Upstream Health Project

Violence Against Children: A Hidden Driver of Lifelong Inequity

Wed, 07 Oct 2026 19:18:28 GMT

About one in two children worldwide experience violence each year — most often at home. Why this is a public health issue, not just a criminal justice one.

A note before you read: this post discusses violence against children, including sexual abuse, and includes statistics some readers may find difficult. If you or a child you know is currently in danger, please contact emergency services. Resources for support are listed at the end of this post.

For a fuller discussion of how we overspend on medicine compared to other government functions, see [Where Do Our Tax Dollars Go?]

In this series, we have explored how early life conditions — poverty, housing, and food insecurity — shape health across the lifespan. Another critical, and often less visible, upstream factor is violence against children.

Violence is a complex and deeply harmful phenomenon. It includes physical, emotional, and sexual abuse. And its reach is far greater than many of us are comfortable acknowledging.

Globally, about one in two children experience some form of violence each year. Even more troubling, two in three experience violence regularly within their own homes — the very places where they should feel safest.

The Scale and Severity of Harm

The consequences of violence against children are profound and, in many cases, life-threatening.

They include:

Physical injury and disability
Mental health challenges such as anxiety, depression, and trauma
Sexually transmitted infections and unintended pregnancy
Developmental and behavioural difficulties
And, at times, death

Every four minutes, a child dies somewhere in the world as a result of violence.

Sexual violence alone affects staggering numbers of children. Globally, approximately one in four or one in five girls experiences sexual assault each year. For boys, the estimates range from one in seven to one in eleven. Boys, meanwhile, are more likely to die as a result of violent acts in general.

Violence is not only destructive in the moment — it is also cyclical. Children who experience violence are more likely to engage in or be exposed to violent interactions later in life, perpetuating harm across generations.

A Canadian Reality

While these global figures are alarming, Canada is not immune.

In 2019 alone, approximately 70,000 children in Canada were victims of violence serious enough to involve police. The majority — about 57% — were girls.

Much of this violence occurs close to home:

About one-third of incidents involve parents
Approximately 15% occur between siblings

These are not distant or isolated events. They are happening within families and communities across the country.

Beyond Immediate Injury

When a child is physically harmed, the medical system often becomes involved. But the visible injuries are only part of the story.

All children who experience violence are at risk of long-term health consequences, including:

Chronic stress and its biological effects
Increased risk of mental illness
Challenges with learning and social development
Higher likelihood of substance use and risky behaviours
Long-term impacts on physical health

As we have discussed throughout this series, early adversity shapes lifelong outcomes. Violence is one of the most powerful and damaging forms of that adversity.

Violence as an Upstream Health Issue

Too often, violence is treated as a criminal justice issue alone. While legal responses are essential, they are not sufficient.

From an upstream health perspective, violence against children often is a preventable risk factor — one that must be addressed at its roots.

This means looking beyond individual incidents and asking:

What conditions increase the risk of violence?
What supports can reduce stress within families?
How can communities create safer environments for children?

Violence does not occur in a vacuum. It is closely linked to many of the other issues we’ve explored — poverty, housing instability, and social isolation.

Connecting Back to Upstream Health

If we are serious about improving population health, we cannot ignore violence against children.

It is a moral issue and a foundational health issue.

What Can and Is Being Done

In Chicago, they are replacing guns and education with jobs. Over four years, in communities where the program has been introduced, rates of gun violence have decreased 33%. 1 In Milwaukee, they are framing gun violence as a public health issue. This is called 414LIFE, and it endeavours to root out the first signs of violence — like immediate action at the first signal of an infectious disease spreading. 2

What Can You Do

Learn about conflict resolution skills.

If this post raised anything difficult for you:

Kids Help Phone (Canada, ages up to 20, 24/7, confidential): call 1-800-668-6868 or text CONNECT to 686868
If a child is in immediate danger, call 911 or your local emergency services
To report suspected abuse or access support in your province, contact your local child welfare services

1. https://reasonstobecheerful.world/the-transformative-power-of-replacing-guns-with-jobs/

2. https://reasonstobecheerful.world/police-violence-coronavirus-public-health/

Universal School Food Programmes: An Upstream Solution to Childhood Inequity

Wed, 30 Sep 2026 19:09:54 GMT

One-third of food bank users in Canada are children. Universal school meal programmes are a proven, practical way to break that cycle — starting in the classroom.

For a fuller discussion of how we overspend on medicine compared to other government functions, see [Where Do Our Tax Dollars Go?]

In previous discussions, we explored how poverty shapes health — especially for children. We looked at how early life conditions create pathways that influence education, wellbeing, and opportunity across the lifespan.

Food insecurity is one of the most immediate and visible expressions of that inequality.

Food insecurity in Canada is growing rapidly and becoming impossible to ignore.

In March 2024, more than 2 million people in Canada relied on food banks. That represents a staggering 90% increase since 2019 — in just five years. Even more concerning is who these numbers represent: one-third of food bank users are children.

That means millions of children across the country are going to school hungry or relying on the less nutritious food available in foodbanks.

For many, there is no packed lunch waiting in their backpack. No reliable breakfast before the school day begins. And without adequate nutrition, children are asked to do something incredibly difficult: focus, learn, and succeed while their basic needs remain unmet.

