Gary Bloch, of St. Michael’s Hospital, answers questions about income inequality and how it affects people living with HIV.
The HIV Endgame conference logo appears on screen. Text reads: Gary Bloch answers questions on income inequality. Gary Bloch sits in front of a wood-paneled wall, answering questions from off-camera interviewers. The text of each question appears between clips.
Gary Bloch: So, I’m Gary Bloch. I work out of Saint Michael’s Hospital, primarily. I also do work with the homeless, so at the Good Shepherd homeless shelter in Toronto.
Q: What impact does poverty have on people living with HIV?
Bloch: Poverty is incredibly prevalent within the community of people living with HIV. I think there are probably many reasons for that. I think some of that marginalization comes from the communities that people are a part of before they ever contracted HIV, and that’s certainly part of the story, and you have to look at, kind of, people’s overall context.
I think some of the poverty has to do with, you know, people dealing with the fallout of living with HIV. And that’s personally and it’s also socially, right? I mean, the stigma the, you know, challenges to getting employment and maintaining it and these sorts of pieces. You know, the challenges, if you’ve been living for a long time with HIV, of walking in for a job interview with significant lipoatrophy on your face. I mean, you know, I mean there are many different pieces and elements to this that play in — but, you know, kind of sorting through all of that, you still reach this core fact of people — of a community living with significant social deprivation, right?
And significantly — and really falling down towards the bottom of social hierarchies in many different ways, and it’s not just about poverty — it’s about many social factors that can play in, which really do compound with each other. You know, and I think it just, to me, should raise the profile of this type of intervention within the HIV support and treatment community.
It is very hard to imagine truly seeing, you know, the kinds of positive outcomes we would like to see 10 or 20 years from now for people living with HIV, without making sure that they have just the basic social foundations for support. Because, you know you, can treat their HIV but, quite honestly, if they’re still living in poverty, living in substandard housing, and living with the stigma of being from multiple marginalized groups, they’re gonna feel the health impacts of that no matter what. So the HIV just becomes one little piece of what they’re facing from a health perspective.
Q: How much money do people actually need to be happy?
Bloch: So, the studies have pointed to numbers like, you know, as kind of $70,000 a year top out when it comes to the, kind of, money and happiness scales. Which I think is fine to look to. But I think what that doesn’t take into account is the inequality piece.
So, a good part of happiness in society comes from knowing that you’re not sitting at a way lower level than your neighbors, right? And than a bunch of people who live around you in your community, or in your city, or your province. Because that, in itself, holds stress, right? I mean, that leaves — and again, the evidence bears this out, right? That, if we know that we are sitting right down at the bottom of the scales of inequality, it may not matter whether or not we’re making enough to buy food or to pay our rent, because we still have the stress of feeling like we’re less worthy than all those people who are sitting higher up the scale.
So, you really need to look at it from two sides. I mean, absolutely, absolutely we need to raise people’s incomes. We also need to, kind of, start narrowing the gap between the rich and poor.
Q: Why do we hesitate to take steps that could end poverty?
Bloch: You kind of have to look historically, I think, to understand some of the, sort of, prevailing thinking about people who live in poverty in our society. And I say historically, I mean if you go just back to the 1970s, I mean, that’s where we really saw a political shift in our society towards, you know, what I think we can still call a kind of neoliberal agenda, right? This idea of really focusing in on enabling individuals to reach their maximum potential — this is, kind of, the language that that they would use — and starting to withdraw societal supports for people, right? So, it’s kind of dismantling social safety nets and leaving people to their own devices, right?
And so, we see things like cutting taxes on the rich, for instance, and then reducing welfare rates and reducing access to welfare programs. And, what this has meant is that there’s been this incredible increase in income inequality in our society, right? So we see this huge increase in the spread between the richest and poorest in our society, and that continues, right? And so — and, you know, not surprisingly people who have more money tend to have more influence on politics as well, and so, you know, we see an ongoing trend where politicians will kind of feed into these types of ideas and focus on austerity and, you know, pieces that really do not help people at the lower end of the income spectrum.
From a health perspective, and from a health evidence perspective, it’s pretty clear that if you look internationally, societies that have done the best job of resisting these types of trends, you know, even just looking at, sort of, what we call these, kind of, “developed” societies — I mean the, kind of, richer countries in the world, the ones that have done the best jobs at resisting these types of trends have the best overall health outcomes, right? So, they have the highest life expectancy. They have the best outcomes, like perinatal outcomes, lowest rates of infant mortality, as well as better outcomes when it comes to chronic disease management, etc. They’re also spending less, quite honestly, on health care, right? Because their populations tend to be healthier.
Canada does not fare so well in those international comparisons. We do very well when it comes to the, kind of, publicly funded hospital and physician care system that we have. The rest of it, not looking so great, right? So, we don’t have a great national housing support, we don’t have great income supports, we’re missing things like supports for medications on a universal basis, we’re missing things like a proper child care program, and there are many other ways to look at this. And this is having a real impact on health outcomes, right?
So, in an ideal world, we as health providers would be thinking at that level as well as thinking about what happens for individual patients. And we kind of have to, right? I mean, we can keep, sort of, digging around in the dirt not really making a lot of change, or we can start to really shift, you know, the shape of the sandbox, I guess. Really changing the way our society looks.
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Note on content: Interview questions have been edited for brevity.