R. Wiebe, P. Keirstead
"Surviving on Hope is Not Enough" examines how provincial and
local policies concerning income support affect women's health.
The health of populations - individuals, their families and communities
- is determined by the complex interaction of many factors - social, political,
economic, legal, cultural, historical and biomedical. Of these determinants
of health, income has long been recognized as one of the most important.
The relationship between socio-economic status and health is well established.
People with higher incomes and higher socio-economic status tend to live
longer, have lower rates of illness and injury, and are more likely to
report that they have good or excellent health. People living in poverty
have a lower life expectancy and higher rates of illness across a wide
spectrum of diseases.
Women are more likely to live in poverty than men. Women with disabilities,
Aboriginal women, and single mothers have higher rates of poverty. Women
who live in poverty have poorer physical and mental health than those
with higher incomes.
Publicly funded income support programs can reduce the depth of poverty
and the level of income inequalities generated by the market economy.
By doing so, they can contribute to greater social equality and may improve
the health and welfare of the population. But how do women who rely on
these programs experience them? How do the policies governing these programs
affect their health and well-being?
This project was sponsored by the Prairie Women's Health Centre of Excellence
as part of a larger research initiative to examine social assistance policies
in Manitoba and Saskatchewan, their impact on women's health, and women's
access to justice as recipients of social assistance. The initial impetus
for this research came from a study in Ontario that looked at similar
This Manitoba research examines women's experiences with income support
programs. It also explores the ways in which community supports, advocates
and the appeal process can affect women's access to justice. The report
"walks through" the chronology of women's experiences as they engage with
the income support system, looking at:
The possibilities of becoming independent
from the system.
- First encounters in applying
for income support;
- The process of "starting up;"
- Living conditions;
- Training and employment opportunities;
Recommendations for Employment and Income Assistance in Manitoba and others
Methods and Findings
- Communication between the program
and women on income support;
- Women and children on income
- Women with disabilities on
income support, and,
- Social equality for women on
Researchers for this study conducted in-depth interviews with 28 women
who received income support or who applied and were refused income support.
Seven advocates in various communities, and six service providers from
agencies who work with women on income support were also consulted. One
or both of the researchers traveled throughout the province to the homes,
women's centres, or other gathering places where women meet to conduct
one-to-one interviews or focus groups.
A priority in the study was the inclusion of the perspectives of marginalized
women who had experiences with income assistance. Eighteen of the 28 women
participants identified themselves as being of Aboriginal descent, and
eleven of the 28 identified themselves as women with disabilities. Among
key informants interviewed, there was representation from the disability,
Aboriginal and immigrant women's communities.
Relating experiences of health and illness was a major part of every discussion
held with the 28 women who participated in this study. Women described
the stress of living in a state of dependency on a system that shames
them, scrutinizes them, withholds significant information from them, is
inaccessible to them at critical junctures in their lives, and blatantly
expresses no interest in understanding the day-to-day factors in their
lives. The stress of these conditions not only harms the overall well-being
of women living on income support, but also worsens the detrimental effects
of pre-existing mental health issues, physical disabilities, and other
medical conditions. Woven throughout conversations about mental health
and stress is the recognition by many women that they have little control
in determining their living conditions, their livelihoods, their sense
of well-being, or their children's futures.
All 28 women described their inability to provide healthy food and medication
to their families because of income support allotments. Twenty-six out
of 28 do not have enough money to rent a safe, healthy place to live.
Women dependent on income support programs for their essential needs are
in vulnerable positions given the power imbalance between themselves and
those whose decisions affect their access to financial support. Challenging
those decisions can be overwhelming and may require the support of skilled
and knowledgeable advocates in order to ensure that women receive the
full benefits to which they are legally entitled.
Issues identified by women who participated in this research include:
- Lack of access to information
about eligible benefits, appeal mechanisms, and opportunities for
vocational and educational upgrading from the Employment and Income
Assistance Program. Women identified an atmosphere of mistrust within
the system, perpetuated by surprise visits from workers, inaccessibility
to workers in times of crisis, and lack of understanding and respect.
Furthermore, women were not informed of an Appeal process regarding
Income Assistance decisions, and no ombudsperson or fair practices
office is in place to ensure women on Income Assistance are treated
justly by the system.
- Women are not provided with
enough income for safe, healthy housing, adequate nutrition, or adequate
clothing and daily living supplies for themselves and their children.
Children are also unable to participate in basic and important social
interaction and physical activities because of prohibitive fees for
extracurricular and school activities, not covered by Income Assistance.
This not only deprives children of physical fitness opportunities
but also places children at a distinct social disadvantage from a
very early age. The social inequality present in these situations
can have devastating lifelong effects.
- The lack of knowledge of Income
Assistance staff about living with disabilities. Women with disabilities
are subjected to incorrect assumptions about their daily living needs
and their capacity to function by misinformed or uninformed Income
Assistance workers and policies that do not address their needs. This
is particularly prevalent among women with mental health issues and
other invisible disabilities. The compound effects of having disabilities
and living in poverty create a double barrier that has devastating
consequences on women's health.
