Poverty and Health 1

Where Illness and Poverty Intersect: Social Workers in Health

Social Work 541

Leya Eguchi

SOWK 541Professor Frank TesterFriday, October 14, 2022

Poverty and Health 2

Poverty and Health 3

Introduction

Social and political forces that shape people’s health and

well being operate within us, around us and across our society.

These forces ensure social status, wealth and good health to some

members of society, while entrapping others in a life of poverty

and suffering. These forces are largely invisible to us because

of powerful myths in our society that prevent us from critical

thought (Fiala, 2010, p156). The most powerful and pervasive

myths have been constructed by those who have held power for

centuries: the wealthy owners of land and corporations, the

government, the church, and anyone else who profits from the

exploitation of the poor. Our daily lives and the social

privileges we enjoy are based on these myths: the majesty of the

law (Fiala, 2010, p156-158); the inherent superiority of

technologically advanced civilizations; meritocracy (Seabrook,

2002, p108-109); and the belief that creating more wealth through

a capitalist free market will eventually make everyone’s life

better (Seabrook, p78). These forces inflict extreme poverty

and suffering on society’s most disadvantaged while maintaining a

comfortable lifestyle for the middle class and disproportionate

Poverty and Health 4

wealth for those most advantaged by the system. Most people are

positioned closer to the middle of the social ladder and are both

exploiters and exploited. Those who fall in the “middle class”

experience both the advantages and disadvantages of the system

simultaneously. The process of social stratification is complex,

and oppression occurs through the interaction of race, gender,

ability, sexual orientation and poverty. Each of these layers of

oppression are not separate but are inextricably linked (Dei,

1999), creating a local and global ‘underclass.’ Farmer refers

to the forces that cause extreme poverty and human deprivation as

structural violence, since suffering is "structured" by

historical and economic processes that restrict individual

agency.

Healthcare workers come face to face with the manifestation

of this suffering most visibly and starkly in the course of

interacting with people suffering from physical and mental

illness. Care work is socially constructed within the powerful

myths of society. Thus social workers need to be reflective

about their framework of practice in order to identify and

address the power dynamics that deeply influence the helping

Poverty and Health 5

relationship (Barker, 2001). As Alfred (2009, p44-45) argues,

societal values are not fixed, and change is possible. We may

challenge the powerful myths in our societies by stepping out of

our conditioned mindset and thinking critically, and by exploring

indigenous and non-Western world views as pathways to move

towards a more harmonious and egalitarian society. In this

paper, I will first explore the origins of these socio-political

forces and the pathways in which they operate. I will then

explore alternative frameworks of practice, and show how social

workers can become agents of change, not only within the confines

of our workplace, but also in a larger societal context. My

vantage point is based on my work experience in the downtown

Eastside of Vancouver, but as argued by many contemporary

thinkers, the same forces of structural violence operate on a

global scale (Alexander, 2008; Babones, 2009; Farmer, 2005;

Singer, 2009).

The Social Work Role and Ethical Distress

The social worker today has increasingly become a recognized

and respected member of healthcare teams in both the hospital and

the community. The main role of the social worker in these

Poverty and Health 6

settings is to assess the psychosocial context of the patient in

order to identify and support the patient’s strengths, as well as

to garner support from the patient’s family, friends and

community resources (Robbins & Birmingham, 2005). The social

worker also advocates for the modification or creation of

programs where they have identified gaps in supports (Barnes &

Hugman, 2002). Social workers in the health field regularly come

into contact with intensely vulnerable populations that are

overwhelmed by poverty and oppression, trauma and multiple health

problems (Bride, 2007; Cunningham, 2003; Dane & Chachkes, 2001;

Gitterman & Germain, 2008; Pockett, 2003). For many individuals,

the scope of their problems is so great and complex that we must

decide what specific problem we will focus on for the time being,

and how much time and resources we will allocate to it. How each

of us perceives human suffering depends on our social location

and ideological background; and the differences in understanding

and attitudes about the suffering of our clients are reflected in

the overall climate of the workplace. While there is much

disagreement on what constitutes human suffering, the fact

remains that a disproportionate share of pain and suffering is

Poverty and Health 7

endured by those living in poverty (Farmer, 2005). Social

workers are most attuned to this grave reality, not only because

we are involved in actively listening to their life story, but

also because our profession expects us to fully live by our

social work values and take part in ethical action (Manning,

1997). The core social work values of human rights and social

justice give us a “particular interest in the needs and

empowerment of people who are vulnerable, oppressed, and/or

living in poverty” (Canadian Association of Social Workers,

2005).

