The majority of Ontario residents think poverty—and privilege—are contributing to ill health

Lofters A, Slater M, Kirst M, Shankardass K, Quiñonez C. How do People Attribute Income-Related Inequalities in Health? A Cross-Sectional Study in Ontario, Canada. PLoS ONE 9(1): e85286. Contact: Aisha Lofters (

Issue: Research shows that people living on higher incomes have better health than people living on lower incomes. It is not clear, however, how the relationship between income and health is understood by the public. As public opinion is an important factor in moving policy-makers to take action, we worked with our partners to ask Ontario residents what they think about income and health.

What we did: We worked with our partners to analyze results from phone interviews conducted in 2010 with 2,006 Ontario residents over the age of 18. Study participants were generally representative of the Ontario population. Participants were asked if they agreed or disagreed with a series of statements on population health. First, we looked at the data to explore the degree to which Ontario residents recognize the fact that people living on high incomes are healthier than people living on low incomes—a summary is available here. In this paper, we ask why Ontario residents think people living on high incomes are healthier than people living on low incomes.

We found that Ontario residents:

Believe the social determinants of health are key drivers of poor health. 84% agree that ‘if you work in a poorly paying job, the insecurity you feel can have a bad effect on your health.’ 74% agree that ‘the rich are healthier because they have better access to high quality food.’

Do not believe that health problems are largely due to personal behaviours. For example, 60% – 63% do not believe health inequalities can be attributed to ‘unhealthy coping behaviour’ or ‘unwise spending.’

Believe that the privilege of people living on high incomes plays an important role in generating health inequalities. For example, 55% agree that the ‘rich get more out of the health system than the poor’ and 84% agree that ‘the rich have more choices and control over their lives and health than the poor.’

Implications: These findings can inform educational campaigns to raise awareness about income-related health inequalities. In addition—as the majority of Ontario residents understand the importance of the social determinants of health—policy-makers, organizations and groups working to address issues like economic injustice, quality housing and food insecurity may wish to discuss the links between these issues and health.