Michel Grignon

Following the legalization of medical assistance in dying (MAID) in Canada in 2016, the expansion of eligibility criteria in 2021 permits MAID for both individuals whose death is reasonably foresee...

Background Universal Credit (UC) is a major UK welfare reform that consolidates six means-tested benefits into a single monthly payment, aiming to simplify benefits delivery and incentivize labour market participation. However, concerns have emerged regarding its potential adverse consequences on recipients’ mental and physical well-being. Existing evidence is limited by methodological weaknesses, short follow-up time, and a narrow focus on psychological distress. Methods Applying the heterogeneous difference-in-differences approach developed by Callaway and Sant’Anna, we used waves 6–14 of the UK Household Longitudinal Survey (UKHLS), focusing on working-age individuals receiving social benefits to evaluate the short and long-term effects of that welfare reform on psychological distress (GHQ-12), mental functioning (SF-12 MCS), physical functioning (SF-12 PCS), but also employment, perceived financial outlook, benefits income, and total income. Results Transitioning to UC significantly increased GHQ-12 scores by 1.20 points (95% CI: 0.33 to 2.07) and decreased SF-12 MCS scores by 2.19 points (95% CI: − 3.79 to − 0.59), indicating deteriorating mental health. No significant effect was observed for SF-12 PCS. UC was also associated with a £93.05 reduction in monthly benefit income, a borderline significant decrease in total income of £222 and an 8 percentage-point decrease in perceived financial optimism. No significant effect on employment status was detected. Conclusions Our findings suggest that the transition to UC adversely affected mental health and financial well-being, while yielding limited employment benefits. These adverse impacts appear to reflect both implementation challenges, such as payment delays and benefit deductions, and structural design flaws, including rigid conditionality and reduced income security for vulnerable groups. The results underscore the need for welfare reforms that integrate health considerations and provide more flexible, targeted support to mitigate unintended harms.

Equality of opportunity (EOp) is a broad category of egalitarian theories that has attracted considerable attention in recent decades. Empirical implementations of EOp primarily focus on the explained component of inequality, classifying determinants of the outcome (e.g., health) into effort—legitimate causes of inequality—and circumstance—illegitimate causes of inequality. Largely overlooked is unexplained variation, which in statistical analysis manifests as residuals and is often ignored as a statistical annoyance. The true random component of residuals is now often referred to as luck. In this paper, we propose the playing field framework that serves as a pragmatic test as to whether residuals signal unfairness in empirical EOp analyses and that enables empirical explorations of roles of luck within the EOp framework. Using a large sample of Canadian older adults, our empirical application of the playing field framework shows that distributions of residuals are not always fair, though there is no consistent pattern of unfairness across age-sex groups. The paper’s three main conclusions are: luck matters; luck should be explicitly incorporated in the EOp framework through the brute luck-effort characterization; and residuals are not just an innocuous statistical annoyance but can represent unfair inequality, and ignoring them can underestimate unfair inequality.

On 1 January 2013, the federal Canada Student Financial Assistance Program (then known as the Canadian Student Loan Program) granted loan forgiveness to family physicians or nurses working at least 400 hours a year in a “rural” area of Canada. This is a return-for-service (RFS) program forgiving a maximum amount of the loan for each year worked in a designated area, up to a maximum of five years. The goal of the policy was to attract more family physicians and nurses to underserved areas and address the inequality in health between rural and urban areas in the country. The policy was accepted on principle but raised issues of non-compatibility between the federal and provincial RFS to attract health care workers to underserved areas, in particular its blanket definition of those areas as “rural,” whereas provincial programs use criteria based on the density of physicians or nurses per population. Le 1er janvier 2013, le Programme canadien d’aide financière aux étudiants (connu à l’époque sous le nom de Programme canadien de prêts étudiants), a accordé une exonération aux médecins de famille et personnels infirmiers travaillant au moins 400 heures par an dans une région « rurale » du Canada. Il s’agit d’une d’obligation de retour de service (RDS) exonérant d’un montant maximum du prêt pour chaque année travaillée dans une région désignée, pour un maximum de cinq ans. L’objectif de cette politique était d’attirer davantage de médecins de famille et de personnels infirmiers dans les régions mal desservies et de remédier à l’inégalité de santé entre les zones rurales et urbaines du pays. La politique a été acceptée sur le principe, mais a soulevé des questions d’incompatibilité entre les RDS provinciaux et fédéraux visant à attirer des personnels infirmiers dans les zones mal desservies, en particulier sa définition générale des zones comme « rurales », alors que les programmes provinciaux utilisent des critères basés sur la densité de médecins ou de personnels infirmiers par rapport à la population.

After some initial controversy, an inverted U‐shape relationship between the consumption of alcohol and earnings seems to be an established result, at least in North America. It has been dubbed a “drinking premium”, at least in the lower portion of the consumption curve. It is still unclear, perhaps even counter‐intuitive, why such a drinking premium exists and the literature suggests it is not causal but results rather from selection effects. We suggest here that part of the premium is linked to occupation: some occupations pay better, controlling for the usual human capital determinants, and also attract drinkers or induce workers to drink more. Using a sample of full‐time employed or self‐employed individuals aged 25–64 and not in poor health from the 2015‐16 Canadian Community Health Survey (CCHS), we confirm the existence of a drinking premium and a positive return to the quantity or frequency of drinking up to high levels of consumption. Using information on jobs held by respondents, linked to a data set of job characteristics, we find that controlling for job characteristics reduces the premium or return to drinking by approximately 30% overall, and up to 50% for female workers.