Is social assistance boosting the health of the poor? Results from Ontario and three countries

Abstract

Social assistance programs supplement incomes of the most income-insecure. Because income is a fundamental source of health, income supplementation is expected to result in a boost to health status. As Canada finds itself in the midst of heated debate regarding the structuring (and restructuring) of social assistance programs, there is little evidence available for policymakers about the effectiveness of current social assistance programs in improving the health of the income-insecure. In this paper, we evaluate the health effects of social assistance programs in Ontario, Canada-wide and in peer programs from the United States and the United Kingdom. We used nationally representative household panel surveys (e.g., Canadian Survey of Labour and Income Dynamics) which follow individuals over time. Using fixed effects modelling, which controls for time-invariant characteristics of individuals, and further controlling for key time-varying characteristics, we modelled change in health status associated with change in receipt of social assistance in these societies. Health status was measured using self-rated health (fair/poor versus good/very good/excellent). Our results suggest that the health of social assistance recipients was worse (Ontario, Canada, UK) or no different (US) than the health of non-recipients. For example, in Canada, receipt of social assistance was associated with 52.5% higher odds of reporting fair or poor health. Social assistance programs in Canada and peer countries are currently inadequate for improving the health of the income-insecure. This is likely due to insufficient benefits, exposure to precarious job conditions, or selection factors.