Hunger in the Classroom

Hunger affects far more than just physical health. A child who is hungry struggles to concentrate, retain information, and regulate emotions. Over time, this can translate into lower academic achievement, behavioural challenges, and reduced confidence.

The classroom, ideally a place of growth and opportunity, can instead become a place of struggle.

And yet, this is a solvable problem.

A Simple, Powerful Solution

Universal school food programmes offer a clear and effective response.

In countries and regions where these programmes exist, children can arrive at school without food — and still receive a healthy breakfast with a side of community and dignity.

When done well, school meals are:

Nutritious, with fresh fruits, vegetables, and adequate protein
Locally sourced, supporting nearby farmers and food producers
Warm and comforting — especially important during Canadian winters
Available for everyone, removing stigma and ensuring no child is singled out

Children don’t just benefit from these programmes — they often love them. Shared meals can become a positive part of the school day, fostering social connection and a sense of belonging.

With support, shared meals can become an opportunity to learn about inclusion and acceptance of difference.

More Than Food: A Community Investment

Universal school food programmes can be economic and community-building tools.

By sourcing food locally, these programmes can:

Provide stable income for farmers, fishers, hunters and so on
Create jobs in food preparation, delivery, and program coordination
Strengthen local food systems and knowledge of same

This creates a “win-win” situation: children are nourished, families are supported, and communities become more resilient.

Long-Term Health, Lifelong Impact

The benefits of proper nutrition in childhood extend far beyond the school years.

Healthy food supports:

Physical growth and immune function
Brain development and cognitive performance
Emotional regulation and mental wellbeing

Over time, these benefits translate into better health outcomes, improved educational attainment, and greater opportunities in adulthood.

In other words, feeding children today is an investment in the future health of our society.

Moving Upstream

If we are serious about addressing poverty and health inequities, universal school food programmes are a practical and evidence-based investment.

They address an immediate need — hunger — while also tackling its long-term consequences. No child should have to try to learn on an empty stomach. No teacher should have to compensate for hunger in the classroom. And no country as wealthy as

Canada should accept this as normal.

The question is not whether we can afford to implement universal school food programmes. It is whether we can afford not to.

What Can and Is Being Done

There are government-supported lunch and breakfast programmes in various parts of the world. Sometimes the students become involved and help in fundraising, packing, and serving food and the like. Another interesting initiative pairs learning about sustainable foods with access to food, such as the programme featuring fresh seafood from Monterey Bay. 1 Helping school children by providing them with fresh seafood also enables fishers to count on steady markets. 2

What You Can Do

Read about this programme in Kenya. 3 Volunteer at your local school for lunchtime duty.

1. https://reasonstobecheerful.world/sea-to-school-monterey-bay/

2 . https://reasonstobecheerful.world/the-spark-kids- making -meaningful-change-in-communities/

3 . https://reasonstobecheerful.world/kenya-giga-kitchen- school -meals/

The Health Benefits of Nature: Is a Walk in the Park Good Medicine?

Wed, 23 Sep 2026 19:02:39 GMT

Doctors are now prescribing time outdoors. Here's what the research says about green space, and why nature might be one of the most underused tools in preventive health.

For a fuller discussion of how we overspend on medicine compared to other government functions, see [Where Do Our Tax Dollars Go?]

What if one of the most powerful health interventions wasn’t found in a pill bottle or in surgery — but just outside your door?

In 2013, the Toronto Board of Health made a striking recommendation: for the sake of public health, Toronto should aim to maintain 40% green cover across the city. This wasn’t about beautification. It was about disease prevention, wellbeing, and the kind of everyday health support that doesn’t require medical intervention.

The city’s Strategic Forest Initiative highlighted something many of us intuitively feel but often overlook — access to nature is deeply therapeutic. Green spaces encourage physical activity, invite social connection, reduce stress, and restore our cognitive energy. They offer shade on hot days, cleaner air to breathe, and a subtle but powerful shift in how we experience our environment.

The Evidence

And this isn’t just theory. The research is remarkably consistent. Access to green space has been linked to lower mortality rates, reduced cardiovascular disease, lower obesity rates, and improved mental health. Perhaps most compelling: people living in greener neighbourhoods tend to live longer — even when compared to communities with similar income levels. This pattern has been observed across countries, suggesting something fundamental about the human relationship with nature.

One particularly memorable study found that planting just ten additional trees on a city block produced a health benefit comparable to a $10,000 increase in annual income for each householder — or the feeling of being ten years younger. It’s a poetic finding, but also a practical one. Small environmental changes can yield meaningful health returns.

So powerful is this body of evidence that medicine itself is beginning to adapt. Through initiatives like PaRx, physicians are now prescribing time in nature as part of treatment plans. The recommended “dose”? About two hours per week, or roughly 20 minutes a day.

Even Parks Canada has become part of this movement. In partnership with healthcare providers, some patients can now receive free park passes — an acknowledgment that access to nature isn’t just a luxury, but a legitimate component of care.

Why Isn’t This More Central to Healthcare?

All of this raises an important question: if we know that nature supports health so effectively, why isn’t it more central to how we think about healthcare?

