Author: Shuhei Omi, UBI Taiwan
Economic inequality produces significant gaps in health outcomes in Taiwanese society, according to researchers who worked with the Taiwan Ministry of Health and Welfare.
Last year, the Institute of Health Equity at University College London published its report “Health Inequalities in Taiwan,” prepared over three years and commissioned by the Ministry of Health and Welfare. While physical well being of Taiwanese people in general has consistently improved over time, the report found persistent differences among groups with varying socioeconomic conditions, most notably in income and employment.
From 2001 to 2010, average life expectancy in the most deprived townships was 73 years – a full eight years less than in the richest areas. The report found across the income spectrum that “the less the amount of deprivation in a township, the longer people in the township could expect to live and be free of disability.” Breaking down the common causes for death also revealed a consistent relationship between lower incomes and poorer health, as rates for circulatory disease, cancer, and suicide were persistently higher for townships with greater levels of deprivation.
The report noted the steep income inequalities present in Taiwanese society – the top and bottom fifths of households differ in amount of disposable income by a six to one ratio. This is significant as poorer health often stems from literal poverty, while at the same time “ill health can result in a lower earning capacity.”
Accordingly, level of education attainment, an indicator of income, produced visible consequences. Rates of infant immortality were 80 percent higher for mothers without a senior high school education than for mothers who did. Men graduating from junior high school were more than twice as likely to smoke than their university graduating counterparts, while both men and women only graduating from junior high school were 14 and 21 times more likely to be admitted to the hospital for alcohol-related reasons than for those who attended university, respectively.
Citing past research indicating worsened health for the unemployed, the report warned of widening unemployment in Taiwan, especially among the youth. While solving unemployment will improve health for many, the government should pay attention to the kinds of work it makes available. Perhaps in one of the report’s most revealing findings, mortality rates among individuals differed substantially between occupational groups. Grouping occupations into blue and white-collared jobs, blue-collar death rates were 84 percent higher. At the extremes, death rates for “skilled agricultural, forestry and fishery workers” and “elementary workers” were six times that of “professionals.”
This difference can be attributed to the nature of much blue-collar work. While “being without work is rarely good for one’s health,” the researchers wrote, “jobs that are insecure, low-paid and that fail to protect employees from stress and danger make people ill.” These “precarious” forms of work often involve unsafe working conditions and “strenuous tasks over which the worker has little control, low wages and high job instability.” All of these conditions induce unhealthy levels of physical and mental stress on workers.
The report explains the social determinants of health as “the conditions of daily life – the circumstances in which people are born, grow, live, work and age – and structural drivers of these conditions – the inequitable distribution of power, money and resources.” Its authors contend the health inequalities they observed are not only fundamentally “unnecessary and unfair” but have repercussions for the wider economy. “The unnecessary loss in productivity and tax receipts and increased costs to health services and in terms of welfare payments are a considerable burden on the national economy.”
The first report of its kind in Taiwan, or the whole of Asia, the report revealed evidence of the tangible effects of income insecurity, which have been well documented in other parts of the world.
Among its many recommendations, the report prescribed universal child care and educational offerings to reduce the social gradient and new management standards to reduce workplace stress. Speaking to United Daily News on the report’s findings, Professor Chiang Tung-liang from the National Taiwan University College of Public Health urged for reforms in regulations on work hours, wages, leave, and benefits.
The report also suggested implementation of a “minimum standard of income,” particularly among older individuals, in addition to stronger social protections against economic adversity. Past implementations of basic income have shown to improve health. A study of the five-year minimum income Canadian basic income experiment from 1974 to 1979 found lower hospitalization for injuries and mental health diagnoses. The researchers from the University of Manitoba concluded that modest levels of guaranteed income may lead to significant savings in the healthcare system.
Read the original report or the translated Chinese version on the Ministry of Health and Welfare website.