journal7

Housing & Income as Social Determinants of

Women’s Health in Canadian Cities

Toba Bryant

1

, York University

KEYWORDS: HEALTH, WOMEN'S HEALTH, HOUSING, POLITICAL

ECONOMY

Health policy is increasingly conceptualized as concerned with broader

issues that influence health rather than simply focused on health care. One such

concern is with the social determinants of health which are the conditions in

which people live and work. Social determinants provide the context for

understanding population health and women’s health in particular. Especially

important to health are the social determinants of income and housing. This

article examines how income and housing policies interact with gender to

influence these social determinants of Canadian women’s health. It compares

income and housing data for unattached men and women of working age (18 to

64 years), couples with children, and female and male lone-parents in the

Montreal, Toronto, and Vancouver Census Metropolitan Areas (CMAs). The

study found that although the incomes of female lone-parents increased slightly

in Montreal and Toronto, female lone-parents and unattached females without

children continue to show higher rates of poverty than other groups. Female

lone-parents are the most socially and economically disadvantaged. Women’s

lower incomes provide the context in which health-related effects of housing and

income policies can be understood.

Health policy is increasingly being conceptualized as concerned

with broader societal issues that influence population health rather than

simply focused on health care. Related to this concept is the belief that

developing appropriate health policy has the capacity to both improve

population health and reduce the health inequalities that exist within

populations. Health policy should address the social determinants of

health, that is, the living conditions that include income, housing, food,

and employment security. Particularly important to health are the social

determinants of housing and income (Bryant, 2008). These specific social

determinants provide a key context for understanding the living

1

Inquiries about this manuscript should be forwarded to Department of

Sociology, York University, 4700 Keele St. Toronto, Ontario, M3J 1P3 (e-mail:

toba.bryant@sympatico.ca)

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conditions of the population in general but may have special relevance

for understanding the health of women (Armstrong, 2004).

Research has examined the specific health effects of housing

conditions (e.g., the relationships between mould and the development

of respiratory conditions, and between overcrowding and poor mental

health) (Bryant, 2008). But more thoughtful research has demonstrated

that housing conditions are closely related to low income, insecure and

low wage employment, and food insecurity suggesting that it is a

clustering of disadvantage in living conditions that contribute to poor

health (Shaw et al., 1999). As one example, Canadian women with low

incomes have serious housing needs and greater risk of living in unsafe

and unhealthy environments (McCracken & Watson, 2004). More

specifically, research has shown that urban housing conditions are

closely associated with violence against women (DeKeseredy &

Schwartz, 2002). One Canadian study found that 19.3% of women who

participated in the study public housing survey in eastern Ontario

reported experiencing one or more types of physical violence

(DeKeseredy et al., 2003).

Hulchanski’s study on Toronto neighbourhoods reveals

increasing neighbourhood polarization since 1970 (Hulchanski, 2007).

The polarization has resulted from changes in the economy, increasing

part-time and short-term jobs, and declining government income

transfers. The study found that three distinct cities within Toronto — the

wealthy, the middle, and the disadvantaged — primarily defined by

income had developed. Women are especially likely to be affected by

such developments (Davies et al., 2001). These adverse living conditions

and declining incomes — and their clustering — result from public

policy decisions (Bryant, 2008). Moreover, it appears that women are

especially susceptible to these adverse public policy decisions (Davies et

al., 2001).

For example, some provinces such as Alberta, British Columbia

and Ontario have removed rent control which had protected middle and

modest income households from high rents and helped maintain an

affordable rental housing market. In addition, federal and provincial

governments have withdrawn from social housing production and

provision (Bryant, 2008). More recently, the Ontario provincial budget

released in March 2009 reduced spending to the Ontario Ministry of

Municipal Affairs and Housing (Shapcott, 2009). Women, due to their

generally lower incomes — as compared to men — and caregiving

responsibilities within their families, are especially susceptible to these

adverse public policy decisions (Davies et al., 2001).

This study examined the housing and income situations of

Canadian women in three major urban areas. The objective is to aid

analysis of how these social determinants are shaped by gender and

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public policy. To accomplish this task, the study compared income and

housing indicators for men and women among different family types

living in Canada’s three largest Census Metropolitan Areas (CMAs):

Vancouver, Toronto and Montreal. The study was carried out within a

feminist political economy perspective.

Feminist Political Economy

Political economy is concerned with the cluster of institutions

and social relations that form political and economic systems

(Armstrong, 2008; Coburn, 2001, 2006). It considers how the

organization, production, and distribution of economic and social

resources — such as employment, health care, and housing, lead to

different exposures, i.e. different types of housing and environmental

conditions — that result in inequalities in health outcomes in a

population.

Feminist political economy adds a gender lens to this analysis. It

is a theoretical approach that, in addition to seeing political, economic,

social and ideological features of society as integrally connected, also

sees these features as being strongly gendered (Armstrong & Armstrong,

2003). Feminist political economy is concerned with the dominant

societal ideas about women and men and how these ideas are translated

into inequalities between women and men in power, influence,

resources, and health (Armstrong, 2006; Armstrong, 2008). Feminist

political economy applies its gender lens to focus on class, value, power

and political ideology as key factors that structure women’s access to

employment and financial resources within a society (Armstrong, 2001).

