CJNR Guest Editorial Vol. 41, No. 2, June 2009
Poverty and Human Development
It is hard for us as nurses to escape the important role played by
poverty and human development. While this issue encompasses so much
of our work, paradoxically we often render it invisible in our practice
and our research. A defining moment for me occurred when I was working
in a psychiatric setting and the government introduced a policy of co-payment
for medications taken by recipients of public assistance. I recall the
rhetoric of the time: "It's only $2 per prescription. It will barely
make a difference." One consumer of mental health services came
to me with his bank book and detailed budgeting sheets. He had managed
to balance his budget by cutting back to two meals a day. He was taking
several medications, so the new policy was going to stretch his $800-a-month
disability income to the limit. He already had no discretionary income
and had given up his phone. He had identified two alternatives and wanted
input on which was the healthier choice: to cut down to one meal a day,
or to start taking his medications every other day.
Inadequate social assistance, disability payments, and minimum wages
across Canada still keep many of our vulnerable citizens in poverty
and force them to make difficult choices. In Ontario currently, a single
person receiving provincial disability support gets $1,020 per month
and a single person receiving welfare benefits gets $572. It is difficult
to pay for rent, utilities, transportation, clothing, and food with
these levels of support. I have researched issues related to income
support, adequate housing, and homelessness, since the people I work
for are struggling with these issues (Forchuk et al., 2007; Forchuk,
Ward-Griffin, Csiernik, & Turner, 2006).
This issue of CJNR addresses the complex subject of poverty and human
development. This topic has been addressed previously by the Journal,
in response to a call by the Council of Science Editors for all journal
editors to publish a special issue on poverty and human development
last autumn. This focus was in support of the Millennium Development
Goals set by the United Nations to reduce extreme poverty by the year
2015. The October 2008 issue of CJNR included several short reports
exemplifying the contributions of Canadian nurses to this worldwide
endeavour. The current issue goes into more detail, with lengthy reports
on those contributions.
Our present focus topic is certainly timely considering the global
economic challenges that we face today. These challenges will make the
2015 goal more difficult to achieve. For nurses, however, poverty is
a constant concern as a social determinant of health and as a barrier
to access to needed services and human development. Poverty underpins
many of the social determinants of health. For example, access to education,
housing, transportation, and social support is more difficult in the
absence of adequate income. When we see a client struggle with poverty,
it important for us to consider the impact of poverty on health, the
systemic issues at play, and the worldwide effort to address poverty
and human development.
In the pages that follow, Dennis Raphael provides an excellent overview
of the concept of poverty, including current research aimed at understanding
and addressing this problem, such as through appropriate public policies.
He highlights the need for wider dissemination of findings and for advocacy
to ensure their implementation.
Two of the contributions in this issue of the Journal address homelessness.
Manal Guirguis-Younger and colleagues examine knowledge-integration
strategies employed by nurses and other care providers in assisting
people who are homeless. Miriam Stewart and colleagues evaluate a strategy
for promoting health and coping among homeless youths. Jodi Hall and
Lorie Donelle look at methodological issues with respect to another
vulnerable group, women serving court-mandated probation or parole orders.
However, all of the articles identify, to some extent, the difficult
methodological issues that can arise with research in this area.
The Happenings column gives us reason to hope for changes in both policy
and practice. Myra Piat and colleagues present an overview of initiatives
launched by the newly formed Mental Health Commission of Canada to specifically
address issues related to homelessness and mental health.
Nurses can play a key role in advocating not only for our individual
clients but for change within the systems in which we operate. To achieve
visibility on this front, we need to proclaim loudly that poverty is
a health issue and therefore a nursing issue. We hope that this focus
issue of CJNR will raise the profile of poverty and human development
and will prove to be an opportunity for thoughtful reflection on how
we can best participate in the necessary processes of change. How can
nursing research contribute to the goal set by the United Nations for
2015? As we continue to identify the specific issues, we must work across
sectors (health, social welfare, housing, and corrections, to name but
a few) to develop and test programs and policies that support human
development by reducing poverty. We need to cast our eyes higher and
resolve to address the problems not just one person at a time, or even
one system at a time, but through the entire web of systems that together
serve to perpetuate poverty.