Prairie Women's Health Centre of Excellence

  Surviving on Hope is Not Enough
Women's Health, Poverty, Justice and Income Support in Manitoba


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Hard copies of this report in regular and large print format are also available from Prairie Women's Health Centre of Excellence.
Tel: (204) 982-6630

The research and publication of this study were funded by the Prairie Women's Health Centre of Excellence (PWHCE). The PWHCE is financially supported by the Women's Health Contribution Program, Bureau of Women's Health and Gender Analysis, Health Canada. The views expressed herein do not necessarily represent the views of the PWHCE or the official policy of Health Canada.

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R. Wiebe, P. Keirstead

Executive Summary

"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 questions.

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:
  • First encounters in applying for income support;
  • The process of "starting up;"
  • Living conditions;
  • Training and employment opportunities; and finally,
The possibilities of becoming independent from the system.

Recommendations for Employment and Income Assistance in Manitoba and others address:
  • Communication between the program and women on income support;
  • Women and children on income support;
  • Women with disabilities on income support, and,
  • Social equality for women on income support.
Methods and Findings

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:
  1. 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.
  2. 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.
  3. 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.
  4. 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 entitled.

Communication between the Employment and Income Assistance Program and women on income support
  1. Make consistent information about benefits and eligibility readily available to women when they apply.
  2. 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 trauma.
  3. 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.
  4. 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 concerns.
  5. 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.
  6. Provide toll free telephone access in all catchment areas in which clients are required to make long distance calls to communicate with workers.
  7. 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.
  8. 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.
  9. 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
  10. Review food and housing allowances for all income support recipients.
  11. 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

  12. 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
  13. 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.
Finding Hope

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 their families.

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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