Feminist political economy is also a materialist approach because

it is concerned with women’s access to social and economic resources

such as income and housing (Doyal, 1995). It therefore provides an

excellent analytical approach for considering the social determinants of

health and the clustering of disadvantage associated with the social

determinants of health (Shaw et al., 1999). Feminist political economy

represents an under-utilized approach in the health inequalities field.

This is evidenced by the dearth of research that considers gender and

how it interacts with the social determinants of health to increase the risk

of adverse health outcomes (Bryant, 2005).

By applying a feminist political economy approach to analysis of

the social determinants of health, the multiple disadvantages

experienced by women becomes a focus. This study therefore examines

the multiple disadvantages experienced by women with a specific focus

on income and housing issues and how these are shaped by public

policy.

Figure 1 shows how a feminist political economy analysis can be

applied to a social determinants of health perspective. The figure does so

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by suggesting that political ideology — specifically neo-liberalism —

influences public policies and hence the distribution of economic and

social resources such as income and housing within a population. It

outlines the role of political ideology, politics, and economics and how

gender interacts with each of these. The figure calls attention to public

policies that affect housing affordability, and government income

transfers (i.e. pensions, social assistance, Employment Insurance)

spending on health and social programs which lead to citizens spending

more of their incomes on housing and other social determinants. These

public policy decisions in turn interact with social location (i.e. gender,

social class, race) to produce adverse quality social determinants of

health as a function of gender (women), social class (low-income

populations) and race (people of colour) that result in poor health

outcomes for these populations.

This analysis suggests that these populations will be more

vulnerable to regressive public policies that threaten the quality of these

social determinants of health. This perspective directs attention to the

Policies that reduce

availability of affordable

quality housing

Policies that reduce

availability of financial

resources

Health Status:

Increased morbidity and

mortality

Neo-liberal

Ideology

Social Location:

Gender, Class, Race

Direct material effects

of poor quality

housing

Direct material effects

of

low income

Stress

associated

with income

and housing

insecurity

Figure 1: Political Ideology, Public Policy, and the Social

Determinants of Health of Housing & Income

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relationship between health and the economic, political, and social life of

different people, geographic areas, or societies (Coburn, 2006). In

Canada, these key social determinants of health have been profoundly

influenced by changing policy environments that have increased income

and housing inequalities (Curry-Stevens, 2008).

Income Policy

The Organization for Economic Development and Cooperation

reports that Canada has had the greatest recent increases in income

inequality and poverty among developed nations (Organisation for

Economic Cooperation and Development, 2008). Several Canadian

studies have documented how the gap between high and low income

groups has come about (Curry-Stevens, 2008; Yalnizyan, 2007). In recent

years the federal government has offered numerous tax cuts which

disproportionately benefit high income groups. It has also ratcheted back

the welfare state by reducing public spending on support programs that

had previously allowed many families and individuals with low income

to live above the poverty line.

The reduction of the welfare state has been justified as enhancing

Canada’s economic competitiveness in the new global economy (Bakker,

1996; Scarth, 2004). The most notable aspect of this has been generally

stagnating wages among the lower 80% of Canadians (Yalnizyan, 2007).

Of particular note is the lack of any increase among the most vulnerable

— the lowest 20% of income earners. Much of this has to do with

minimum wages not keeping up with inflation, declining union

membership, and increasing casualization of labour in all sectors of the

Canadian economy (Tremblay, 2008).

These developments reflect the failure of income transfer

programs to distribute income and wealth more equitably across the

population as is the case in many other developed nations. As Yalnizyan

argues, the tax and transfer system in Canada had helped low-income

households stay out of poverty (Yalnizyan, 2007). The effect of reducing

income transfer programs has been to weaken the ability of many

families with children to live above the poverty line (Innocenti Research

Centre, 2005; Rainwater & Smeeding, 2003; Raphael, 2007a). The income

effects on poverty — strongly related to income inequality — and health

are well established (Auger & Alix, 2008).

Housing Policy

There have been significant changes in housing policy in recent

years. Most notable is the withdrawal of the federal and provincial

governments from social housing provision in the early 1990s (Shapcott,

2008). The provincial governments of British Columbia, Alberta and

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Ontario all removed rent control. The provincial government in Alberta

changed rent control to protect only seniors’ rental accommodation.

Non-elderly individuals and families with children therefore have no

protection from high rents. In the mid 1990s the Ontario government

replaced rent control with vacancy decontrol which removes rent control

one rental unit at a time (Bryant, 2004a; Bryant, 2008). As a rental unit

becomes vacant, landlords are free to increase rent without restriction.

The removal of rent control served to turn low-income renters into

disadvantaged consumers exposing them to the private rental market.

This has been associated with an explosion of evictions in major

metropolitan areas in Canada (Shapcott, 2008). The United Nation’s

special rapporteur on the right to adequate housing commented on

'Canada’s nation-wide housing crisis' as violating the international

human rights agreements that recognize housing as a human right

(Kothari, 2007). These agreements oblige governments that sign them to

initiate efforts to address problems. Canada signed these agreements and

has failed to take appropriate action to reduce the housing crisis that

affects many Canadians.

