One of the key principles of population and public health is social justice and equity. We recognize that inequalities in health exist, but that when they are unfair, unjust and preventable, they are unacceptable.
Moreover, we recognize that such health inequity is rooted in unacceptable inequalities in environmental, social and economic conditions.
These inequalities must be remedied not only because they are morally unacceptable, but because history has taught us that when such inequalities become unacceptable to a large part of the population, the result is social unrest, even revolution. Indeed, the remarkable social, political and economic reforms seen in Britain in the mid-19th century can be seen as the establishment’s largely successful attempt to fend off revolution.
So ever since I first heard it 30 years ago, I have valued a quote attributed to the philosopher Raymond Aron: “When inequality becomes too great, the idea of community becomes impossible.” If you want to create a healthier community, you have to address this issue head-on.
This is a thought worth considering when a billionaire has been inaugurated as U.S. president and has appointed other white male billionaires and millionaires to his cabinet, and when the World Economic Forum in Davos — an international organization for public-private co-operation — has again brought together the world’s “foremost political, business and other leaders of society to shape global, regional and industry agendas.”
Here, our own prime minister flies off on vacation to a billionaire friend’s private Bahamian island, while our premier, whose government has done very little to reduce poverty in B.C., until last week had happily taken an extra $50,000 annually on top of her salary, presumably just to make ends meet. While these Canadian examples are not in the same league as U.S. President Donald Trump, they all speak to the disconnect to which Aron was referring.
Timed to coincide with the Davos meeting, Oxfam released its latest figures on global — and Canadian — inequality, and they are staggering. They report that globally, “eight men own the same wealth as the 3.6 billion people who make up the poorest half of humanity,” while in Canada the two richest Canadians have as much wealth as the bottom 11 million.
But it is not just wealth where inequality is apparent. The Canadian Centre for Policy Alternatives also released a report this month saying that the top 100 CEOs earned an average of $9.5 million in 2015. This is almost 200 times the average industrial wage in Canada — and more than 400 times the average minimum wage.
We should question the basis for these excessive incomes; the CEOs might be improving the short-term bottom line, but if it comes at the expense of people, communities and the environment, as it often does, we should be penalizing them, not rewarding them.
It’s hard to imagine the super-wealthy, or even the wealthy, having much shared understanding of the situation of their fellow citizens. This is compounded by the deliberate strategy, coming from the right, of labelling people as taxpayers rather than citizens. As taxpayers, people focus on their taxes, and are encouraged to resent paying them; this makes tax-dodging and even tax evasion socially acceptable.
The whole point about community is a sense of shared identity and interest. But when the gap between the wealthy and the poor becomes so great, there is no “we,” just “them” and “us.” And pretty quickly “we” don’t want to pay for “their” children’s education, “their” health care, “their” public transit, roads or pavements.
But citizens, seeing themselves as part of a community, focus on their shared interests, common purpose and common good. They understand, as U.S. Supreme Court Justice Oliver Wendell Holmes put it a century ago, that taxes are the price we pay for civilization.
Revolution is an understandable response to exclusion and unacceptable inequality. Arguably, what we have just seen in the U.S. is a revolution, although in this case a revolution from the right — as was the case in Germany in the 1930s. But it’s not the best or healthiest way to change society.
Here in Canada, we still have time for evolution and reform. If we want healthier communities and a healthier society, we have to embrace that opportunity.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.