Despite witnessing great human suffering in many domains,

social workers are asked to maintain emotional distance and turn

our attention only to the immediate ‘presenting problem.’ While

this narrowing of vision may protect us from secondary traumatic

stress (Badger, Royse & Craig, 2008) and keep us focused on the

immediate crisis, it also serves to maintain a system that is

ultimately oppressive. For the most part, we turn a blind eye

to the glaring human rights violations and deprivation we witness

daily: people living on the street or in infested and hazardous

rooms, people who can’t afford to eat, women who are torn apart

Poverty and Health 8

from their children due to poverty, or women who sell their

bodies to survive. However the wounds were inflicted, through

interpersonal violence or societal negligence, their bodies tell

the stories of trauma and abuse. Hearing their stories, if they

are comfortable enough to share them, is even more heart

wrenching. Through interviews and assessments, social workers

catch a glimpse into a life of great suffering, and record a

summary of these life stories. We maintain this

compartmentalization for complex reasons involving the need to

balance professional socialization with self protection. While

we have gained much respect for our ability to build an empathic

connection with our clients, we are expected to use this

connection to manage client behaviour, gain their cooperation for

‘efficient’ medical treatment and help speed up discharge from

the hospital. It is still largely taboo for social workers to

advocate for clients in respect to clients' wishes that go

against the medical team’s opinion, especially if this would slow

down the treatment process or be more costly to the system. It

is also difficult for social workers to speak out against routine

practices and systemic issues, as job security is still

Poverty and Health 9

precarious for those who threaten the system. As a result,

social workers are constantly negotiating their values, making

sure the system runs smoothly while also trying to advocate for

social justice and secure their client’s right to self

determination.

Ethical stress may result when there is a conflict between

our social work values and the pressures exerted on us by an

increasingly managerial system (Corley, 2002; Corley, Minick,

Elswick, & Jacobs, 2005; Sasson, 2000). According to

psychodynamic theory, this type of internal turmoil and

traumatisation of the worker may cause a ‘division in identity’

which ‘fractures’ the self (Stocks, 2007). If left unchecked,

internalized stress may lead to interpersonal conflict, job

dissatisfaction, physical illness, burnout and abandonment of the

profession (O'Donnell, et al., 2008). While many social workers

try their best to uphold their values in their day to day work,

our work environment is shaped by a larger social and political

context. I believe we can mitigate this stress by better

understanding the forces that interact to maintain an oppressive

Poverty and Health 10

system, and by ‘externalizing’ the stress through advocacy and

collective action.

The Current Political and Economic Context

During the last two decades, social and healthcare programs

have been subjected to a variety of neo-liberal reforms focused

on fiscal restraint, sustainability, efficiency and

accountability (Benoit & Hallgrímsdóttir, 2008). Canada reached

its peak as a welfare state in the mid-1960s, with its hallmark

accomplishments of universal healthcare, income security and a

wide range of universal social programmes (Habibov & Fan, 2008).

There is broad agreement that the shift to a neoliberal regime

came as a result of the economic recession in the early 1990s,

and the signing of the North America Free Trade Agreement, which

pushed the Canadian system to be more aligned with the United

States (Habibov & Fan; Kitchen, 2001). This shift was fuelled by

a sense of national crisis, with an unemployment rate of over 10%

and a public debt at nearly 90% of the GDP (Armitage, 2003).

Neoliberal economists argued that social expenditures were to

blame for this crisis, since they were using up valuable

resources that could stimulate the private market, which in turn

Poverty and Health 11

would promote economic growth. Neoliberalism has also

transformed the concept of citizenship. The emphasis on human

rights that is central to many welfare states has been eclipsed

by notions of individual responsibility (Ilcan & Basok, 2004).

Propelled by public support, the Canadian government rapidly

reduced social expenditures during the 90s and introduced tax

cuts for corporations and high earners. Taking care of society’s

neediest was left to private corporations, charities and

religious organizations (Lightman & Irving, 2009). According to

the conservative conception, a generous welfare system

discourages people from working and creates a bloated government.

The neoliberal regime of the 1990s used this justification to

increase social programmes for the “deserving” ranks of society

and significantly reduce programmes for the “undeserving” groups

(Lightman & Irving). By the end of the 20th century, the income

inequality in Canada had significantly increased (Frenette,

Green, & Milligan, 2006; Picot & Myles, 2005), with the income of

the poorest 5% of Canadians dropping from $2047 in 1992 to a mere

$730 in 2000 (Frenette, Green & Picot, 2004). This neo-liberal

policy shift had the effect of significantly disadvantaging

Poverty and Health 12

marginalized populations affected by poverty, racism and

disability, while most brutally affecting those who depend on

social welfare for survival – single mothers with small children,

people with physical and mental disabilities, Aboriginal women

and the homeless (Morrow, Hankivsky & Varcoe, 2004). The severe

cutbacks in social welfare and the increasingly restrictive

qualification criteria have been justified through public

discourse of welfare fraud. Chunn and Gavigan (2004) argue that

the language linking welfare and fraud serves to criminalize

poverty.

Historical Backdrop and the Myth of ‘Deservedness’

Many social programs in British Columbia, and in most of

Canada, have been designed to help the “deserving” while weeding

out the “undeserving” and “moochers” of the system. The idea of

“deservingness” originated in Elizabethan England, where

differential treatment between the deserving and undeserving poor

was clearly established in the Poor Laws first enacted in 1601

(Raphael, , 2007, p30). The 1834 amendment known as the New Poor

Law deemed anyone who was employable but not working to be the

“undeserving poor,” and subjected them to forced labour in

Poverty and Health 13

exchange for scant food and shelter (Raphael, p30). People with

visible disabilities or illnesses, seniors and orphans were

deemed deserving, and were either given money and food or

subjected to workhouses, depending on the degree of disability.

The poor laws emerged as part of a capitalist labour market

reorganization that divided the population into middle and

working class (O'Connell, 2009). The breadwinner model of the

family was firmly entrenched in this re-organization, which

denoted women and children as properties of the male head of the

household (Clark, 2000).