The ideology driving such policy changes — neo-liberalism —

considers rent control and social housing to be artificial barriers to the

proper functioning of the market (Bryant, 2004b). In short, the federal

and provincial governments have increasingly shifted to market

strategies in housing and other public policy areas. Governments have

justified these changes as necessary to allow the private sector to build

housing. There is concern that these changes have exacerbated the

housing crisis and the extent of homelessness in Canada (Bryant, 2008;

Shapcott, 2008).

Present Study

Income and housing may be especially important issues for

women. This is the case since women generally have lower incomes than

men and are more likely to be influenced by decaying public policy

environments concerned with income and housing issues (Davies et al.,

2001). Women’s economic vulnerability therefore makes them especially

susceptible to regressive changes in public policy. Women are not only

more likely to be poor than men, but in their role as caregivers of both

their children and other family members, women are most likely to be

affected by changes in policies on social assistance, employment

insurance, housing and health and social service provision (Agbayewa

et al., 1998; Armstrong, 2004; Cote, 1998; Townson & Hayes, 2007).

This hypothesis would be consistent with Fast and Keating’s

analysis of four key changes in the Canadian policy environment during

the 90s (and the present) (Fast & Keating, 2000):

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• Declining government expenditure on health, income security, and

social services;

• Thrust towards the privatization of health and continuing care;

• Change from institutional to community-based health and

community care; and

• Growing geographic inequity in health and social service delivery

across Canada.

These policy changes have had particularly adverse implications

for primary caregivers in families, the majority of whom are women. The

authors emphasize how these interact with women’s’ domestic

responsibilities.

The broad implications of these changes for women have been

considered in recent analyses of Canadian public policy directions

(Armstrong, 2004; Armstrong et al., 2002; Armstrong & Armstrong,

2002). Yet to be done is examination of the impacts of housing and

income policies on women’s housing situations. This is critical for

identifying means to improve the situation of women with low incomes,

thereby improving the determinants of their health.

This study therefore examines the vulnerability of Canadian

women to public policy changes by comparing the income and housing

situations of men and women in the three largest CMAs in Canada. More

specifically, it compares the incidence of low income and living in

poverty among men and women in two-parent families, lone-parent

families, and those who are unattached and aged 18 to 64 years. It also

examines the incidence of core housing need (see below) and the

proportion of income being allocated to housing by members of these

groups.

Methodology

Data were obtained from two sources. Canada Mortgage and

Housing Corporation (CMHC) provided national and Census

Metropolitan Area (CMA) indicators of housing expenditures and core

housing need of owners and renters in Vancouver, Toronto and

Montreal — the largest and most densely populated urban centres in

Canada — for 1998-2001, the years for which these data were available

(Canada Mortgage and Housing Corporation, 2001). This three-year

period was chosen for study because CMHC had undertaken a

comprehensive analysis of this period and was able to provide a

breakdown of data on the housing situations of women in various types

of households. They also provided data on the numbers of households

led by women living in adverse housing conditions, or core housing

need.

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Core housing need refers to households experiencing housing

difficulties. It exists when one or more of the following conditions is

present (Engeland et al., 2005):

• Affordability: tenants pay more than 30% of their gross income on

their housing.

• Suitability: tenants live in overcrowded conditions, whereby

household size exceeds recommended actual space.

• Adequacy: tenants’ homes lack full bathroom facilities, or require

significant repairs.

CMHC also calculates a shelter-to-income ratio (STIR) to assess

how much of household income is spent on housing (Engeland et al.,

2005). CMHC has earlier reported that renter households experienced a

larger increase in the average STIR growing from 27% to 30% compared

to owner households whose average STIR increased from 18% to 19%

between 1991 and 1996 (Canadian Mortgage and Housing Corporation,

2001). For this study, a special data run provided these indicators as a

function of gender for Canadians under 65 years of age for two-parent

households, female and male lone-parent households, and unattached

men and women.

Statistics Canada provided Census data on income for these

same population groups for 1998 to 2002 (Statistics Canada, 2005). These

data enabled comparisons among the groups of interest in the three

CMAs to determine the extent of women’s financial vulnerability with

respect to housing. These data facilitated analysis of how housing and

income policies interact with gender to affect women’s living conditions

in general and their housing situation in particular.

FINDINGS

The Current State of Women’s & Men’s Incomes

Income determines one’s ability to access housing, food and

other necessities of life (Auger & Alix, 2008). Historically, Canadian

women have earned one-half to two-thirds of men’s incomes and have

been more likely to live in poverty (Hadley, 2001). Women also represent

85% of all lone-parent families — an especially poverty-stricken group —

in Canada and more than 90% of poor lone-parent families (National

Council of Welfare, 2002b).

