,
Australia. 2010. Accessed online 28 September 2016:
26. McQueen, David V.; Wismar, Matthias; Lin, Vivian; Jones, Catherine M.; Davies, Maggie,
eds. Intersectoral Governance for Health in All Policies: Structures, actions and experiences.
World Health Organization: European Observatory on Health Systems and Policies. 2012.
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27. Fuller, Daniel; Folwell, Emily J.; Jones, Catherine; Sharp, Keisha; Meili, Ryan. Health in All
Policies: Description of tools and practices with recommendations for the Government of
Newfoundland and Labrador. Upstream: 2014.
28. Fuller, Daniel; Folwell, Emily J.; Jones, Catherine; Sharp, Keisha; Meili, Ryan. Health in All
Policies: Description of tools and practices with recommendations for the Government of
Manitoba. Upstream: 2015.
29. McIntyre, Lynn; Patterson, Patrick B.; Anderson, Laura C.; Mah, Catherine L. "Household
food insecurity in Canada: Problem definition and potential solutions in the public policy
domain." Canadian Public Policy (vol. 42, no. 1). 2016: 83- 93.
30. Kirst, Maritt; Shankardass, Ketan; Singhal, Sonica; Lofters, Aisha; Muntaner, Carles;
Quinonez, Carlos. "Addressing health inequities in Ontario, Canada: What solutions do the
public support?" BMC Public Health (17:7). 2017.

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