O'Connell (2009) argues that the poor laws were exported to

Canada during the time of confederation, with an underlying

motivation of subjugating and managing other races in order to

serve the interests of the white bourgeois subjects of the

British Empire. This history continues to shape modern social

policy, and directly contributes to the racialization of poverty

(O'Connell). The definition of traditional families and who is

considered white may have shifted over time, but the fundamental

societal assumptions of the poor laws remain. Being well

educated, well spoken (in English) and well endowed (based on

Poverty and Health 14

European ideals) are preconditions for power, respect, status,

land and money. For the most part, these privileges are

inherited and protected so as to maintain a position of

privilege. Appiha (2006, p. xviii) argues that “thoroughgoing

ignorance about the ways of others is largely a privilege of the

powerful.” It is true today that the suffering of the poor is

invisible to those who take for granted the privileges realized

through colonization: Poverty is something that happens to people

that are “worlds apart” from us and therefore less affecting

(Farmer, 2005).

Wright (1994) argues that poverty is not a by-product of

capitalism, but rather a necessary condition for maximizing

profits by suppressing wages. It is therefore in the best

interests of the powerful and privileged to construct and

propagate myths that will maintain the status quo. Those who are

poor are often type casted in popular media as lazy or lacking

moral character, and are even associated with criminality or

treated as scapegoats for social problems (Raphael, 2007). The

dichotomy between a respectable family headed by a working man

and the degenerate pauper is deeply entrenched in Canadian

Poverty and Health 15

history and culture, reinforced by social Darwinism (Jones,

1980), eugenics (McLaren, 1990) and neoliberal ideology that have

been pervasive through most of the 20th century.

The poor also became subjects of anthropological studies,

and anthropologists such as Lewis (1998) developed theories about

the culture of poverty. He postulated that the poor had their

own unique value system and worldview marked by hopelessness,

helplessness, inferiority and fatalistic thinking.  Yet although

research has linked the effects of poverty and human deprivation

to cognitive processes which may lead to hopelessness, hostility,

addictions and risk taking behaviours (Fiscella & Franks, 1997;

Subramanian & Kawachi, 2004), the effects of poverty are neither

predictable nor homogenous (Goode and Eames, 1996). Moreover,

there are no fixed personal attributes that cause poverty

(Raphael, 2007), despite the pervasiveness of beliefs in this

respect propagated by popular culture.

Social Determinants of Health and Illness

While there are many different methods for measuring

poverty, the debate on how to measure poverty only serves as a

smokescreen hiding the lived reality of the many people that

Poverty and Health 16

occupy the bottom rung of the social ladder in Canada. The

people who make up the lowest 5% of the income group tend to be

those who have experienced historic and systemic oppression:

aboriginal persons, women, new immigrants, persons with

disabilities, and persons with lifestyle choices that are not

agreeable to the ‘mainstream’ Western culture.

Research has demonstrated time and time again that the

higher the social class, the better the health and life

expectancy, regardless of what health indicator is used (Canadian

Public Health Association, 2001). The income gap between rich and

poor continues to increase in Canada (Ivanova, 2009; Myles &

Pyper, 2000). The figures are staggering: 10 per cent of

Canada’s wealthiest families controlled over half of Canada’s

wealth, with the richer half of our country claiming 94.4 per

cent of our country’s wealth, leaving only 5.6 per cent for the

poorer half of Canada’s population (Kerstetter, 2002). In

particular, income inequality has been marked for Aboriginal

peoples, whose earning averaged 70% of the average for non-

Aboriginals (Wilson & Macdonald, 2010). The poorer half of BC

families have been hit harder than in other provinces, with a

Poverty and Health 17

greater drop in real after-tax incomes than in any other province

(Ivanova).

Socioeconomic disadvantages take a toll on a person’s

health, beginning in early childhood and throughout their life

course. This includes a higher risk of cardiovascular diseases

(Diez Roux et al., 2001; Smith et al., 1998), cancer, dental

problems and substance abuse (Poulton et al., 2002; Melchior et

al., 2007). For example, a longitudinal study of 1,037 children

in New Zealand concluded that low childhood SES was responsible

for 55-67% of poor health outcomes through a person’s life course

(Melchior et al.). Even in Canada, where healthcare is

supposedly universal, Heslop, Miller and Hill (2009) found that

non-cardiovascular mortality risk rose by 21–30% for each

quintile drop in socioeconomic status. When comparing the lowest

and highest quartiles of socioeconomic status, they found a

tenfold disparity in cancer mortality (Heslop, Miller & Hill).

Despite a world famous healthcare system, health care access

in Canada continues to be highly problematic for marginalized

populations, such as the Aboriginal people in Canada. According

to the Provincial Health Officer Annual Report (Ministry of

Poverty and Health 18

Healthy Living and Sport, 2007), the health outcomes of status

Indians in BC were significantly below non-Aboriginal people in

all measures of mortality, morbidity and illness. According to

this report, the life expectancy for Status Indians living in BC

was 5.4 years less for males, and 6.1 years less for females,

compared to non-Aboriginal BC Residents. The Aboriginal

population continues to experience poverty, economic

marginalization and discrimination at disproportionate rates to

non-aboriginal Canadians, with negative consequences to their

health and well-being. 

