Lived experience of economic and political trends related to globalization.

Cushon, Jennifer A. ; Muhajarine, Nazeem ; Labonte, Ronald 等

Globalization, defined for our study purposes as "a process of greater integration within the world economy through movements of goods and services, capital, technology and (to a lesser extent) labour, which lead increasingly to economic decisions being influenced by global conditions," (1) is considered to influence health status and the determinants of health in important ways. Since the effects of globalization are extremely context dependent, (2) scholars suggest that the next stage in globalization and health research should be studying the pathways between globalization and health on a case-by-case basis. (3,4) In this paper, we focus on the results from the interview component of a population health case study that investigated the economic and political pathways by which globalization influences the determinants of health among low-income families with young children (aged zero to five) in Saskatoon, Canada. In-depth interviews sought to elucidate the lived experience of low-income families with young children in relation to economic and political trends that are related to the processes of globalization.

Population health case study

Labonte and Torgerson's globalization and health analytical framework (5) guided the case study and acted as a heuristic device. Methods for the case study included: a demographic profile of Saskatoon since 1980 (this year is often marked as a turning point in the nature of globalization (6,7)); an environmental scan of federal, provincial, and municipal policy that has direct relevance for child health; in-depth interviews; trend analysis of child health outcomes; and process tracing.

Building upon Labonte and Torgerson's analytical framework, Figure 1 illustrates the pathways between globalization and child health that were found in the case study. As argued elsewhere, (8,9) our study substantiated that the current phase of globalization has co-evolved with the implementation of neoliberal policies emphasizing increased trade liberalization, privatization, deregulation, and global economic integration. To reflect this finding, whenever the term 'globalization' is used in this paper, it refers to the specific characteristics of neoliberal globalization. Although previous studies regarding globalization and the welfare state have produced conflicting results, (10-12) this study found that globalization has contributed to the retrenchment of the welfare state in Canada and Saskatchewan (Saskatchewan being a province within Canada, and Saskatoon its largest city), resulting in diminished program access. This study also showed that poverty has deepened among those who were already poor. Other research argues that globalization encourages the development of 'flexible' labour markets, (13,14) which in Saskatoon's case was manifest by an increase in non-traditional (multiple job-holding, fewer benefits, less secure) employment arrangements. A restructured labour market and reduced access to services and programs likely contributed to the rise in income inequality that was found in our case study. Other research affirms the link between globalization and increased income inequality. (15,16) Housing prices in North American cities are also affected by processes associated with globalization, (17,18) and likely contributed to decreased housing affordability in Saskatoon, as our study found. More detailed results from the case study elaborating upon these findings, and the linkages back to globalization, are described elsewhere. (19,20)

[FIGURE 1 OMITTED]

Interview component

The purpose of the interview component was to uncover the lived experience of low-income families and their children in Saskatoon with regards to the pathways depicted in the Community Contexts and Household Contexts levels in Figure 1, an important supplement to the usual globalization and health research relying primarily on highly stylized cross-country regressions in which the personal impacts remain hidden. (21)

METHODS

We pursued a phenomenological approach to the interviews, which emphasizes individuals' construction of their 'life-world' experiences. (22) Our approach further emphasized that individuals are social actors within a social system; one cannot analyze people's experiences in isolation from their social world. (23)

The interview component was approved by the University of Saskatchewan's Ethics Review Board in June 2008, and strict measures ensured the anonymity of all interview participants. We used a combination of criterion and volunteer sampling. Each interview participant met predefined eligibility criteria (i.e., parent of child/children ages zero to five; resident of Saskatoon; low-income, according to Statistics Canada's low-income cut-off; and has been affected by the pathways depicted in Figure 1), and were recruited from within a volunteer pool of potential participants served by two local organizations working with low-income families. One of the limitations of volunteer sampling is that people who choose to participate may be different from those who do not. (24)

Since globalization is an abstract and nebulous concept, (25) interview questions were framed in terms of people's experiences in relation to economic and political trends that have occurred since 1980 and which other research has linked to globalization. (26) Interview participants were asked open-ended questions, probing their experiences of the pathways depicted in Figure 1 (e.g., living in poverty, employment experiences, etc.). All interviews were conducted by the primary author of this paper in July and August 2008, tape recorded, and transcribed verbatim.

Phenomenological reduction was employed throughout the interview and analysis processes, which requires researchers to suspend judgement regarding the validity of participants' experiences in order to arrive at an unprejudiced description of the phenomenon. (27,28) This was achieved throughout the interview and analysis processes by journaling and consistently reflecting on our roles (doctoral candidate, faculty member) in relation to the interview participants.