A walk in the park may not replace medical treatment — but it may reduce the need for it. It may ease anxiety, lower blood pressure, improve mood, and reconnect us to something steady and grounding in an increasingly fast-paced world.

In a healthcare system that often focuses downstream — on treating illness after it appears — green space offers an upstream solution. It’s preventative, accessible, and remarkably cost-effective.

So yes, a walk in the park might just be good medicine.

And perhaps the more important question is not whether it works — but what we can do to take this research finding more seriously.

What Can and Is Being Done

In 1982, Japanese doctors began prescribing “forest bathing.” In New Zealand, green prescriptions are a formal part of health care. And since 2017, green prescriptions have been available in part of the US. In this spirit, Canada now provides free access to parks (PaRx) for a certain number of doctors in certain provinces. As of the publication date of this resource, 4,000 prescriptions had been written by 10,000 doctors. And the Canadian Medical Association has officially endorsed this! 1

What You Can Do

Take a walk in a park.

1. https://reasonstobecheerful.world/green-prescriptions-health-nature-parks

Where Do You Live? Why Housing Is Health Care

Wed, 16 Sep 2026 18:56:54 GMT

Nearly 30% of people in Canada live in insecure, unsafe, or inadequate housing. Here's why where you live may matter more to your health than any doctor's visit.

For a fuller discussion of how we overspend on medicine compared to other government functions, see [Where Do Our Tax Dollars Go?]

When we think about health, we tend to picture hospitals, doctors, and medications. But one of the most powerful determinants of health is much closer to home — literally.

Housing is a health issue.

In Canada, nearly 30% of people live in housing that is insecure, unsafe, or inadequate. That’s a widespread condition shaping the health of millions. And the evidence is remarkably consistent: access to safe, stable, and suitable housing has a direct and lasting impact on physical and mental well-being.

So what makes housing “good” from a health perspective?

Four Elements of Healthy Housing

There are four key elements: condition, size, affordability, and neighbourhood. Each one plays a distinct role, and when even one is missing, health begins to suffer.

Condition. Start with the physical condition of a home. Substandard living environments — excess heat or cold, mold, leaks, pests, asbestos, radon, or exposure to volatile organic compounds — can directly cause disease. These risks translate into higher rates of respiratory illness, cardiovascular strain, and chronic conditions that often end up being treated downstream in the medical system.

Space. Overcrowded housing isn’t just uncomfortable — it’s a public health concern. Close quarters facilitate the spread of infectious diseases and can place enormous strain on mental health, particularly for families without access to private or quiet space. Think COVID, and the high rates of the disease found amongst those who lived in denser quarters, such as multigenerational households.

Affordability. When too much income goes toward housing, people are forced to make trade-offs — cutting back on food, recreation, transportation, medications, or other essentials. The stress of financial insecurity compounds the problem, contributing to anxiety, depression, and other long-term health consequences.

Neighbourhood. Where you live shapes how you live. Access to public transit, grocery stores, community centres, and green space all influence daily habits and overall well-being. On the flip side, living near high-speed roadways or in areas with high pollution exposes residents to harmful particulate matter, persistent noise, and environmental stress. These factors have powerful effects — conditions like asthma and other respiratory illnesses are both triggered and worsened by proximity to heavy traffic.

Housing Shapes Futures, Not Just Present Health

The impact of housing goes beyond immediate health outcomes. It also shapes life trajectories.

In one landmark study, children who moved out of poor housing in poor neighbourhoods into better housing environments were significantly more likely to attend college and went on to earn higher incomes over their lifetimes, compared to those who remained in low-income housing. The implications are profound: improving housing conditions doesn’t just change present circumstances — it alters futures.

This is what upstream health looks like.

If we are serious about improving health outcomes and reducing pressure on the medical system, we cannot ignore housing. Investments in safe, affordable, and well-located housing are not just good social policy — they are good health policy. They are prevention in its most practical form.

Because where you live should not determine how healthy you are.

But right now, for far too many people, it does.

What Can and Is Being Done

“Housing First” is a policy which begins all interventions to assist vulnerable people by finding housing first, then supporting people from that stable base into getting a job, planning meals and buying groceries, getting a doctor, dentist, and optometrist, and so on. In this model, housing is the first step! And it has worked in decreasing the numbers of unhoused people in communities. It has also brought along all kinds of other benefits to health and well-being.

New York City has introduced a plan for preventing homelessness: a risk assessment tool used to predict who might be on the verge of homelessness, and then to put supports in place to avoid that outcome — for example, paying for utilities, linking people to job training programmes, and finding volunteer lawyers to dispute unfair evictions. 1

What Can You Do

Get better informed. Find out the cost of an average rental accommodation in your community. How much do people living on government subsidies such as employment insurance, disability insurance, or pension plans receive? Is housing affordable with this level of support? Speak up and vote on the basis of information such as this.

1. https://reasonstobecheerful.world/homebase-program-prevents-homelessness-in-new-york-city / n/

The Cost of Growing Up Poor

Wed, 09 Sep 2026 16:13:43 GMT

More than 800,000 Canadian children are growing up in poverty — and the health effects don't stay in childhood. They accumulate across a lifetime.

