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resulting in experiences of economic strain and financial toxicity in Canada (Meredith & Chia, 2015; Prince, 2008; Sayani, Dilney, et al., 2021). Systems of oppression, including colonization and structural and systemic racism, are also responsible for the quality and distribution of the SDOH, including income. As such, intergenerational poverty is the outcome of jurisdictional policies and processes that have been designed to privilege some and marginalize others—leading to social structural inequalities (Sayani, 2019a) that underpin the health divide between groups of people based on income.

What evidence do we have that income is related to health outcomes? Evidence across multiple Canadian provinces demonstrates that income and health are closely tied together across a number of health risk, morbidity, and mortality statistics. In Quebec, a study examining the neighbourhood material deprivation index (measured based on income, education, and employment) against average life expectancy illuminated how neighbourhood deprivation was related to a shorter life span in males (by four years) and in females (by three years) (Auger & Alix, 2016). Living in materially deprived neighbourhoods was correlated with a variety of health conditions, including respiratory illnesses, heart disease, higher rates of suicidal deaths and accidents, and cancers (Auger & Alix, 2016). A study in Saskatchewan highlighted the correlation between income, smoking, physical inactivity, and heart disease—and concluded that income was the most significant determinant of heart disease beyond behavioural risk factors (Au