Analysis occurred by immersing ourselves in the data and reading transcripts at least three times. A process of open coding was then undertaken to determine themes and 'core' categories. Once the 'core' categories were determined, selective coding occurred, whereby 'core' codes were used to develop 'sub-codes'. (24) Coding led to the construction of "narratives of experiences". (28) Trustworthiness was addressed by triangulating the methods used in the larger case study.

Twenty-six interviews were conducted. Saturation was used to determine the number of interview participants. Six of the participants were male and 20 were female; their ages ranged from 18 to 47. Almost all participants did not have education post-high school. More than half of the interview participants (n=19) were on some form of social assistance.

RESULTS

Deepened poverty

Poverty rates among the population overall, and for children specifically, stagnated or slightly improved in Saskatoon since 1980.19 However, poverty deepened among low-income families; the poor became that much poorer. Basic necessities such as housing, transportation and food were unaffordable for many low-income families. Budgeting for living expenses often involved a careful balancing act:

   I just finally got my power paid off. I don't know if you've seen
   the commercial where the girl's trying to decide whether she should
   eat something or pay the power, but that's exactly what happened to
   me. While many low-income families may have struggled in the past,
   the recent economic situation--in which rapid resource-driven
   growth led to an influx of people to Saskatoon creating a sudden
   and rapid rise in housing and other living expenses (19)--has made
   this struggle even more pronounced.

   Well [for] most of them it was a stretch to make their rent in the
   first place. It was rob Peter to pay Paul. Welfare would only cover
   so much and then you had to throw all your bills in a hat and draw
   out four and those are the ones you pay and everybody else has got
   to wait. [The rise in the cost of living has an] all around toll on
   everybody.

Deepened poverty often produced a sense of helplessness, isolation, and/or anger in participants. Poverty also profoundly affected parents' self-esteem.

   You know you try to get help and it seems like you get three rungs
   up the ladder and someone's there to kick it out from underneath
   you.

Increased income inequality

Income inequality has worsened in Canada, in Saskatchewan, and in Saskatoon. (19) This was apparent to many interview participants.

   If this province is on an upswing and it's so rich and you listen
   to [the premier] and all the politicians, why are the people living
   in the streets? This isn't a far away place in Africa. This is
   downtown Saskatoon.

Recent economic prosperity in Saskatchewan and Saskatoon seemed to benefit only certain segments of the population, and this exacerbated stress and low self-esteem among parents and children.

Some participants felt that the economic boom had at least increased the number of employment opportunities available, although these opportunities were of a non-traditional and contingent nature.

   I think it is easier to find a job nowadays, but to get anything
   decent that will help you keep a place and stuff you'd probably
   have to find two or three because half of them pay only minimum
   wage.

Diminished program access

Programmatic restructuring and decreased social spending across most sectors by the federal and provincial governments led to diminished program access in Saskatoon. (19,20) Participants believed there were not enough programs and supports available for children and families, and that support and assistance from the larger community was lacking.

   It seems like there used to be a lot more programs. Before you
   could get into these programs and now there are only selective
   programs ... With people here it doesn't matter if you have a job or
   anything. They're not going to help you period unless you've got a
   really good reason.

Specific to Saskatchewan's social assistance program, the level of social assistance benefits were not keeping pace with the cost of living, particularly housing costs.

   It was a lot easier in the past to make ends meet because the rent
   wasn't so high, but nowadays it's just unbelievable. It's hard to
   keep up with the rent and pay the power and everything when you
   have to dig into your basic allowance to pay for your housing and
   your basic needs.

For participants with a lengthy history of social assistance engagement, a common sentiment was that rates were sufficient up until program restructuring in the late 1990s, at which time the Canadian provinces, including Saskatchewan, implemented workfare approaches to welfare. This was an approach based on the assumption that individuals and families thrive most when they are part of the labour market. (29)

   My mom, for instance, she's been on assistance for a while. While
   we were growing up, she was on assistance as well. And we seemed to
   get along ... fine back then. So I think it is way harder now than
   ten years ago because my mom was able to survive with six kids. And
   now she's got two, but she can't look after them.

Most participants on social assistance did not want to remain so since they wanted to avoid feelings of dependency and inadequacy. Yet, for most of the parents interviewed, the only available jobs also represented an intense struggle to survive.

Restructured labour market

A restructured labour market in Saskatoon meant that many low-income parents without post-secondary education were relegated to non-traditional employment situations. (19) Wages were considered insufficient to raise a family and to provide for basic necessities such as food and housing. Only one employed participant and his children had access to benefits such as sick leave, medical or dental. An underlying reason, and a common theme, was participants' low education levels.

   And that's what I'm worried about because I have my baby and a low
   education, and then to try and find a decent job that pays good
   money ... You've got to have good self-esteem to succeed. A lot of
   people don't have that I don't think and I think it's mostly
   because of lack of education.

The number one barrier to employment was child care responsibilities. Employers were unwilling to provide flexible schedules, benefits, or child care that would help parents, and this served to perpetuate a sense of vulnerability among parents.