For a fuller discussion of how we overspend on medicine compared to other government functions, see [Where Do Our Tax Dollars Go?]

As of 2025, more than 10% of Canadian children live in poverty. That amounts to more than 800,000 individual lives. These figures are based on the poverty lines drawn by the federal government. If a more generous definition is used for the poverty line, the estimates would be higher — including more than 1.4 million children.

Children living in certain situations are more likely to be impoverished. For example, almost half of children (45.2%) who live in one-parent households live in poverty. More than half of children living on reserve live in poverty. Income inequality is high, and in the wider context, disparity is enormous: the top 10% of families in Canada have an average of 19 times the income that the bottom 10% have. 1

The Health Consequences Begin Early

We have talked briefly about the material and the social consequences of poverty for health. Is there anything different about children? No — except that the negative health consequences begin early.

Children growing up poor have higher rates of asthma, malnutrition, anxiety, and other mental health issues. They are vulnerable to marginalization in school if they don’t have the “right” lunch, or school supplies, or they can’t afford to go on trips with their classmates. They may be more likely to have learning delays, possibly resulting from a lack of school-aligned and preparatory things like books in their homes. Lifelong emotional and psychosocial problems can also arise from the uncertainty of living with material insufficiencies.

Disadvantage Accumulates

All of these issues, and more, cause greater problems when they occur in children, because they can set children on a path through the whole of life. From the very beginning they face challenges in school, can’t keep up with their peers, and fall behind educationally, in extra-curricular activities, and in many other aspects of life. These issues accumulate over time, making the inequality of childhood even greater as the child becomes an adult.

Early life events have significant consequences for health and wellbeing. For example, a child who goes to school already comfortable with books, because they have been read to, begins the early grades with a learning advantage. This advantage generally results in greater success in primary and secondary school and beyond. Educational achievement is linked to health literacy, income, job stability, and ultimately to disease, disability, and death.

Being born underweight is also more common in poorer circumstances, and leads to a greater likelihood of experiencing various physical and mental hardships such as disease and disability. The effects of these disadvantages accumulate over time.

Children born into poverty may face housing inadequacies and uncertainties. They may confront homelessness and rely on foodbanks for their meals. They may lack diets full of nutrient-rich foods because of living in a fresh food desert. They may have to get most of their nutrition from unhealthy ultra-processed foods. Their neighbourhoods may lack green spaces and community centres for play and sports — places to congregate that are more common in neighbourhoods of higher socio-economic level.

And so, being born into an impoverished situation can have many more problematic and accumulative consequences than coming into poverty later in life.

What Can and Is Being Done

So-called kangaroo mothers and babysitting co-ops are among the local interventions for impoverished children and families described by Reasons to be Cheerful. The first is the story of volunteers who hold especially vulnerable babies skin to skin. This is done by both women and men in communities in India. 2 It’s especially important for babies born early and underweight, who are at risk of a number of different diseases. Sometimes these babies are placed in an incubator, and at other times incubators aren’t available. About 10% of babies born worldwide are premature and underweight. This intervention improves the immune system and the healthy functioning of newborns, and sets them on a healthy pathway.

A community-based shared babysitting service in Philadelphia, Pennsylvania is another innovative model designed to help parents living in poverty to work or engage in recreation. Using a point system to equalize the contributions, parents help each other out with childcare. Such community-based and supportive programmes have the capacity to enable single parents, especially, some possible avenues toward employment and improved mental health. 3

What Can You Do

Think about and do research on what political party has the best ideas for alleviating short-, medium-, and long-term income inequality and building a more equitable society.

You can help by advocating for:

Designing schools that foster connection to surrounding communities
Supporting programs that reduce poverty, increase access to nutritious food, and make affordable housing more available
Voting for policies that enhance inclusion as public health priorities

Reducing sickness isn’t just about treating disease — it’s about creating a society where children are well-fed and housed and feel connected, supported, and valued.

And that’s something worth investing in.

1. https://campaign2000.ca/new-release-2025-report-card-on-child-and-family-poverty-in-canada/#:~:text=Investing%20in%20Tomorrow:%20A%20Future,impact%20has%20weakened%20over%20time

2. https://reasonstobecheerful.world/kangaroo-mother-care-newborns/

3. https://reasonstobecheerful.world/the-spark-how-to-make-parenting-fun-again/

It's Not Just Poverty — It's Connection

Wed, 02 Sep 2026 20:09:59 GMT

Material hardship isn't the whole story. Trust, belonging, and social cohesion shape health just as powerfully as food and housing do — and inequality erodes all three.

For a fuller discussion of how we overspend on medicine compared to other government functions, see [Where Do Our Tax Dollars Go?]

But why is poverty bad for your health? Is it just that the material inadequacies of the conditions of life, such as being unhoused, get under your skin through mechanical and biological processes? Is it the direct result of such invasive and deleterious things as household mold, radon, or another environmental polluter? Is it nutrient inadequacies due to the lack of healthy fresh vegetables? What things — besides the obvious material insufficiencies such as food and housing — have an impact?