Table I shows the before-tax median incomes of unattached

males and females in 1998 to 2002 in Canada as a whole and in the three

CMAs. The national figures suggest that the gap during this period

between men’s and women’s was not as high as previously seen but still

significant. For unattached individuals, women’s incomes were almost

82% of men’s incomes in 1998 and increased to 88% of men’s incomes by

2002. The CMAs showed a mixed pattern.

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Table I: Median Incomes of Unattached Working-aged Women & Men in

Montreal, Toronto & Vancouver CMAs, 1998 to 2002

CMA/

Family Type

1998

1999

2000

2001

2002

Canada

Male

Female

31,700

25,900

32,400

28,700

34,200

27,800

34,800

28,800

34,800

30,500

Montreal

Male

Female

27,800

28,600

27,500

30,300

32,300

30,500

35,400

29,600

33,700

32,300

Toronto

Male

Female

43,300

32,300

41,600

45,300

44,800

39,600

46,100

39,700

41,600

43,700

Vancouver

Male

Female

37,300

29,300

39,100

28,000

39,100

29,900

37,600

33,100

35,900

36,100

Source: Statistics Canada. (2005). Before-tax incomes by household type and CMA, 1980

to 2002. Hull: CANSIM

Of the three CMAs, Montreal had the lowest median incomes for

all groups, and well below the national medians. Women’s incomes in

this CMA exceeded those of men from 1998 to 2000, falling by 2001 and

remaining slightly lower than men’s in 2002. Toronto had the highest

average incomes among the CMAs, and also showed the largest gap

between men’s and women’s median incomes with women’s incomes

tending to be less than those of men in 1998. However, the gap reversed

by 2002 when women’s median incomes exceeded those of men from

1999, but then fell again in 2000 and 2001. In Vancouver, women’s

incomes were less than men’s from 1998 to 2001, and then exceeded

those of men in 2002.

Table II shows median incomes of two-parent and lone-parent

families led by men and lone-parent families led by women for 1998 to

2002. Data for male lone-parent families were only available at the

national level. For Canada as a whole, median incomes of two-parent

families vastly exceeded those of lone-parent families. At both the

national and CMA levels two-parent families showed increases in their

relatively high median incomes throughout the period, lone-parent

households maintained their relatively low incomes.

Lone-parent families — of which female-led families constitute

the great majority — earned rather less than two-parent families. The

median incomes of these female lone-parents are consistently about 40%

to 45% of the median incomes of two-parent families across the three

CMAs between 1998 and 2002. Over the five years, the median incomes

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of female lone-parents increased modestly in Montreal and Toronto and

actually declined in constant dollars in Vancouver.

Table II: Before-tax Median Incomes of Families with Children by

Census Metropolitan Area, 1998 to 2002

CMA / Family type

1998

1999

2000

2001

2002

Canada

2-parent Families w/ children

Male Lone-Parent, one-earner

Female Lone-Parent, one

earner

77,000

49,500

30,600

78,200

48,300

31,100

81,000

52,400

33,900

82,800

49,500

35,600

83,000

49,900

33,800

Montreal

2-parent Families w/ children

Male Lone-Parent

Female Lone-Parent

75,500

N/A

29,900

74,900

N/A

29,300

80,200

N/A

32,600

80,800

N/A

35,500

86,800

N/A

32,400

Toronto

2-Parent Families w/ children

Male Lone-Parent

Female Lone-Parent

91,100

N/A

38,600

94,100

N/A

38,700

99,800

N/A

45,900

103,000

N/A

47,600

95,400

N/A

41,200

Vancouver

2-Parent Families w/ Children

Male Lone-Parent

Female Lone-Parent

85,800

N/A

37,000

86,400

N/A

30,100

87,400

N/A

35,700

88,900

N/A

31,700

84,700

N/A

36,900

Source: Statistics Canada. (2005). Before-tax median incomes by household type and

CMA, 1980 to 2002. Hull: CANSIM.

These data report median incomes and suggest that the

situations of unattached females showed significant improvement over

this time period. But increasing median incomes may reflect increases for

those at the top of the income distribution and stagnate at the lower ends

of the income distribution. Examination of the proportion of these

groups living at the lower end of the distribution may provide a more

sensitive measure of the income situations of the most vulnerable

households.

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Incidence of Low Income

Statistics Canada’s low-income cut-offs (LICOs) show the

incidence of low-income — i.e., relative poverty (although the LICOs in

reality are a curious blend of both absolute and relative poverty) —

among individuals and families (Statistics Canada, 2005b). The before-

tax LICOs reflect the situation where people spend significantly larger

proportions (>20%) of their incomes on food, shelter and clothing as

compared to higher income Canadians. Although Statistics Canada

states that LICOs are not poverty lines, many advocacy groups in

Canada use them in this way as they are consistent with international

measures of poverty (Raphael, 2007b). Table III shows the incidence of

low income (i.e. relative poverty) among two-parent families with

children, female lone-parent families (low income rates were not

available for male lone-parent families), and unattached males and

females (Statistics Canada, 2005).

