Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
Department of Economics, Glendon College-York University, 2275 Bayview Ave., Toronto, ON, M4N 3M6, Canada.
Can J Public Health. 2019 Aug;110(4):386-394. doi: 10.17269/s41997-019-00206-3. Epub 2019 Apr 25.
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.
社会援助计划补充了最缺乏收入保障的人的收入。由于收入是健康的根本来源，因此预计收入补充将促进健康状况的提高。随着加拿大发现自己正处于激烈辩论社会援助计划的结构（和重构）之中，关于现行社会援助计划在改善收入不稳定者健康方面的有效性，决策者几乎没有可用的证据。
在本文中，我们评估了加拿大安大略省、加拿大全国以及美国和英国的同行计划中的社会援助计划对健康的影响。
我们使用了全国代表性的家庭小组调查（例如，加拿大劳动力和收入动态调查），这些调查会随着时间的推移跟踪个人。我们使用固定效应模型，该模型控制了个人的时间不变特征，并进一步控制了关键的时变特征，从而模拟了这些社会中与社会援助领取情况变化相关的健康状况变化。健康状况使用自我评估健康状况（一般/较差与良好/非常好/优秀）来衡量。
我们的结果表明，社会援助领取者的健康状况较差（加拿大安大略省、加拿大、英国）或与非领取者的健康状况没有差异（美国）。例如，在加拿大，领取社会援助与报告健康状况一般或较差的几率增加了 52.5%。
加拿大和同行国家的社会援助计划目前不足以改善收入不稳定者的健康状况。这可能是由于福利不足、面临不稳定的工作条件或选择因素所致。