Social Cohesion

Social cohesion also plays an influential role in healthy lives. Social cohesion refers to the presence of positive bonds between and among individuals, social groups and communities. These bonds may be forged across racialized groups, ethnicities, genders, ages, income and educational levels, and so on. Social cohesion is embodied by feelings of trust, connectedness, sense of belonging, and solidarity with others in community. Polarization and partisanship challenge the health of individuals in communities. 1

The perception of inequality, regardless of the actual level of material want, threatens and weakens social cohesion. So, societies where material living standards for everybody are impoverished, but in which there is little inequality, tend to have higher social cohesion than societies where there are big economic gaps between groups. 2 These latter societies tend to have higher levels of illness, particularly mental and emotional illness. In other words, health outcomes depend on far more than material standards; they also reflect the characteristics of communities. 3

Addressing problems in community social cohesion would reduce sickness, disability, and death.

What Can and Is Being Done

Although we cannot change these large and systemic problems right away, there are things we can do to address social cohesion. Reasons to be Cheerful is one positive news and social policy/programme site that is full of examples. For example, they describe a peer-based method of dealing with diabetes. The one described happens in Miami — one of 35 cities and towns across Florida and California, funded by the federal government in the US. It's based on peers with the same condition who have learned to manage the many complexities of living with diabetes and have been trained in how to support others. 4

In Hungary there is a programme that links high school students with older people who want help learning how to use their computers for social media, email, information, and other "techie" stuff. Internet savvy may increase social cohesion — it helps enable communication with friends and family, as well as all the numerous mundane occasions upon which email is now required. A review of more than 50 studies from around the world found a 58% reduction in dementia for those who used the internet. The teens who offer the service say that they are benefiting too. Related research found the teens engaged in such intergenerational projects emerged with a better sense of purpose. Two other links from Reasons to be Cheerful describe programmes for peer-to-peer diabetes support and Google support for older people from teens. 5

What Can You Do

You can assess whether you have opportunities, feel valued, have control over your life, and belong to a community — and if not, think about what you might do to help yourself.

These are not irrelevant factors. They are core components of the social determinants of health, and they shape outcomes in ways that medicine alone cannot fix. Addressing poverty's impact on health requires more than improving material conditions — it requires rebuilding the social fabric.

You can help by advocating for:

Designing communities that foster connection
Supporting programs that reduce isolation
Valuing fairness and inclusion as public health priorities

Because in the end, reducing sickness isn't just about treating disease — it's about creating a society where people feel connected, supported, and seen.

And that's something worth investing in.

https://faculty.washington.edu/matsueda/courses/590/Readings/Kawachi%20and%20Berkman.pdf , https://en.wikipedia.org/wiki/Canada_convoy_protest , https://www.publicsafety.gc.ca/cnt/trnsprnc/brfng-mtrls/prlmntry-bndrs/20221013/03-en.aspx , Miller HN, Thornton CP, Rodney T, Thorpe RJ Jr, Allen J. "Social Cohesion in Health: A Concept Analysis." ANS Adv Nurs Sci. 2020 Oct/Dec;43(4):375-390. doi.org/10.1097/ANS.0000000000000327
https://ed.ted.com/lessons/how-economic-inequality-harms-societies-richard-wilkinson/digdeeper?theme_id=universal-human-rights
De Vogli R, Ferrie JE, Chandola T, Kivimäki M, Marmot MG. "Unfairness and health: evidence from the Whitehall II Study." J Epidemiol Community Health. 2007 Jun;61(6):513-8. doi.org/10.1136/jech.2006.052563 , https://www.who.int/news/item/30-06-2025-social-connection-linked-to-improved-heath-and-reduced-risk-of-early-death
https://reasonstobecheerful.world/living-well-with-diabetes-with-help-from-a-peer/
https://reasonstobecheerful.world/teens-teaching-grandma-to-google-hungary/

Poverty Is a Health Issue, Not a Side Issue

Wed, 26 Aug 2026 16:05:30 GMT

Poverty in Canada isn't just about income — it's structured, predictable, and it shapes who gets sick, who ages into hardship, and who can't get care when they need it.

For a fuller discussion of how we overspend on medicine compared to other government functions, see [Where Do Our Tax Dollars Go?]

One of the most important downstream factors in predicting death, disease and disability is poverty.

But poverty in Canada isn’t just about income . It isn’t even only about individuals having enough of the material things... it is about the organization, culture and well-being of communities and individuals within them.

Repeated research demonstrates the people living on lower incomes face shorter life expectancies. They confront more illness, disability, accidents and suicide. Poorer people also suffer the daily stressors of trying to make ends meet. This stress can increase mental health challenges. Poverty isn’t a chance occurrence. It’s structured. It’s predictable.

For example, poorer people tend to lack reliable access to sufficient nutritious food, adequate and stable housing, safe streets and sufficiently available, secure and rewarded work. These issues heighten challenges to all aspects of their lives.

Food Insecurity

Food insecurity is one of the clearest — and most troubling — examples of this inequity. About one-quarter of Canadian households struggle to afford enough food, or a sufficient variety of it. That’s not a marginal issue — it’s a systemic one. In March 2026 alone, 2.2 million Canadians used foodbanks , underscoring just how persistent and widespread the problem has become.