Table III: Incidence of Low Income (Pre-tax) of Unattached Men and

Women, Two-parent & Lone-parent Families by City, 1998 to 2002

Geography/Family Type

1998

1999

2000

2001

2002

Canada

Unattached Male

Unattached Female

Two-Parent Families

Female Lone-Parent

33.9

43.7

12.3

55.1

35.3

42.4

12.0

51.9

30.3

41.7

11.2

47.6

29.0

39.4

10.3

44.9

28.2

35.0

10.1

51.6

Montreal

Unattached Male

Unattached Female

Two-Parent Families

Female Lone-Parent

44.1

43.9

27.2

62.6

43.2

40.0

20.1

62.6

33.1

39.8

17.3

54.9

26.8

40.3

15.9

47.2

24.7

30.0

11.5

57.6

Toronto

Unattached Male

Unattached Female

Two-Parent Families

Female Lone-Parent

25.5

29.8

12.7

56.3

30.6

31.2

14.7

46.9

21.4

28.6

15.0

41.6

23.3

24.5

10.2

32.6

20.0

25.7

13.7

50.8

Vancouver

Unattached Male

Unattached Female

Two-Parent Families

Female Lone-Parent

27.7

43.7

10.6

40.3

33.1

48.8

14.5

49.2

26.7

40.0

12.7

36.0

25.8

44.2

11.4

49.2

31.3

24.7

16.0

53.4

Source: Statistics Canada (2005). Low-income cut-offs, 1998 to 2002. Ottawa: Statistics

Canada.

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Overall, these data show lower poverty rates for unattached

males and two-parent families at the national level. A different picture

emerges in the CMAs. Poverty rates in the CMAs increased quite

markedly over the period, particularly for unattached females and

female lone-parent families. Unattached females continue to show

markedly higher rates of poverty than unattached males, particularly in

Montreal and Vancouver. The income situations of female-led families

continue to show strikingly high poverty rates across all three CMAs.

These poverty rates for female lone-parents were four to five times

higher compared to those for two-parent families, unattached males and

unattached females.

In 2002 Montreal and Vancouver had the highest incidence of

poverty for unattached females and female lone-parent families. The

incidence of low income among female lone-parents in Canada as a

whole was over 50% during the entire 1998 through 2002 time period.

The housing situation of this group mirrors these findings.

The State of Housing

As noted, one-third of all Canadian households live in the three

largest metropolitan areas of Montreal, Toronto, and Vancouver (Canada

Mortgage and Housing Corporation, 2001). The housing situation of

these key groups of Canadians—unattached males and females and lone-

parent male and lone-parent female households < 65 years of age — is

explored in a set of three key indicators.

The first indicator is that of core housing need. Overall in

Canada, 12.5% of total households < age 65 years have core housing

need (Engeland et al., 2005). The respective figures are 17.6% for

Montreal, for Toronto, 17.3%, and for Vancouver 16.2%. In Montreal, the

percentage of each group in core housing need is as follows: unattached

males (22% are in core housing need); unattached females (23% are in

need); female-led families (29% are in need) and male-led families (14%

are in need). To provide some indication of the magnitude of this

problem, unattached males constitute 13% of all Montreal households,

unattached females (12%); female-led families (10%) and male-led

families (2%).

Similar findings were seen in Toronto and Vancouver. In

Toronto, 21% of unattached males are in core housing need; 23% of

unattached females; 42% of female-led families, and 27% male-led

families have core housing need. The proportion of these groups in the

population are as follows: unattached males constitute 9% of all

households, unattached females (8.5%); female-led families (9%) and

male-led families (2%).

And in Vancouver, 24% of unattached males are in core housing

need; 22% of unattached females; 38% of female-led families and 23%

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male-led families are in need. Unattached males constitute 12% of all

households, unattached females (11%); female-led families (8%) and

male-led families (1.7%).

What are the income and income to housing costs of individuals

in core housing need in these CMAs? What role does renter versus

owner status play? In Montreal, 52% of households are owners versus

48% of renters. In Toronto 65% are owners vs. 35% renters. In

Vancouver 63% of households are owners and 37% are renters. Table IV

shows the income and housing cost situation of these groups in the three

CMAs. The average shelter-to-income ratio (STIR) provides an indication

of the extent to which housing costs dominate household budgets.

Spending more than 30% of income is seen as problematic by the

Canadian Mortgage and Housing Corporation and spending more than

50% is an extremely serious situation.

Table IV: Incidence of Core Housing Need of One-person (18 to 64

years) & Lone-parent Households, by tenure in Montreal,

Toronto, and Vancouver, 2001

Owners

Renters

City & Family Type

# of

Households

Avg. Income

Mthly. Shelter

Cost

Avg. Shelter-to-

income ratio

# of

Households

Avg. Income

Mthly. Shelter

Cost

Avg Shelter-to-

income ratio

Montreal

Male 1-person <65 yrs

Female one-person

Female lone-parents

Male lone-parents

3,800

3,400

3,365

540

12,902

11,801

17,381

17,325

560

531

741

778

57.3

55.4

53.9

56.9

27,480

27,035

27,885

2,650

9,804

10,468

14,932

15,246

419

448

538

531

55.3

355.3

47.9

46.6

Toronto

Male one-person

Female one-person

Female lone-parents

Male lone-parents

3,370

5,330

11,485

1,800

17,653

17,325

31,091

33,024

837

763

1,208

1,214

57.5

54.5

49.7

47.0

19,260

18,925

35,840

3,690

16,732

17,017

24,162

28,143

671

669

775

837

51.3

50.3

43.7

40.7

Vancouver

Male one-person

Female one-person

Female lone-parents

Male lone-parents

1,950

3,080

4,330

725

14,910

14,954

25,373

23,754

696

630

1,008

1,073

56.9

52.5

49.8

55.9

14,305

9,780

12,365

1,390

13,002

14,516

21,294

22,706

539

603

772

818

53.5

53.7

48.2

48.0

Source: Canada Mortgage and Housing Corporation. (2005). Census-based housing

indicators and data. Ottawa: Canada Mortgage and Housing Corporation.