Decreased housing affordability

Saskatoon's housing market recently experienced unprecedented demand and growth. (19) All participants but one felt that housing was not affordable. Due to the high cost of housing, many participants had to stay temporarily with friends, live with extended family, reside in shelters, sleep on couches, or sleep in tents.

   This housing thing has become impossible. I've probably housed ten
   friends just in the last few months until they could find a place
   to live. Especially with little kids it's really, really hard and I
   find it really depressing to see kids on the street. All the other
   cities I've ever lived in they weren't allowed to just boom the
   rents up like that. The rent is skyrocketing and there's no control
   on it. There's no control on what they're doing and how they're
   moving people out.

Overcrowding was prevalent and usually led to mental and physical health issues such as increased stress levels. The relationship between housing and health was starkly apparent in a number of the interviews.

   There's black mould in the bathroom. Whenever the last snow melts
   and when it rains, it comes in through my bedroom and soaks the
   rug. It's been like that since I moved in and now my baby and I are
   taking turns having nose bleeds or getting sick all the time ...
   But I can't move because the rent is so high everywhere else.

Parent and child health was often jeopardized due to substandard housing (i.e., the only form of housing that low-income families could afford).

CONCLUSION

The larger case study determined that globalization-related trends have contributed to deepened poverty, increased income inequality, diminished program access, increased labour market insecurity, and decreased housing affordability in Saskatoon. Low-income families with young children described a struggle to survive, despite the tremendous economic growth occurring in Saskatchewan and Saskatoon at the time of the interviews. This struggle created feelings of helplessness, low self-esteem, and despair among parents who could not meet their families' needs. Parents often felt trapped by their straitened economic circumstances, and this could limit their sense of community. Many expressed being left behind by the economic boom occurring.

Any phenomenon that perpetuates a sense of helplessness, detachment, and/or low self-esteem has enormous potential to negatively affect the health of parents and children. When the disadvantaged members of social groups compare themselves to others, this can produce negative psychosocial implications, even among young children. (30,31) Moreover, a sense of detachment from one's community will likely diminish levels of social cohesion. (32,33) A divided community, one where there are large inequities, is almost never a healthy community. (34)

While interviews found the political and economic processes of globalization have exacerbated many hardships for low-income families, this is not to suggest that globalization was the only phenomenon at work. When investigating the 'life-worlds' of interview participants, it is nearly impossible to attribute experiences and perceptions to simply one phenomenon. However, studies of this nature are important for contributing to our understanding of the complex structures that influence health and for building up the linkages between globalization and health on a case-by-case basis. (35,36)

Acknowledgements: The primary author was supported by an Institute of Population and Public Health-Public Health Agency of Canada Doctoral Research Award. The study was supported, in part, by Canadian Institutes of Health Research Grant 80070, Globalization and the Health of Canadians.

Received: July 30, 2009 Accepted: December 1, 2009

REFERENCES

(1.) Jenkins R. Globalization, production, employment and poverty: Debates and evidence. J Int Development 2004;16:1-12.

(2.) Bradford N. Canadian Social Policy in the 2000s: Bringing Place In. Canadian Policy Research Networks, 2008.

(3.) Waters WF. Globalization, socioeconomic restructuring and community health. J Community Health 2001;26(2):79-92.

(4.) Doyal L. Understanding gender, health and globalization: Opportunities and challenges. In: Kickbusch I, Hartwig KA, List JM (Eds.), Globalization, Women and Health in the Twenty-First Century. New York, NY: Palgrave Macmillan, 2005;9-28.

(5.) Labonte R, Torgerson R. Interrogating globalization, health and development: Towards a comprehensive framework for research, policy and political action. Critical Public Health 2005;15(2):157-79.

(6.) Teeple G. Globalization and the Decline of Social Reform: Into the Twenty-First Century. Aurora, ON: Garamond Press, 2000.

(7.) Cornia GA. Globalization and health: Results and options. Bull WHO 2001;79(9):834-41.

(8.) Cornia GA (Ed.). Harnessing Globalisation for Children: A Report to UNICEF. UNICEF, 2001.

(9.) Harvey D. A Brief History of Neoliberalism. New York: Oxford University Press, 2005.

(10.) Garrett G, Mitchell D. Globalization, government spending and taxation in the OECD. Eur J Political Res 2001;39(2):145-77.

(11.) Rodrik D. Why do more open economies have bigger governments? J Political Economy 1998;106(5):997-1032.

(12.) Schulze G, Ursprung HW. Globalization of the economy and the nation state. The World Economy 1999;22:295.

(13.) Burke M, Shields J. Tracking nequality in the new Canadian labour market. In: Burke M, Mooers C, Shields J (Eds.), Restructuring and Resistance: Canadian Public Policy in an Age of Global Capitalism. Halifax, NS: Fernwood Publishing, 2000;98-123.