Food insecurity disproportionately impacts Northern and remote communities, families relying on government benefits, and single-parent households. These are not random or isolated pockets but are foreseeable outcomes of broader social and economic policies.

Children and Elders

And there are specific groups of people in Canada who are structurally disadvantaged. Let’s look at children and elders for a moment.

Child poverty in Canada remains stubbornly high — higher, in fact, than in comparable countries like the United Kingdom, Germany, and France. That’s a reflection of our policy choices and priorities.

The impact of children growing up in poverty is profound and long-lasting. It shapes everything from educational outcomes to physical and mental health. It increases the likelihood of social exclusion later in life. In other words, poverty in childhood doesn’t stay in childhood — it follows people across their lifespan.

If we’re serious about breaking this cycle, the evidence is clear: we have to start early. Interventions in childhood are compassionate and they’re more effective than later intervention.

They lead to longer and healthier lives. Investments like child benefits, accessible early education and childcare don’t just provide short-term relief — they create the conditions for long-term stability and opportunity.

Turning to the other end of the age spectrum — retirement doesn’t necessarily mean having the means to live on a good pension. And for those without the benefit of retiring with a pension plan, the monies provided by the government are barely enough to survive. Expenses can change, and change suddenly. An unexpected illness, a rent hike, inflation at the grocery store can exacerbate the underlying financial precarity and throw a person into further impoverishment. This affects single and female seniors, especially. As the Canadian population ages — with the number of seniors expected to reach 10 million by 2036 — these deficits will grow.

Evidence clearly suggests that increasing income supports and enhancing community services and connectivity are essential to ensuring that aging in Canada doesn’t come with increased risk of poverty and declining health.

Barriers to Care

Finally, when medical care is needed, it is not always available to those living in poverty. Although we have a publicly funded and “universal” health care system, access to it is uneven and unequal. Many low-income Canadians face significant barriers to care — out-of-pocket costs, parking and transportation challenges, and the sheer complexity of organizing time off. Getting childcare and time off from inflexible or precarious hourly-waged work, seeking care becomes not just difficult, but sometimes impossible.

What Can and Is Being Done

North Carolina has initiated a programme that diverts Medicaid dollars to provide services to poorer people. These services include, among other things, weekly food delivery, transportation to medical care appointments, and similar types of help. The model has already been successful in lowering the costs of medical care. It has had positive effects for the individuals and families participating in the programme, and it has also provided benefits for the local economy.

There is a programme in New York City which provides a secure and reliable space for people who are unhoused to recuperate once they leave the hospital . St. Michael’s Hospital in downtown Toronto offers a navigator programme and other outreach assistance for unhoused people who are discharged from hospital care.

Another programme based in New York City provides a guaranteed income for unhoused mothers.

What Can You Do

Learn about inequality in your community. Find out what is being done to reduce inequality and what you can do to be part of the solution in your own local area.

Further Reading

Social Determinants of Health Animation — a short animated explainer on how social determinants shape health.
Pacific Public Health Foundation, “Visualizing the Social Determinants of Health” — background on SDH imagery, including the CMA’s “What Makes Canadians Sick?” infographic referenced above.

Where Do Our Tax Dollars Go?

Thu, 20 Aug 2026 14:33:20 GMT

Canada spends almost $6,000 per person a year on health care — and just 1% on housing. A look at what our government spending actually reveals about what we value.

Do you know how much of your tax dollars go into the medical system?

What if I told you that I think we spend a wildly — yes, wildly — disproportionate share of public money downstream: on medical care, rather than on the upstream conditions that shape whether we become sick in the first place?

To kick off this conversation for The Upstream Health Project, I want to start with something simple but revealing: government spending.

Statistics Canada ¹ breaks down how federal, provincial, and municipal governments allocate public funds — in other words, this is our tax money in action. Step back and look at the numbers, and a clear pattern emerges. One that says a lot about what we value.

Health Spending Dwarfs Everything Else

The largest single category of government expenditure, by far, is health spending .

This covers the administration, development, and delivery of medical services — an enormous public investment running into almost $6,000 per person annually.

Most of it goes to:

Hospitals (about 67%)
Outpatient services, including doctors (around 16%)
Medical products, including in-hospital pharmaceuticals (roughly 7%)

And even at that scale, the number above doesn’t tell the whole story.

A significant chunk, more than 30%, of health-related spending happens outside the public system entirely. Prescription drugs, over-the-counter medications, supplements, and many medical devices are paid for privately, out of pocket. Add dental care, vision care, psychotherapy, social work, and home care — none of it universally covered — and the real cost of “health” climbs a lot higher.

And still, millions of Canadians are left on the outside looking in. Roughly 6 million people in Canada don’t have access to a family doctor — the primary gateway into the healthcare system. Some turn to the parallel private system, online medical care, or increasingly, AI. Others cross borders as medical tourists. The system, in short, doesn’t cover everybody or everything.

Despite this massive financial investment, access for Canadians is uneven and incomplete. Add to that the working conditions crushing doctors, nurses, and everyone else propping up the system, and we have a crisis in care.

We Underspend Everywhere Else

Here’s where things get even more head-spinning.

We underspend on nearly every downstream intervention that could reduce the need for medical care, diagnosis, and treatment in the first place.