Bryant: HOUSING, INCOME & HEALTH

14

All household types in core housing need have significant

housing affordability issues. Table IV shows that households in core

housing need spend — on average — at least 40% to 50% of their

incomes on housing. In Montreal for example, the median income of

unattached female households who are homeowners living in core

housing need — of which there are 3,400 – is $11,801. Of this sum, 55.4%

goes towards shelter costs. For unattached female renters in Montreal of

which there are very many more — 27,037 — their median income of

$10,468 leads to their spending 55% of income on shelter.

Focusing on female lone-parent households, Table IV indicates

that in Montreal there are 27,885 households whose median income is

$14,932 per annum. These figures show that these households allocate a

whopping 48% of income to housing costs. In Toronto, there are 35,840

female-led families living in core housing need whose median income is

less than $24,162 per annum. These families spend over 43.7% on their

shelter costs alone. A similar situation is seen in Vancouver. These

figures indicate an extremely serious housing affordability issue in

Canadian cities.

The households identified in Table IV are faced with very low

income and high housing costs. This suggests living circumstances of

poor quality social determinants of health of which income and housing

are the most obvious. These data also probably indicate greater

likelihood of precarious work situations, issues of food insecurity and

the presence of stress and anxiety about their housing conditions

(Bryant, 2008).

DISCUSSION

These findings indicate that while unattached Canadian women

and female-led families are vulnerable in the current economic

environment, their situation is not much different than that of their male

counterparts. There are, however, relatively few male-led families in

Canada indicating that the precarious income and housing situations of

lone-parent families in Canada is primarily a women’s issue. Many

Canadian women — and their children — are living in rather adverse

living conditions. The findings are consistent with other research on

women’s economic and housing situation in Canada: women are

especially at risk for experiencing poor quality income and housing

situations (CERA, 2002; McCracken & Watson, 2004; Rude & Thompson,

2001).

Some of the differences in income among women observed in

the CMAs may be attributable to different employment rates in each of

the provinces. For example, women in Ontario and British Columbia are

generally more likely to be working in paid employment than women in

Bryant: HOUSING, INCOME & HEALTH

15

Montreal (Canada Mortgage and Housing Corporation, 2001). These

employment patterns may explain the higher incidence of low income

and core housing need among women in Montreal CMA compared to

Toronto and Vancouver CMAs.

Nationally, more women than men live in poverty. The National

Council of Welfare attributes the differences in income between women

and men to the disadvantaged position of women in the paid labour

force (National Council of Welfare, 2002a, 2004). Women’s earnings are

usually lower compared with the earnings of men. They are also more

likely to have part-time jobs than men (Jackson, 2005). In 2003, 28% of all

women in the labour force, worked less than 30 hours per week at their

main job, compared to 11% of employed men (Jackson, 2005; Statistics

Canada, 2004). Seven in ten part-time employees are women. Part-time

workers are less likely to have benefits such as retirement benefits and

may also have lower job security compared to full-time workers. Most of

these part-time jobs are likely to be non-standard or precarious

employment (Jackson, 2005). Precarious employment is characterized as

having low remuneration, few or no benefits, and low job security.

These adverse income and housing situations experienced by

women have developed as a result of changing public policies that

directly affect the distribution of income and housing affordability for

women and other vulnerable populations. Government income transfers

to households provide additional income in the form of pensions,

welfare and unemployment benefits (Curry-Stevens, 2008). Government

transfers such as these equalize incomes as they increase the incomes of

those at the boom of the income distribution. Federal and provincial

governments have reduced income transfers which have resulted in

increasing income polarization as illustrated by Hulchanski’s study on

Toronto neighbourhoods and Yalnizyan’s work on changing incomes in

Canada (Hulchanski, 2007; Yalnizyan, 2007).

With respect to housing, as stated earlier, the federal and some

provincial governments withdrew from social housing provision during

the 1990s. In addition, the removal of rent control in some provinces

allowed significant increases in rents which contribute to affordability

issues for many medium- and low-income households. Although the

federal government advocates housing in international forums, back in

Canada it has enacted policies that contribute to increasing homelessness

in large urban centres in Canada in particular (Shapcott, 2008).

Research has also shown that Canada has one of the most

private-sector dominated market-based housing systems of any western

industrialized nation (Freeman, Holmans & Whitehead, 1996). It also has

the smallest social housing sector among western nations with the

exception of the United States (Hulchanski, 2002). Federal and provincial

Bryant: HOUSING, INCOME & HEALTH

16

governments’ policy decisions have contributed to the growing

polarization in income and housing in Canada.