(14.) Ostry A, Spiegel JM. Labor markets and employment insecurity: Impacts of globalization on service and healthcare-sector workforces. Int J Occup Environ Health 2004;10(4):368-74.

(15.) Wilkinson RG, Pickett KE. Income inequality and population health: A review and explanation of the evidence. Soc Sci Med 2006;62:1768-84.

(16.) Cornia GA, Kiiski S. Trends in Income Distribution in the Post-World War II Period: Evidence and Interpretation. UNU-WIDER, 2001.

(17.) Kenna P. Globalization and housing rights. Indiana J Global Legal Studies 2008;15(2):397-469.

(18.) Ley D, Tutchener J. Immigration, globalisation and house prices in Canada's gateway cities. Housing Studies 2001;16(2):199-223.

(19.) Cushon J. Child Health in an Era of Globalization: A Case Study of Saskatoon, Saskatchewan [PhD dissertation]. Saskatoon: University of Saskatchewan, 2009.

(20.) Cushon J, Muhajarine N. The cousin of globalization: Neoliberalism and child-relevant policy. In: McIntosh T, Jeffery B, Muhajarine N (Eds.), Population Health Research in Canada: New Directions and New Voices. Toronto, ON: University of Toronto Press, In press.

(21.) Labonte R, Schrecker T. Globalization and social determinants of health: Introduction and methodological background (part 1 of 3). [online] Globalization and Health 2007;3(5).

(22.) Ainlay S. The encounter with phenomenology. In: Hunter J, Ainlay S (Eds.), Making Sense of Modern Times: Peter L. Berger and the Vision of Interpretive Sociology. London, UK: Routledge and Kegan, 1986;31-56.

(23.) Becker C. Living and Relating: An Introduction to Phenomenology. Newbury Park: Sage, 1992.

(24.) Rice PL, Ezzy D. Qualitative Research Methods: A Health Focus. South Melbourne, Australia: Oxford University Press, 2000.

(25.) Labonte R, Torgerson R. Frameworks for Analyzing the Links Between Globalization and Health. Geneva, Switzerland: World Health Organization, 2003.

(26.) Labonte R, Schrecker T, Packer C, Runnels V (Eds.). Globalization and Health: Pathways, Evidence and Policy. London: Routledge, 2009.

(27.) Kvale S. Interview: An Introduction to Qualitative Research Interviewing. Thousand Oaks: Sage Publications, 1996.

(28.) Caelli K. Engaging with phenomenology: Is it more of a challenge than it needs to be? Qualitative Health Res 2001;11:273-81.

(29.) McBride S. Paradigm Shift: Globalization and the Canadian State, 2nd ed. Halifax: Fernwood Publishing, 2005.

(30.) Pickett KE, Wilkinson RG. Child wellbeing and income inequality in rich societies: Ecological cross sectional study. Br Med J2007;335:1080-85.

(31.) Coburn D. Income inequality, social cohesion and the health status of populations: The role of neo-liberalism. Soc Sci Med 2000;51:135-46.

(32.) Coburn D. Beyond the income inequality hypothesis: Class, neo-liberalism, and health inequalities. Soc Sci Med 2004;58:41-56.

(33.) Wallerstein N. Powerlessness, empowerment, and health: Implications for health promotion programs. Am J Health Promot 1992;6(3):197-205.

(34.) Wilkinson R, Pickett K. The Spirit Level: Why More Equal Societies Always Do Better. London: Allen Lane, 2009.

(35.) Labonte R, Schrecker T, Gupta AS. Health for Some: Death, Disease and Disparity in a Globalizing Era. Toronto: Centre for Social Justice, 2005.

(36.) De Vogli R, Birbeck GL. Potential impact of adjustment policies on vulnerability of women and children to HIV/AIDS in sub-Saharan Africa. J Health, Population Nutr 2005;23(2):105-20.

Jennifer A. Cushon, PhD, [1] Nazeem Muhajarine, PhD, [2] Ronald Labonte, PhD [3]

Author Affiliations

[1.] Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK

[2.] Department of Community Health and Epidemiology, University of Saskatchewan, Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, SK

[3.] Department of Epidemiology and Community Medicine, University of Ottawa; Institute of Population Health, University of Ottawa, Ottawa, ON

Correspondence: Dr. Jennifer Cushon, Health Science Building, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Tel: 306-655-4634, E-mail: [email protected]

Table 1. Distribution of Respondents by Household Income
Categories, before Taxes and Transfers

Income Category                N

Less than $5,000               3
Between $5,000 and $10,000     10
Between $10,000 and $15,000    5
Between $15,000 and $20,000    4
Between $20,000 and $25,000    1
Unknown                        3