The other large category of spending is social protection but it involves many diverse programs— programs meant to reduce poverty and provide a basic safety net for hard times and difficult situations: employment insurance, disability insurance, pensions, and the like. None of these programs is adequate on its own. People who depend entirely on this money end up living in poverty — facing housing and food insecurity, using foodbanks, living on the streets or in tents — lacking the basic necessities for a sustainable life.

These are the upstream government interventions. And none of them comes anywhere close to the cost of the downstream one: medical care.

Education is another upstream issue worth naming. Governments spend about half as much on education as on healthcare — despite education being one of the strongest predictors of long-term health and life expectancy. More education tends to mean better health, and longer lives.

In other words: we’re underinvesting in two of the most powerful upstream drivers of health — poverty reduction and education — while pouring resources into treating illness after it’s already appeared.

The Rest of the Pie

A few more categories round out the picture:

General public services (government administration, foreign aid, fiscal affairs, public debt)
Other functions — environmental protection and cultural investment: libraries, museums, archives, historic and nature parks, arts and performing arts, film and broadcasting, multiculturalism, and more

Broken down further, these areas receive surprisingly small shares of support:

Culture: ~1%
Environmental protection: ~3%
Recreation and religion: ~1%
Public order and safety: ~5%
Defence: ~2%

And then there’s housing.

Housing and community amenities — water supply, street lighting, social housing — account for only about 1% of total spending.

Just 1%.

Yet we know that safe, stable, and adequate housing is foundational to health. Clean water, proper ventilation, and secure shelter aren’t luxuries. They’re prerequisites for a healthy life.

The Core Tension

This is the tension at the heart of the upstream conversation: we invest heavily in treating disease, while comparatively underinvesting in the conditions that prevent it and support well-being in the first place.

If we’re serious about improving health — not just healthcare — we have to ask a harder question:

What would it look like to shift even a fraction of these resources upstream?

That’s the question this project will keep returning to.

P.S. — Two categories we won’t dig into here are economic affairs (agriculture, transportation, energy, industry) and the administrative side of general public services (foreign aid, fiscal affairs, public debt). Both are real spending categories, but they’re technical, complicated, and don’t map directly onto funding for citizens’ day-to-day lives — so we’ll leave them aside for now.

¹ Statistics Canada, “Government spending by function, 2024.” statcan.gc.ca

Introducing 'Upstream Health Project'

Tue, 19 May 2026 00:00:00 GMT

Welcome to my new blog that is a part of the Upstream Health Project.

My intention with Upstream Health Project is to demonstrate the fundamental importance of looking ‘upstream’ when trying to understand how to improve both health and medical care. By ‘upstream’ I mean to explore and document how health issues are deeply shaped by broad social, economic and environmental conditions that occur long before disease, disability and death happen. This perspective is a reality grounded in an overwhelming amount of excellent research that reinforces the crucial role of the ‘social’ in health. Despite our knowledge of the importance of the social for health we, through our governments, spend much more of our money downstream, on treatment for disease rather than on upstream prevention and equity. And our medical system is broken. Millions of people do not have access. Health care providers are burned out and over-worked. We need to fix these problems and I have some ideas about how.

Picture this:

You are downstream on the bank of a beautiful river. You look around to take in the scenery, but you see people are in the water and about to drown. You respond urgently. You jump in and pull people, one after another, out of the water. This goes on continuously, and you (who is doing life-saving work) become tired and frustrated and the people who are saved become traumatized, or at least thoroughly wet, from the ordeal. This is what happens when we focus on problems downstream . All of the effort goes into solving difficulties faced by individuals, one wet (or sick) person after another.

Now imagine this different scenario:

You are upstream and engaged in building all sorts of safety nets and guardrails, as well as resting places for seeing what is happening downstream. You make sure that everyone is protected and that very few people fall in the water. In the world of health care, these safety nets and guard rails consist of policies ensuring equity in income, education, race and gender statuses and so on. Your guardrails and nets are enabling almost everyone to be more prepared and able to take helpful and health-giving action to avoid or delay falling into the river.

In this project I want to contribute to conversations that shift perspectives from downstream to upstream , from hyper-medicalization to examining the role of social influences. I see our current focus as a society as an over-emphasis on medicine in everyday life . I want to expand an understanding of the impact of broader social conditions such as equity and justice on health and wellbeing. This is a socially grounded perspective (in SDH) and is central to understanding the crucial place of upstream interventions in mitigating rates and experiences of sickness, disability and death.

The Upstream Health Project asks us to look beyond immediate symptoms and medical diagnoses to fundamental causes of illness such as income inequality, housing stability, social isolation, access to education, employment, racism, social cohesion and the structure of our healthcare systems themselves. In this project, we recognize the importance of social-demographic factors such as gender, ethnicity and racialization status. While downstream interventions—clinical treatments, medications and acute care—are essential, they often address the consequences or symptoms rather than the origins of illness and distress. The Upstream Health Project is based on the belief that meaningful, lasting improvements in health and well-being require us to engage more directly with these upstream social determinants.

The Upstream Health Project is both a reflective and practical endeavor . It aims to create space for dialogue, writing and knowledge-sharing that uses social analysis in an accessible and human-centred way.