In addition, women’s sanctioned role as primary caregivers

within their families may also contribute to their economic vulnerability.

This role renders them more economically dependent on their families as

caregiving interferes with employment (Armstrong, 2008). Additionally,

federal and provincial governments have changed eligibility criteria and

support levels for income support programs such as social assistance and

Employment Insurance that particularly disadvantage women. Stringent

work requirements in terms of hours worked for Employment Insurance

fail to take into account the nature of women’s relationship with the

labour market (Townson & Hayes, 2007).

Women are more likely to have frequent interruptions in their

employment to accommodate education, and child and other family care

responsibilities. Although they pay into the program while they are

employed, many are not eligible to receive benefits when they become

unemployed (Townson & Hayes, 2007). These policies can affect both

men and women, but women may be more at risk of having low income

and being in core housing need.

Policy Responses

A national housing strategy is needed to address the housing

needs of low income households (Shapcott, 2008). Public policies that

would protect incomes such as the federal and provincial governments

raising minimum wages to levels where living in poverty would not be

the outcome of full-time employment are also required. Canadian

governments could also devise strategies to reduce the number of non-

standard jobs in the Canadian economy (Curry-Stevens, 2008). In

addition to these policies, a universal affordable childcare program

would enable female lone-parents in particular to pursue education and

employment.

Governments should introduce measures that would protect

women’s incomes if they leave the labour force involuntarily or choose

to carry out caregiving roles. Related to this, Canada needs stronger

active labour market policies that would ensure that laid-off workers

receive training for alternative employment that provides a living wage

(Tremblay, 2008).

Implications for the Health of Canadian Women

Few studies consider gender in analyses of the impact of the

social determinants of health on women’s health (Armstrong, 2008). The

current field of women’s health is dominated by medically-oriented

investigations of issues such as access to care, risk factors for a variety of

Bryant: HOUSING, INCOME & HEALTH

17

physical and mental illness — usually reproductive-based — and the

prevalence of these conditions among marginalized populations (Bryant,

2005). The role public policy plays in shaping the social determinants of

women’s health is less advanced.

While women live longer than men, they report higher incidence

of most chronic diseases even after accounting for age (Pederson &

Raphael, 2006). Among women, most studies on health outcomes show

that women who are economically and socially marginalized have poor

health status and higher premature mortality than women with higher

income (Auger & Alix, 2008).

As one example, women with lower income have a higher

incidence of type 2 diabetes and higher mortality rates from this disease

as compared to higher income women (Hux, Booth & Laupacis, 2002;

Wilkins et al., 2002). The incidence of diabetes among low-income or

poor women (the lowest quintile) is almost four times that of the highest

income quintile women (Hux, Booth & Laupacis, 2002). And mortality

rates resulting from complications related to diabetes for poor women

are 57% higher for the lowest quintile women as compared to the

wealthiest quintile women (Wilkins, Berthelot & Ng, 2002).

CONCLUSIONS

The findings of this study show that housing and income

policies interact with gender to create especially adverse conditions for

unattached individuals and lone-parent families. This study has

identified a concrete situation where over tens of thousands of

households in Canada’s largest cities are living in material deprivation.

Women show greater disadvantage as indicated by higher poverty rates

and their much greater likelihood of leading lone-parent families.

Canadian public policies have done little to address these issues

(Yalnizyan, 2007).

These findings support the validity of the hypotheses suggested

by Figure 1. Political ideology is seen as influencing housing and income

policies. Ascendant neo-liberal approaches lead to reduced

governmental interventions in the economy. These policies serve to

reduce the availability of affordable housing and financial resources of

households to provide basic material needs. These policy decisions

interact with gender to lead to particularly poor quality social

determinants of health for women as compared to men.

To state the obvious, the least desirable action to improve the

social determinants of women’s health is to create situations of

disadvantage through housing and income policies that reduce the

affordability of housing and increase material deprivation.

Implementation of such policies may require the building of social

Bryant: HOUSING, INCOME & HEALTH

18

movements that will force policymakers to implement these policies

(Wright, 1994).

This study focused on gender. Race is also an important

consideration when examining income and housing issues among

Canadian women and this is especially the case in the large urban areas

studied here. Although the data to examine the income and housing

situation of women of Aboriginal and diverse ethno-racialized

communities were not available, research suggests it is likely that

women in these communities also experience the kinds of income and

housing insecurity presented here (Wallis & Kwok, 2008).

Future research can monitor the incomes and housing situations

of women with a focus on Aboriginal women and women of colour to

understand how gender, race and social class interact to affect the social

determinants of health of these groups. Such research can inform policy

debates on how to redress the inequities experienced by women in

general and specifically the inequities experienced by women of diverse

ethno-racial backgrounds living under conditions of low income.

REFERENCES

Agbayewa, M., Marion, S. & Wiggins, S. (1998). Socioeconomic factors

associated with suicide in elderly populations in British Columbia:

An 11-year study. Canadian Journal of Psychiatry, 43(8), 829-836.

