Scurvy in Canada Is a Symptom of Our Sick Politics

Last year, the Canadian Medical Association Journal published an article on a case of scurvy diagnosed in an elderly woman in Toronto. It deserved attention because scurvy, a condition resulting from lack of vitamin C, is virtually never reported in advanced countries like Canada.

This year we have learned of 27 more cases, all diagnosed last year or this year, in the Lac La Ronge Indian Band in northern Saskatchewan.

As Oscar Wilde might have put it, to find one case of scurvy may be considered a misfortune; to find 27 more begins to look like criminal neglect.

And the neglect is not confined to northern Saskatchewan. Scurvy is a metaphor for our times, a sign that Canada is sicker and poorer than it wants to admit.

Live without vitamin C for three or four months and you will begin to feel bad. You’ll be exhausted and irritable, and your arms and legs will hurt. Your gums will swell and start to bleed easily. Your teeth will loosen in their sockets, and you’ll have bad breath. Your skin will be rough and dry and will bruise easily. Wounds won’t heal quickly; in severe cases, old scars will open again. Left untreated, scurvy can result in internal bleeding, convulsions, organ failure and jaundice.

Vitamin C can remedy these symptoms, but teeth, bones and nerves can all suffer permanent damage. In children, scurvy can affect brain development.

Once citrus fruits were recognized as a curative for scurvy in the mid-18th century, it still took almost 50 years before the British navy mandated three-quarters of an ounce of lemon juice daily for every sailor (mixed with grog to ensure he drank it).

The new policy was expensive; it required some 50,000 gallons of lemon or lime juice yearly. But it ended scurvy as an occupational hazard of sailors and enormously improved the ability of the British navy to sustain long operations at sea.

Food insecurity everywhere

Some 230 years later, it should be profoundly embarrassing to any government if its people develop scurvy. But it is an almost predictable outcome of the rising costs of food we have seen since the start of the pandemic almost five years ago, and the medical harm done to millions of us.

Reports of the cases in La Ronge focused on its remoteness and the difficulty of supplying affordable fresh food. But food insecurity is becoming a serious issue even in major Canadian cities.

According to Food Banks Canada’s HungerCount 2024 report, food banks had two million visits last March — six per cent higher than in March 2023, and 90 per cent higher than in 2019.

A third of food bank users are children. Forty per cent of users are on social assistance or disability supports, and 18 per cent are currently employed — the highest percentage ever recorded.

Here in B.C., food banks saw 225,000 visitors in March 2024, an increase of 15 per cent from 2023 and an 81 per cent increase from 2019.

Children made up 70,000 of those visits.

Those numbers have not likely fallen since last March.

Meanwhile, the British journal The Lancet recently published a study titled “Ten Americas: A Systematic Analysis of Life Expectancy Disparities in the U.S.A.” It studied life expectancies between 2000 and 2021 in 10 groups defined by ethnicity, geographical location, metropolitan status, income and other factors.

“America 10,” made up of “American Indians and Alaska Natives” in the western United States, was the only group “to experience substantial declines in life expectancy from 2000 to 2019, and experienced the largest decline from 2019 to 2021.”

By 2021, the report said, the gap between highest and lowest life expectancy was 20.4 years.

Excess mortality: the long tail of COVID-19

At least part of that gap, especially after the start of the pandemic, could be explained by excess mortality — an increase in deaths over those normally reported year over year. Swiss Re, a company that insures insurance companies, recently published the report “The Future of Excess Mortality After COVID-19.”

Excess mortality matters to Swiss Re’s clients that provide life and health insurance. Continuing excess mortality will mean more claims and higher prices for life policies in coming years.

The report finds that excess mortality rates have varied. The United States saw excess mortality hitting 20 per cent in 2021 but falling to about five per cent in 2023. “Canada reported very low excess mortality in 2020,” the authors write, “with a gradual increase peaking in 2022 and 2023, reflecting a late peak and slow decline.”

Not all excess deaths were due to COVID, the report says. But their causes included respiratory infections, long COVID, cardiovascular diseases and cancer — all of them aggravated either by COVID-19 or by the disruption it caused to health-care systems around the world.

In Canada alone, according to a Statistics Canada report, about two-thirds of adult Canadians reported having had COVID-19 by June 2023, and one in five reported more than one infection.

Out of those infected, 58 per cent (3.5 million people) have had longer-term symptoms.

Six-hundred thousand missed an average of 24 days of work or school. About 100,000 could not return to work or school. Thirty-eight per cent of those infected three times or more reported longer-term symptoms; only 14 per cent who had been infected only once had such symptoms.

Long COVID thrives in poverty

A followup report published in the summer of 2024 found that 35 per cent of Canadian COVID cases living in the lowest-income neighbourhoods reported often or always experiencing limitations in daily activities. Only 15 per cent of cases in the highest-income neighbourhoods reported such limitations.

High percentages of long-COVID limitations were also reported by adults without a high school diploma, Indigenous people and those living in structures needing major repairs.

Long COVID symptoms also hindered many people with prior medical conditions — most often those with high blood pressure, back problems and mental illness.

Life expectancy in Canada varies dramatically by location and income: women in Richmond, B.C., born in 2022 will live to be 88, and men to 85.

In Saskatchewan’s Mamawetan/Keewatin/Athabasca health district, which includes La Ronge, women born in 2022 can expect to live to 75, and men to 71.

Similarly, a C.D. Howe Institute study published in 2018 found that Canadian men in the top fifth of income earners can expect to live to 83, eight years longer than men with the lowest incomes. The richest women can expect to live to 86, just three years longer than the poorest women.

Social determinants of health have been understood for many years, and the COVID-19 pandemic only aggravated the harm already endured by the working poor, by Indigenous people, by old people and those with disabilities.

Looser social bonds

The pandemic also seems to have loosened the social bonds between those people and their relatively prosperous fellow Canadians. We have tended to ignore the ongoing pandemic, the rising cost of living, the strains in the health-care system — until we ourselves fall ill, or have to go to the food bank, or to the local emergency department.

That’s when we lose faith in government and public institutions — and in one another. That’s when old scars begin to open, when we’re always tired and irritable, when the slightest bump leaves a big bruise.

We realize our more prosperous and healthy neighbours don’t want to pay the taxes and prices that would have ensured jobs with a living wage, trained enough doctors to look after our health, built enough homes to house us all. They’d prefer not to think about other Canadians at all, including the scurvy cases in La Ronge.

Like the U.S., the U.K. and other governments that pursued neoliberal policies over the last half-century, Canada has contracted a kind of political scurvy. It is tearing us apart from one another, causing both individual and institutional damage that may be irreparable.

The cure for political scurvy is not for the rich to ignore the poor, but for everyone to redefine the national purpose. If we decide that every Canadian must be well housed, well fed and well cared for, then we will live in a nation as healthy as ourselves.