Many health professionals would argue that they treat

everyone the same, and that the system does not discriminate

against specific races or socioeconomic classes. Tang and Browne

(2008) invite health care professionals to critically examine

their own social location and how we may be, without realizing

it, ‘embedded with power’ (England, 2004, p. 300) and agents of

‘social control,’ since we all have a role to play in the

distribution of healthcare resources. Tang and Browne argue

that healthcare workers exercise control in hospital and clinical

spaces through eviction, disciplinary action (taking away

Poverty and Health 19

privileges), not fully acknowledging the presence of a patient or

failing to explain why the wait time is so long. In the downtown

eastside of Vancouver, I observed that a patient’s neighbourhood

and type of accommodation was enough to change the attitudes of

many of the healthcare workers and affect healthcare allocation

decisions. The everyday discriminatory treatment has real

effects on the patients, who not only have to endure the

suffering of poverty and illness, but also embody inequity

(Adelson, 2005).

Working within the Health Care System

Our healthcare system has cultivated its own set of myths.

As articulated by Meyer and Rowan (1977, p.340),

“institutionalized products, services, techniques, policies, and

programs function as powerful myths, and many organizations adopt

them ceremonially.” The advances of medical technology

fundamentally shifted the nature of the clinical encounter,

moving towards a paternalistic model in which the healthcare

professional dominates the clinical encounter and dictates the

terms of the treatment to a passive and mute patient (Foucault,

1994). By the end of the 20th century, the healthcare system was

Poverty and Health 20

dominated by positivism and evidence-based medicine, whereby the

legitimacy of a professional action must be based on proven

results (Barker, 2001; Goldenberg, 2006). In the zeal to

establish professional legitimacy, social work as a profession

embraced managerialism, with increased managerial control and

regulation of individual practitioners (Gambrill, 2001; Lymbery,

2001; Webb, 2001).

The emphasis on labour market participation has lead to the

undervaluation of care work (England, 2005). Individuals are

seen as responsible for their own poor health, despite the fact

that illness is often an end result of political and

environmental factors outside an individual’s control (Raphael,

2007). The responsibility of caring for sick or disabled

individuals has gradually been downloaded to family members,

community agencies and private care companies (Hallgrímsdóttir,

Teghtsoonian & Brown, 2009). Care work is increasingly viewed as

belonging to the domain of the family, especially women, while

increased specialization of medical professionals has created a

status divide between care workers and ‘specialists’ (Finkler,

Hunter & Iedema, 2008). In this increasingly dichotomized

Poverty and Health 21

culture of healthcare institutions, social work as a profession

has strategically aligned itself with the ‘specialists’ who

derive their authority and status within their workplace from

education and clinical skills. Champagne, Lemieux-Charles and

McGuire (2004) point out the fallacy of the belief that medical

professionals make objective and rational judgements based on the

best available evidence, since practitioners do not have time to

seek out and evaluate such evidence at the bedside (Finkler,

Hunter & Iedema).

Taylor and White (2001) contend that the scientific and

evidence-based frame of practice leads health care professionals

to pay little attention to epistemological questions about our

knowledge and beliefs and where they come from. We are all

embedded in our own social location and world view, and social

workers need to critically examine and reflect on normative

values from a social and historical context (Taylor & White,

2000). Polanyi (1967) asserts that our tacit knowing is implicit

in all clinical judgments. Tacit knowing refers to our beliefs,

assumptions and ways of knowing that we derive from past

experiences and intergenerational transmission. Many healthcare

Poverty and Health 22

professionals, however, are unable to articulate how they came to

know what they know. This tacit knowing is disregarded in the

positivist paradigm, but plays a crucial role in our every day

practice. This is particularly true for social workers, since

we are required to make professional judgements based on complex

psychosocial circumstances of our clients which cannot be

prescribed by technical manuals. Without an adequate

understanding of the values and beliefs embedded in our tacit

knowing, however, social workers can, unintentionally, inflict

harm under the auspices of helping (Gambrill, 2001).

In order to prevent iatrogenic harm (Sharpe & Faden, 1988),

we need to minimize power differentials within the helping

relationship. This requires not only a shift in mindset, but

also changes in the language we use and how we communicate. The

first step is to conceptualize the encounter between the health

professional and patient as an “interpretive meeting” between

equals with the aim of helping the patient get well (Svenaeus,

2001). Pellegrino and Thomasma (1981) studied the relationship

between medicine and philosophy throughout Western history, and

concluded that medicine has always been a practice within the

Poverty and Health 23

healing relationship. This is contrary to the current medical

model that confines the role of healing and helping to one aspect

of the medical system. Throughout early European history and in

many cultures today, the mind and body are regarded as one, and

healing is a holistic activity that encompasses the mind, body

and spirit. This is not only a philosophical construct, but is

now increasingly recognized as medical fact. Numerous studies

have linked negative emotional states to poor physical health

(Glaser & Kiecolt-Glaser, 2005; Lesperance et al., 2002; Lane,

2008 ). Medical research is now extending the boundaries of

these interactions, suggesting that there is a mind-body-society

interaction. Neuroimaging studies have demonstrated links

between physical illness and social factors such as social

exclusion and social evaluative threat (e.g. Eisenberger et al.,

2009; Ohira et al., 2009, Wager et al., 2009a &b). Lanea and

Wagerb (2009) believe that this understanding will be a catalyst

for significant advances in medical practice, whereby

psychological, social and physical domains are considered equally

important in the diagnosis and treatment of a patient. Social

workers are well positioned to facilitate this transition to a

Poverty and Health 24

more holistic vision of medicine, which encompasses the mind,

body, spirit and society.