Through the blog and social media pages, I hope to explore questions such as:

What are the limits of healthcare models that focus on individualized treatment?
How does our focus on medical interventions (or ‘hyper-medicalization’) shape the way we understand ourselves and live our daily lives?
How can we better integrate awareness of the social determinants of health into everyday policies?
How can we amplify the perspectives and voices of people with lived experience of sickness and as carers within our medical care systems?
How will putting a spotlight on the social determinants of health benefit medical care?
How much will attending to the social determinants of health decrease rates of sickness, disability and death?

This project is also informed by my work as a medical sociologist and also hearing the stories of individuals and families facing various serious health challenges such as cancer, heart disease and mental illnesses. In these stories, relevant research and my own lived experience, it has become especially clear how the health care system can cause harm and is far from perfect. For individual patients and families, financial strain, caregiving demands, cultural expectations and systemic gaps in support often intersect with the medical journey – creating extremely difficult and challenging conditions to navigate. Health care providers suffer from the current policies. They may face, among other things, despair, addictions and even suicide because of our failures to care for the caregivers.

An upstream lens does not replace clinical medical care, but it expands the frame —allowing for a more equitable and humane, contextualized understanding of what people inside outside of the system are going through before they get sick and seek medical care.

At its core, this initiative is an invitation : to think more broadly, to question taken-for-granted assumptions and to consider how we might shift both practice and policy in ways that are more responsive to the social realities people face. It is also an attempt to contribute, in a modest way, to ongoing conversations about how to build more equitable and sustainable approaches to health.

I do not see upstream health as a fixed model or the solution for all issues, but as an evolving perspective —one that benefits from interdisciplinary dialogue and from the insights of those with lived experience of caregiving and receiving.

Thank you for taking the time to read this introduction. I look forward to sharing more as the project develops and to engaging with others who are interested in these questions. Be sure to subscribe to the blog and follow along for more content on the Upstream Health Project social media pages:

Upstream Health Project

Violence Against Children: A Hidden Driver of Lifelong Inequity

About one in two children worldwide experience violence each year — most often at home. Why this is a public health issue, not just a criminal justice one.

The Scale and Severity of Harm

A Canadian Reality

Beyond Immediate Injury

Violence as an Upstream Health Issue

Connecting Back to Upstream Health

What Can and Is Being Done

What Can You Do

Universal School Food Programmes: An Upstream Solution to Childhood Inequity

One-third of food bank users in Canada are children. Universal school meal programmes are a proven, practical way to break that cycle — starting in the classroom.

Hunger in the Classroom

A Simple, Powerful Solution

More Than Food: A Community Investment

Long-Term Health, Lifelong Impact

Moving Upstream

What Can and Is Being Done

What You Can Do

The Health Benefits of Nature: Is a Walk in the Park Good Medicine?

Doctors are now prescribing time outdoors. Here's what the research says about green space, and why nature might be one of the most underused tools in preventive health.

The Evidence

Why Isn’t This More Central to Healthcare?

What Can and Is Being Done

What You Can Do

1. https://reasonstobecheerful.world/green-prescriptions-health-nature-parks

Where Do You Live? Why Housing Is Health Care

Nearly 30% of people in Canada live in insecure, unsafe, or inadequate housing. Here's why where you live may matter more to your health than any doctor's visit.

Four Elements of Healthy Housing

Housing Shapes Futures, Not Just Present Health

What Can and Is Being Done

What Can You Do

1. https://reasonstobecheerful.world/homebase-program-prevents-homelessness-in-new-york-city / n/

The Cost of Growing Up Poor

More than 800,000 Canadian children are growing up in poverty — and the health effects don't stay in childhood. They accumulate across a lifetime.

The Health Consequences Begin Early

Disadvantage Accumulates

What Can and Is Being Done

What Can You Do

1. https://campaign2000.ca/new-release-2025-report-card-on-child-and-family-poverty-in-canada/#:~:text=Investing%20in%20Tomorrow:%20A%20Future,impact%20has%20weakened%20over%20time

2. https://reasonstobecheerful.world/kangaroo-mother-care-newborns/

3. https://reasonstobecheerful.world/the-spark-how-to-make-parenting-fun-again/

It's Not Just Poverty — It's Connection

Material hardship isn't the whole story. Trust, belonging, and social cohesion shape health just as powerfully as food and housing do — and inequality erodes all three.

Social Cohesion

What Can and Is Being Done

What Can You Do

Poverty Is a Health Issue, Not a Side Issue

Poverty in Canada isn't just about income — it's structured, predictable, and it shapes who gets sick, who ages into hardship, and who can't get care when they need it.

Food Insecurity

Children and Elders

Barriers to Care

What Can and Is Being Done

What Can You Do

Where Do Our Tax Dollars Go?

Canada spends almost $6,000 per person a year on health care — and just 1% on housing. A look at what our government spending actually reveals about what we value.

﻿

Health Spending Dwarfs Everything Else

We Underspend Everywhere Else

The Rest of the Pie

The Core Tension

Introducing 'Upstream Health Project'

Picture this:

Now imagine this different scenario:

Through the blog and social media pages, I hope to explore questions such as: