I work in a busy, urban hospital in Canada. People come to our Emergency Department and Clinics because they suffer workplace accidents, or family violence, or flare-ups of chronic conditions. They are our patients because they live in inadequate housing, and eat poor diets, and work at brutish jobs if they are fortunate enough to have work, or struggle to qualify for income assistance or disability support if they are not. Our patients are worn down by years of low incomes and pervasive racism. Many struggle with self-harm, exacerbated by job losses associated with economic change. More hospital use is driven by bad luck than by faulty genes.
On days when I need a break from data, I drink coffee with patients like the thirty-five year old learning to cope after he lost his leg at the knee to diabetes, or the fifty-year old with multiple chronic conditions who looks decades older, or the young mother taking a break from the NICU where her little one, born way too early, struggles. I talk to patients who have been flown in for treatment from remote Northern reserves where First Nations people live in deep poverty. I meet people who are in the hospital because they have the great misfortune of being poor in a wealthy country that takes great pride in providing universal healthcare, but makes only a grudging effort to alleviate the ultimate cause of poor health.
A few years ago I began to look seriously for evidence that we can make the population healthier if we invest some of our healthcare budget upfront to address poverty, instead of downstream after poverty wears down bodies and minds. I remembered an old Basic Income experiment that took place in Canada in the 1970s called Mincome. That experiment, like others of the era, was primarily interested in whether the poor, given the option of a Basic Income, would work less. The experiment itself was a victim of changing governments, and its remarkable results went unknown for years. Labour economists in the 1980s showed that few people worked less – just as had been the case in the four contemporary US experiments, but they noted that pregnant women and “young unattached males” did work fewer hours. Married women were essentially using the Mincome stipend to buy themselves maternity leave at a time when the legal entitlement was only four (unpaid) weeks.
I went in search of the data, which I recovered in 1800 cardboard boxes. The old data tapes had become obsolete.
I also talked to participants. Those who were high school students during the experiment, like Eric Richardson, gave me my first clue: he didn’t work because he was in high school. Many of his friends were also the first in their families to graduate from high school. They all told similar stories: before Mincome, low-income families encouraged their adolescent sons to become self-supporting as soon as possible. After all, there were jobs for strong, young men in the 1970s – in agriculture and in manufacturing. Both of these industries have suffered in the past forty years, and it takes little imagination to realize that the lives of these young men who left school before graduating would include job loss, retraining and disruption. When Mincome was introduced, however, some of these families encouraged their young sons to stay in school a little bit longer. The opportunities these young men would have in the next forty years would be very different from those that greeted their older brothers and cousins.
The Richardson Family in the 1970s
I was less interested in labour than in health and wellbeing. Were these families happier and healthier? The participants certainly felt themselves better off. Amy Richardson, Eric’s mother who was widowed during the experiment, claimed that Mincome “made life easier. It was enough to add some cream to the coffee.”
Amy Richardson, 2010
My statistical work supported my instincts: people who had a BI available to them were less likely to be hospitalized and less likely to visit their family doctors. One key reason was improved mental health.
In 2017, the province of Ontario in Canada began an ambitious 3-year experiment with Basic Income. Ontario, like many provinces in Canada, spends more than 50% of its budget on healthcare. Premier Kathleen Wynne was genuinely concerned about the well-being of the population, the challenges of young families and especially the mental health of youth. However, at least some politicians were intrigued by the suggestion that one way to get escalating healthcare costs under control might be to address the ultimate cause of many interactions with the healthcare system – poverty.
- Evelyn L Forget, Economist and Professor of Community Health Sciences, University of Manitoba, Canada
Professor Forget is delivering a seminar on the relationship between basic income and health for the Glasgow Centre for Population Health on April 17th, 2018. You can book to attend here.