Synthesis

This paper has outlined some of the main social and

political forces that impact a person’s health. These forces

operate everywhere: in the family, in social circles, at school,

at workplaces, in the community, and in the greater society.

These forces that shape our social and financial lives are right

in front of our eyes, and yet we do not readily recognize them.

It is as though a large elephant were living in our room since

our birth, and through habituation we got used to it and don’t

think it strange at all, just a fact of life. The most

devastating and visible end result of these forces can be seen in

the form of severe malnourishment, epidemic diseases, multiple

and severe physical and mental illness, homelessness, addictions,

hopelessness, violence and suicide. Singer (2009, p.xiv) uses

the term syndemics to denote the interactions of two or more

diseases and disorders that occur in a socio-environmental

context. He then notes that the detrimental effects of

globalization, social stratification, environmental degradation

Poverty and Health 25

and consumerist culture are much more pervasive and far reaching:

the cluster of diseases known as metabolic syndrome affects about

a quarter of Canadians today (Yusuf, 2010).

Poor sleep, abuse of power, domestic violence and addictions

to alcohol, drugs and gambling affect all social ranks, and are

often condoned and maintained by our social institutions (Singer,

p.153). As social workers in the health field, we are

potentially exposed to the violence of these forces both through

our personal life through societal and family interactions, and

professionally, through vicarious traumatisation. As elaborated

earlier, in order to focus on the immediate work that needs to be

done, we detach from a part of ourselves—the caring, aching,

wounded part of us that wants the suffering and pain to end

today, for everyone in our community, our country and the world.

To acknowledge this part of ourselves and to re-integrate it into

our whole being is a crucial step towards our own healing and

self care. According to van der Kolk (1994), integration is the

process of unification, in which the conflict of the split self

is resolved and the psyche becomes unified.

Poverty and Health 26

In order to move towards healing, we need to articulate and

affirm the experiences that cause us psychological distress,

since speaking about traumatic experiences helps reduce

psychopathology and strengthens the immune system (Harber &

Pennebaker, 1992). This can be achieved through cultivating safe

relationships with supervisors, colleagues or peers where you can

mutually debrief about issues and events that are causing ethical

distress or vicarious traumatisation. It is also important to

consciously create a mutually healing space in our every day

practice, both physically and mentally. This includes

environmental adjustments such as attention to light, colours and

sound, as well as a commitment to serve each client and their

families in ways that are most meaningful to them (Felgen, 2004;

Quinn, 1992). Creating a safe space goes beyond simply being

tolerant or colour blind (Abrams & Gibson, 2007); it means

communicating safety through visual and verbal cues. For

example, having stickers or posters indicating safety for diverse

sexual orientations and racial diversity will communicate a safe

space better than assuming that the lack of discriminatory

material is sufficient. As we build relationships, it may be

Poverty and Health 27

helpful to explore factors that have been barriers to receiving

respectful service in the past, or disclose our own ethical

distress around social injustice. This may facilitate mutual

healing and further dialogue about how to address this perceived

injustice.

Power sharing throughout the social worker – client

relationship is crucial: Habermas (1987/1993) argues that justice

can only be achieved when all persons involved in a decision can

participate freely in a dialogue and achieve a consensus based on

uncoerced rational consent. Buchanan (2000) suggests that

instead of focusing our energy on developing better ways to

control people’s behaviour, we should be working towards

increasing individual autonomy, noting that the best health in

our society is enjoyed by those with the greatest level of

individual autonomy.

In closing, I suggest that we consciously and deliberately

create a healing space within our everyday practice, based on our

values of respect for diversity, individual autonomy and

egalitarianism. Through our workplaces, professional

associations and activism, social workers must advocate for

Poverty and Health 28

sufficient services and resources to ensure that health services

are appropriate and accessible to people of diverse social and

geographic locations. We also need to spearhead the development

of healing environments for healthcare professionals. Power

differentials, colour blindness, ethical distress and cultures of

toughness can be changed over time through modelling behaviour,

open communication and education, such as workshops. As

articulated by Hallgrímsdóttir, Teghtsoonian and Brown (2009),

equity and dignity in the health care setting cannot be separated

from equity and dignity in the wider society, and social workers

are well positioned to lead the way towards positive change.

Poverty and Health 29

References

Abrams, L.S., & Gibson, P. (2007). Reframing multicultural

education: Teaching white privilege in the social work

curriculum. Journal of Social Work Education, 43(1), 147–160.

Adelson, N. (2005). The embodiment of inequity: health

disparities in Aboriginal Canada. Canadian Journal of Public

Health, 96, S45-S61. 

Alexander, B. (2008). The Globalisation of Addiction: A Study in Poverty of the

Spirit.

Oxford, UK: Oxford University Press.

Alfred, T. (2009). Peace, Power, Righteousness: An Indigenous Manifesto. Don

Mills, ON: Oxford University Press.

Appiha, K.A. (2006). Cosmopolitanism: Ethics in a World of Strangers. New

York, NY: W.W. Norton.

Armitage, A. (2003). Social welfare in Canada. Don-Mills, ON: Oxford

University Press.

Babones, S.J. (ed.) (2009). Social Inequality and Public Health. Bristol,

UK: The Policy Press.

Poverty and Health 30

Badger, K., Royse, D. & Craig, C. (2008). Hospital social workers

and indirect trauma exposure: an exploratory study of

contributing factors, Health and Social Work, 33 (1). 63-71.