Armstrong, H. & Armstrong, P. (2003). Wasting Away: The Undermining of

Canadian Health Care. Toronto: Oxford University Press.

Armstrong, P. (2001). Evidence-based health-care reform: Women's

issues. In P. Armstrong, H. Armstrong & D. Coburn (Eds.), Unhealthy

Times: Political Economy Perspectives on Health & Care in Canada (pp.

121-145). Toronto: Oxford University Press.

Armstrong, P. (2004). Health, social policy, social economies, and the

voluntary sector. In D. Raphael (Ed.), Social Determinants of Health:

Canadian Perspectives (pp. 331-343). Toronto: Canadian Scholars’

Press, Inc.

Armstrong, P. (2006). Gender, health & care. In D. Raphael, T. Bryant &

M. Rioux (Eds.), Staying Alive: Critical Perspectives on Health, Illness &

Health Care (pp. 287-304). Toronto: Canadian Scholars’ Press.

Armstrong, P. (2008). Public policy, gender & health. In D. Raphael (Ed.),

Social Determinants of Health: Canadian Perspectives (2nd ed., pp. 350-

361). Toronto: Canadian Scholars' Press.

Armstrong, P., Amaratunga, C., Bernier, J., Grant, K., Pederson, A. &

Wilson, K. (2002). Exposing Privatization: Women & Health Care Reform

in Canada. Toronto, Canada: Garamond.

Bryant: HOUSING, INCOME & HEALTH

19

Armstrong, P. & Armstrong, H. (2002). Thinking it Through: Women, Work

& Caring in the New Millennium. Halifax, Canada: Canadian Institutes

of Health Research, Nova Scotia Advisory Council on the Status of

Women, and Atlantic Centre of Excellence for Women's Health.

Auger, N., & Alix, C. (2008). Income, income distribution, and health in

Canada. In D. Raphael (Ed.). Social Determinants of Health (2nd ed.,

pp. 61-74). Toronto: Canadian Scholars' Press.

Bakker, I. (1996). Introduction: The gendered foundations of

restructuring in Canada. In I. Bakker (Ed.). Rethinking restructuring:

Gender and change in Canada. Toronto: University of Toronto Press.

Bryant, T. (2004a). Housing as a social determinant of health. In D.

Hulchanski & M. Shapcott (Eds.). Policy Options for an Affordable

Rental Housing Strategy for Canada. Toronto: Centre for Urban and

Community Studies, University of Toronto.

Bryant, T. (2004b). The role of political ideology in rental housing policy

in Ontario. Housing Studies, 19, 635-651.

Bryant, T. (2005). Towards a new paradigm for research on urban

women's health. Women's Health & Urban Life: An International and

Interdisciplinary Journal, 4(2), 68-95.

Bryant, T. (2008). Housing and health: More than bricks and mortar. In

D. Raphael (Ed.). Social Determinants of Health: Canadian Perspectives

(pp. 235-249). Toronto: Canadian Scholars’ Press.

Canada Mortgage and Housing Corporation. (2001). Census-based

Housing Indicators & Data. Ottawa: Canada Mortgage and Housing

Corporation.

Canadian Mortgage and Housing Corporation. (2001). Special studies on

1996 census data: Housing conditions in metropolitan areas. Research

Highlights, Socioeconomic Series (55-2).

CERA. (2002). Women & Housing in Canada: Barriers to Equality. Toronto:

Centre for Equality Rights in Accommodation.

Coburn, D. (2001). Health, health care, and neo-liberalism. In P.

Armstrong, H. Armstrong & D. Coburn (Eds.), Unhealthy Times: The

Political Economy of Health & Care in Canada (pp. 45-65). Toronto:

Oxford University Press.

Coburn, D. (2006). Health and health care: A political economy

perspective. In D. Raphael, T. Bryant & M. Rioux (Eds.). Staying

Alive: Critical Perspectives on Health, Illness & Health Care. (pp. 59-84).

Toronto: Canadian Scholars’ Press.

Cote, D. (1998). Who Will be Responsible for Providing Care? The Impact of

the Shift to Ambulatory Care & of Social Economy Policies on Quebec

Women. Ottawa: Status of Women Canada.

Curry-Stevens, A. (2008). When economic growth doesn't trickle down:

The wage dimensions of income polarization. In D. Raphael (Ed.),

Bryant: HOUSING, INCOME & HEALTH

20

Social Determinants of Health (2nd ed., pp. 41-60). Toronto: Canadian

Scholars' Press.

Davies, L., McMullin, J., Avison, W. & Cassidy, G. (2001). Social Policy,

Gender Inequality & Poverty. Ottawa: Status of Women Canada.

DeKeseredy, W., Alvi, S., Schwartz, M. & Tomaszewski, E. (2003). Under

Siege: Poverty & Crime in a Public Housing Community. Lanham, MD:

Lexington Books.

DeKeseredy, W. & Schwartz, M. (2002). Theorizing public housing

woman abuse as a function of economic exclusion and male peer

support. Women's Health & Urban Life: An International and

Interdisciplinary Journal, 1(2), 26-45.