- Lack of support for vocational
and educational opportunities that could lead to independence and
self-improvement for women on Income Assistance. There is very little
built into the system that allows women to develop labour market skills
without putting themselves and their children in financial jeopardy
because of lack of childcare, transportation, and training funds.
Furthermore, there is little investment in looking for vocations beyond
a fast track to ANY job. Women need to find meaningful employment
with opportunities for advancement that require skills, training,
and assurances that the well-being of their children is not at stake.
Recommendations for change that come from concerns are based on the difficulties
women in this research experienced.
Implementation of these recommendations by the Manitoba Employment and
Income Assistance program would help to remedy those barriers that prevent
women from achieving the justice and health to which all Manitobans are
Communication between the Employment and Income Assistance Program
and women on income support
- Make consistent information
about benefits and eligibility readily available to women when they
- Continue to provide information
regarding benefit eligibility, sanctioning, and community resources
at regular intervals to women on income support. Providing this information
once during the orientation sessions is not effective or understood,
particularly if women are in crisis or undergoing emotional or physical
- Create an information booklet
in print and alternate formats. The booklet should be written in easy
to understand language and list community links to children's and
women's programs; used clothing and household goods outlets; literacy,
budget management, and other educational opportunities; and advocacy,
disability, and addiction treatment organizations. This information
may currently be covered in individual meetings with workers, however,
providing a resource tool to be taken home is a more effective means
of disseminating information.
- Implement a program and protocol
for regular home visits (once a year or more.) The intention of this
program is to develop a positive rapport between worker and client.
Each visit would include an assessment to determine if the client
is receiving benefits to which she is entitled; discussion concerning
community options for the client and her children; and an exploration
of training, educational and vocational options for the client if
appropriate. A protocol should be developed for visits that would
include: respecting household timetables; making arrangements whenever
possible to schedule visits with clients ahead of time; and practising
sensitivity regarding cultural and linguistic differences and disability
- Develop mechanisms to ensure
that high standards of practice and respectful treatment of clients
are followed by income support staff. Create the working conditions
to foster positive, supportive interactions between workers and clients,
to overcome the current climate of mistrust.
- Provide toll free telephone
access in all catchment areas in which clients are required to make
long distance calls to communicate with workers.
- Employment and Income Assistance
Offices provide regular and consistent information regarding the appeal
mechanism of the Social Services Appeal Board. This includes providing
contact information regarding the Appeal Board at the time of orientation
AND at any time a dispute comes forward between the Income Assistance
system and clients.
- The Social Services Appeal
Board undertake additional efforts to publicize its existence and
functions. Outreach opportunities such as public information displays
and events could reinforce the third-party, arms-length, independent
function of the Board to make the appeal process less intimidating
for potential appellants.
- Establish an independent ombudsperson
and a Fair Practises Office within the Income Assistance programs.
The advocacy services provided would assist clients with the appeal
process or other disputes with the program. These positions should
be highly visible and accessible.
Women and children on income support
- Review food and housing allowances
for all income support recipients.
- Provide allowances so that
children of women on income support can participate in basic activities
such as school field trips and after-school clubs/teams. This report
substantiates the link between poverty and the diminishment of children's
physical and emotional well-being. Improving the social welfare of
families includes removing those barriers that prohibit participation
in community life.
Women with disabilities on income support
- Train all income support staff
regarding appropriate ways of providing accommodations for women with
mental health issues, learning disabilities and physical disabilities.
Strategies that encourage empowerment and self-determination are fundamental
to women's health and well-being.
Promoting social equality for women on income support
- Create new avenues of opportunity
that allow women to become independent of income support. This includes:
encouraging women to explore vocational/educational options by providing
the necessary economic means (childcare, transportation and training
costs); helping women develop social supports that encourage independence
through existing community networks; and investing in employment incentives
(i.e. hourly wages) that make independence an attainable goal.
How can women on income assistance in Manitoba have hope? According to
them, the answer lies in the ways income support programs interact with
them, and in turn how they will interact with these programs. If the principles
of Income Assistance were grounded in promoting well-being and independence
so that in actuality they nurtured the "welfare" of women and children
rather than upholding attitudes that spawn inadequate income levels, stress,
surveillance and stigma, there might be hope. Any Canadian citizen, female
or male, rich or poor, child or adult, has the right to economic security
and social equality.
Finding hope lies in the ways women can receive information about benefits,
community supports, advocates, and appeal processes. Finding hope lies
in the development of meaningful connections between income support workers
and women that encourage honest communication, caring, and an understanding
of the systemic and social obstacles that prohibit well-being and independence.
Finding hope is having enough money to feed, clothe and house women and
But finding hope and surviving on hope are not enough. Fair, equitable
access to justice and fair, equitable and creative new avenues of opportunity
can allow women to move beyond hope to change.
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