Barker, P. (2001). The tidal model: the lived-experience in

person-centred mental health nursing care, Nursing Philosophy,

2(3), 213–223

Barnes, D. & Hugman, R. (2002). Portrait of social work. Journal of

Interprofessional Care, 16 (3), 277-288.

Benoit, C. & Hallgrímsdóttir, H. (2008). Engendering research on

care and care work across different social contexts. Finding

dignity in health care and health care work. Canadian Journal of

Public Health, 99 , S7-S10.

Bride, B. E. (2007). Prevalence of secondary traumatic stress

among social workers. Social Work, 52, 63–70.

Buchanan, D. (2000). An ethic for health promotion: Re-thinking the sources of

human well being. New York: Oxford University Press.

Canadian Association of Social Workers (CASW). (2005). Code of

Ethics. Downloaded on April 24, 2010 from [www.casw-acts.ca]

Canadian Public Health Association. (2001). Board of Directors

Discussion Paper. Health Impacts of Social and Economic Conditions:

Poverty and Health 31

Implications for Public Policy. Ottawa, ON: Canadian Public Health

Association. Downloaded on May 2nd from

[http://www.cpha.ca/uploads/policy/Future_e.pdf]

Canda, E. R. & Furman, L. D. (2009). Spiritual Diversity in Social Work

Practice: The Heart of Helping (2nd Edition), New York, NY: Oxford

University Press.

Champagne, F., Lemieux-Charles, L., & McGuire, W. (2004).

Introduction: Toward a broader understanding of the use of

knowledge and evidence in healthcare. In L. Lemieux-Charles

& F. Champagne (Eds.), Using knowledge and evidence in health care:

Multidisciplinary perspectives (pp.3–17). Toronto: University of

Toronto Press.

Chunn, D.E. & Gavigan, S.A.M. (2004). Welfare law, welfare fraud,

and the moral regulation of the 'never deserving' poor.

Social Legal Studies, 13, 219-243.

Clark, A. (2000). The new poor law and the breadwinner wage:

Contrasting assumptions. Journal of Social History, 34(2), 261-281.

Corley, M. (2002). Moral distress: A proposed theory and research

agenda, Nursing Ethics, 9(6), 636–650.

Poverty and Health 32

Corley, M.C., Minick, P., Elswick, R K, & Jacobs, M. (2005).

Nurses moral distress and ethical work environment. Nursing

Ethics, 12(4), 381-390.

Cunningham, M. (2003). Impact of trauma work on social work

clinicians: Empirical findings. Social Work, 48,451–459.

Dane, B., & Chachkes, E. (2001). The cost of caring for patients

with an illness: Contagion to the social worker. Social Work in

Health Care, 33, 31–50.

Dei, G.J.S. (1999). The denial of difference: refraining anti-

racist praxis, Race, Ethnicity and Education, 2(1), 17-38.

Diez Roux, A.V., Merkin, S.S., Arnett, D., Chambless, L.,

Massing, M, et al., (2001). Neighborhood of residence and

incidence of coronary heart disease. The New England Journal of

Medicine, 345, 99–106. 

Eisenberger, N.I., Inagaki, T.K., Rameson, L.T., Mashal, N.M. &

Irwin, M.R. (2009). An fMRI study of cytokine-induced

depressed mood and social pain: The role of sex differences.

NeuroImage, 47, 881–890.

Poverty and Health 33

England, J. (2004). Disciplining subjectivity and space:

representation, film and its material effects. Antipode, 36 ,

295-321.

England, P. (2005). "Emerging Theories of Carework." Annual Review

Sociology, 31, 381-399.

Farmer, P.E. (2005). Pathologies of power: Health, human rights, and the new

war on the poor. (2nd edition). Berkeley: University of California

Press.

Felgen, J. (2004). Caring and healing environment: Restoring

caring back into nursing. Nursing Administration Quarterly, 28,

288–301.

Fiala, A. (2010). Public War, Private Conscience: The Ethics of Political Violence.

New York, NY: Continuum International Publishing Group

Finkler, K., Hunter, C. & Iedema, R. (2008). What Is Going on?:

Ethnography in Hospital Spaces. Journal of Contemporary

Ethnography, 37, 246-251.

Fiscella, K. & Franks, P. (1997). Poverty or income inequality as

predictor of mortality: longitudinal cohort study. British

Medical Journal, 314, 1724–1727.

Poverty and Health 34

Foucault, M. (1994) The Birth of the Clinic: An Archaeology of Medical

Perception. New York, NY: Vintage Books. (Original work

published in 1963 in French, translated into English in

1973).

Frenette, M., Green, D. & Milligan, K. (2006). Revisiting recent trends

in Canadian after-tax income inequality using census data. Ottawa: Statistics

Canada. Downloaded on April 25, 2010 from

[www.statcan.gc.ca].

Frenette, M., Green, D. & Picot, G. (2004). Rising Income Inequality

amid the Economic Recovery of The 1990's: An Exploration of The Three Data

Sources. Ottawa: Statistics Canada. Ottawa. Downloaded on

April 25, 2010 from [www.statcan.gc.ca].

Gambrill, E. (2001). Social work: An authority-based profession.

Research on Social Work Practice, 11, 166-175.

Gitterman, A. & Germain, C.B. (2008). The Life Model of Social Work

Practice: Advances in Theory and Practice. New York, NY: Columbia

University Press Publishers.

Glaser, R. & Kiecolt-Glaser, J.K. (2005). Stress-induced immune

dysfunction: implications for health. Nature Reviews

Immunology, 5, 243–251.

Poverty and Health 35

Goldenberg, M. (2006). On evidence and evidence-based medicine:

Lessons from the philosophy of science. Social Science & Medicine,

62 (11), 2621-2632.

Goode, J. & Eames, E. (1996). An anthropological critique of the

culture of poverty (pp. 405–41). in G. Gmelch and W. P.

Zenner, eds.. Urban Life, Prospect Heights, IL: Waveland Press.

Habermas, J. (1987). Theory of communicative action (T. McCarthy,

Trans.). Boston: Beacon. (Original work published 1981)

Habermas, J. (1993). Justification and Application: Remarks on Discourse Ethics

(C. Cronon, Trans.). Cambridge, MA: MIT Press. (Original

work published 1990 and 1991)

Habibov, N. N. & Fan, L. (2008). Comparison of inequality

reduction and income security in Canada from a mixed to neo-

liberal welfare regime: micro-data simulations and policy

implications. Journal of Comparative Social Welfare, 24(1), 33-47.

Hallgrímsdóttir, H.K., Teghtsoonian, K. & Brown, D. (2009).

Public policy, caring practices and gender in health care

work. Canadian Journal of Public Health, 99, s43-s47.

Harber, K.D., & Pennebaker, J.W. (1992). Overcoming traumatic

memories. In A. C. Christianson (Ed.), The handbook of emotion

Poverty and Health 36

and memory: Research and theory (pp. 359–386). Hillsdale, NJ:

Erlbaum.

Heslop C.L., Miller, G.E. & Hill, J.S. (2009). Neighbourhood

Socioeconomics Status Predicts Non-Cardiovascular Mortality

in Cardiac Patients with Access to Universal Health Care.

PLoS ONE, 4(1): e4120. Downloaded on May 16, 2010 from

[www.plosone.org]

Ilcan, S. & Basok, T. (2004). Community government: Voluntary

agencies, social justice, and the responsibilization of

citizens. Citizenship Studies, 8(2), 129-144.

Ivanova, I. (2009). BC’s Growing Gap Family Income Inequality

1976–2006. Canadian Centre for Policy Alternatives.

Downloaded on May 2, 2010 from [www.policyalternatives.ca]

Jones, G. (1980). Social Darwinism and English thought: The interaction between

biological and social theory. New York, NY: Humanities Press.

Kerstetter, S. (2002). Rags and riches: Wealth Inequality in

Canada. Canadian Centre for Policy Alternatives. Downloaded

on May 2, 2010 from [www.policyalternatives.ca]

Kitchen, B. (2001). Poverty and declining living standards in a

changing economy. In Turner, J. & Turner, F. (Eds.) Canadian

Poverty and Health 37

Social Welfare (pp. 232-249). Toronto, ON: Pearson Education

Canada.

Lane, R. (2008). Neural substrates of implicit and explicit

emotional processes: a unifying framework for psychosomatic

medicine. Psychosomatic Medicine, 70, 213–230.

Lanea, R.D. & Wagerb, T.D. (2009). Editorial: The new field of

brain–body medicine: What have we learned and where are we

headed? NeuroImage, 47(3), 1135-1140.

Lesperance, F., Frasure-Smith, N., Talajic, M. & Bourassa, M.G.

(2002). Five-year risk of cardiac mortality in relation to

initial severity and one-year changes in depression symptoms

after myocardial infarction. Circulation, 105, 1049–1053.

Lewis, O. (1998). The culture of poverty, Society, 35, 7–9.

Lightman, E & Irving, A. (2009). Restructuring Canada's welfare

state, Journal of Social Policy 20(1), 65-86.

Lymbery, M. (2001). Social work at the crossroads. British Journal of

Social Work, 31, 369-384.

Manning, S.S. (1997). The social worker as moral citizen: Ethics

in action. Social Work, 42(3), 223-230.

Poverty and Health 38

McLaren, A. (1990). Our own master race: Eugenics in Canada, 1885-1945.

Toronto, ON: McClelland & Steward.

Melchior, M., Moffitt, T.E., Milne, B.J., Poulton, R., Caspi, A.

(2007). Why do children from socioeconomically disadvantaged

families suffer from poor health when they reach adulthood?

A life-course study. American Journal of Epidemiology, 66(8), 966-

74.

Meyer, J.W. & Rowan, B. (1977). Institutionalized organizations:

Formal structure as myth and ceremony. The American Journal of

Sociology, 83 (2), 340-363.

Ministry of Healthy Living and Sport. (2007). Provincial Health Officer

Annual Report. Downloaded on May 2, 2010 from

[www.hls.gov.bc.ca].

Morrow, M., Hankivsky, O. & Varcoe, C. (2004). Women and

violence: Effects of dismantling the welfare state. Critical

Social Policy, 24(4), 358-384.

O'Connell, A. (2009). Building their readiness for economic

"freedom": The new poor law and emancipation. Journal of

Sociology and Social Welfare. 36, (2), 85-103  

Poverty and Health 39

O'Donnell, P., Farrar, A., Brintzenhofeszoc, K., Conrad, A. P.,

Danis, M., Grady, C., Taylor, C. & Ulrich, C. M. (2008).

Predictors of ethical stress, moral action and job

satisfaction in health care social workers, Social Work in Health

Care, 46(3), 29-51.

Ohira, H., Fukuyama, S., Kimura, K., Nomura, M., Isowa, T.,

Ichikawa, N., Matsunaga, M., Shinoda, J. & Yamada, J.

(2009). Regulation of natural killer cell redistribution by

prefrontal cortex during stochastic learning. NeuroImage.

47, 897–907.

Pellegrino, E.D. & Thomasma, D.C. (1981). A Philosophical Basis of

Medical Practice: Toward a Philosophy and Ethic of the Healing Professions.

New York, NY: Oxford University Press.

Picot, G. & Myles, J. (2005). Income inequality & low-income in Canada: An

international perspective. Statistics Canada , Ottawa.

Pockett, R. (2003). Staying in hospital social work. Social Work in

Health Care, 36(3), 1-24.

Poulton, R., Caspi, A., Milne, B.J., Thomson, W.M., Taylor, A.,

Sears, M.R. & Moffitt, T.E. (2002). Association between

Poverty and Health 40

children's experience of socioeconomic disadvantage and

adult health: a life-course study. Lancet, 360 (9346),1640-5.

Quinn, J. (1992). Holding sacred space: The nurse as healing

environment. Holistic Nurse Practice, 6(4), 26-35.

Raphael, D. (2007). Poverty and Policy in Canada: Implications for Health and

Quality of Life. Toronto, ON: Canadian Scholars' Press.

Robbins, C. L. & Birmingham, J. (2005). The social worker and

nurse roles in case management: Applying the three

Rs. Lippincott's Case Management, 10(3), 120-127.

Sasson, S. (2000). Beneficence versus respect for autonomy: an

ethical dilemma in social work practice. Journal of Gerontological

Social Work, 33(1), 5-16.

Seabrook, J. (2002). The No-Nonsense Guide to Class, Caste and

Hierarchies . Toronto, ON: New International Publications &

Between the Lines.

Sharpe, V.A. & Faden, A.I. (1988). Medical Harm: Historical, Conceptual,

and Ethical Dimensions of Iatrogenic Illness. New York, NY: Cambridge

University Press.

Singer, M. (2009). Introduction to Syndemics: A Systems Approach to Public and

Community Health. San Francisco, CA: Jossey-Bass.

Poverty and Health 41

Smith, G.D., Hart, C., Watt, G., Hole, D. & Hawthorne, V. (1998).

Individual social class, area-based deprivation,

cardiovascular disease risk factors, and mortality: the

Renfrew and Paisley Study. Journal of Epidemiology and Community

Health, 52, 399–405.

Stocks, C. (2007). Trauma theory and the singular self:

rethinking extreme experiences in the light of cross

cultural identity. Textual Practice, 21(1), 71-92.

Subramanian, S. V. & Kawachi, I. (2004). Income inequality and

health: What have we learned so far? Epidemiologic Reviews, 26,

78-91.

Svenaeus, F. (2001). The Hermeneutics of Medicine and the Phenomenology of

Health – Steps towards a Philosophy of Medical Practice. Boston, MA:

Kluwer Academic Publishers.

Tang, S. Y. & Browne, A. J. (2008). ‘Race’ matters: Racialization

and egalitarian discourses involving Aboriginal people in

the Canadian health care context. Ethnicity & Health, 13(2), 109-

127.

Taylor, C. & White, S. (2000). Practising Reflexivity in Health and Welfare:

Making Knowledge. Buckingham: Open University Press.

Poverty and Health 42

Taylor, C. & White, S. (2001). Knowledge, truth and reflexivity:

the problem of judgement in social work, Journal of Social Work,

1(1), 37–59.

van der Kolk, B.A. (1994). The body keeps the score: Memory and

the evolving psychobiology of posttraumatic stress. Harvard

Review Psychiatry, 1 (5), 253-265.

Wager, T.D., van Ast, V.A., Hughes, B.L., Davidson, M.L.,

Lindquist, M.A. & Ochsner, K. N. (2009b). Brain mediators of

cardiovascular responses to social threat, Part II:

Prefrontal subcortical pathways and relationship with

anxiety. NeuroImage, 47, 836–851.

Wager, T.D., Waugh, C.E., Lindquist, M., Noll, D.C., Fredrickson,

B.L. & Taylor, S.F. (2009a). Brain mediators of

cardiovascular responses to social threat, Part I:

Reciprocal dorsal and ventral sub-regions of the medial

prefrontal cortex and heart-rate reactivity. NeuroImage, 47,

821–835.

Webb, S.A. (2001). Some considerations on the validity of

evidence-based practice in social work. British Journal of Social

Work, 31, 57-79.

Poverty and Health 43

Wilson, D. & Macdonald, D. (2010). The income gap between

aboriginal peoples and the rest of Canada. Canadian Centre

for Policy Alternatives. Downloaded on May 2, 2010 from

[www.policyalternatives.ca]

http://www.ncbi.nlm.nih.gov/pubmed/16968786

Wright, E.O. (1994). The class analysis of poverty. In E.O.

Write (Ed.), Interrogating Inequality (pp. 32-50). New York, NY:

Verso.

Yusuf, K. (2009). The epidemics of type 2 diabetes, obesity, and

the metabolic syndrome. Medscape Online. Downloaded on May 12,

2010 from [cme.medscape.com].