The wealthier you are, the healthier you are, but little is known about the variables that affect the relationship between poverty and health. (Health Canada, 1999) There is evidence that a woman's level of stress is profoundly affected by the difficulties experienced by her family and others in her social network; this phenomenon has been termed 'vicarious stress'. (Thomas, 1995) In this study, the link between a low-income mother's ability to find affordable recreation programs for her children and her health is examined. To a lesser extent, this research included an exploration of how municipal governments devise policies and programs to facilitate access to recreation and enrichment programs for low-income families.

The research literature is limited as to how the accessibility of publicly funded recreation opportunities for children in low-income families affects the health of mothers. A key finding from Browne (1998) demonstrated that when the children of social assistance recipients in Hamilton were provided with proactive, subsidized recreation services, children's behavioural disorders improved and parent's use of social and health services decreased. This decrease in the use of services resulted in an immediate savings of $1,000 per person per annum that was far in excess of the annual cost of the subsidized recreation. (Browne, 1998) This research project provides additional information on the relationship between a mother's health and her ability to provide her children with recreation activities.

There is a widening gap between the rich and poor in Canada. (Lee, 2000) One of every eight school-aged children lives in a family with an annual income that is less than $20,000.00. At the same time, the fees for recreation programs are increasing across Canada. (Canadian Council on Social Development, 2001) These increases in recreation fees have made it increasingly difficult for low-income families to provide their children with recreation opportunities. The results of this study suggest that when mothers are living in financially stressed situations, and they perceive recreation programs for children to be out of reach, their health is adversely affected. Forty-seven of the 49 women who participated in this study stated that their well being had been negatively affected by the lack of accessible recreation programs for their children. Ten of the 49 women attributed the causation for a physiological problem to be at least partially due to the stress they experienced when attempting to overcome financial or transportation barriers which were making it difficult, if not impossible, to get their children into activities.

Goals of Project:

1. To provide women, researchers and policy makers with information on the relationship between accessible community programs and the health of low-income mothers in the City of Winnipeg.

2. To provide low-income mothers with a voice as to what changes in the policies governing recreation and cultural activities would facilitate access by low-income women and their children.

3. To provide low-income women, the organizations that represent them, and the institutions that provide services to them with research findings that can be used to lobby for services and programs that better meet the needs of low-income women and their families.

Methodology

This study had two distinct phases. The first phase was an in-depth, qualitative survey of the health concerns related by low-income women as they described the barriers encountered when seeking programs for their children. In total, 49 low-income women living in eleven of Winnipeg's twelve community areas completed the survey. There were two characteristics common to all of the respondents: one, there was at least one child under 12 living in the household and, two, the family lived under Statistic Canada's Low-income Cut-offs (LICO). The interviews took place in the women's homes or at a location of their choice, and they were 30 to 120 minutes in length. Participants were told that the researchers were interested in their views on the accessibility of programs and activities for children living in low-income families. Each woman was asked about programs in which their children had participated, and whether or not their children behaved differently when they were enrolled in a program. The mothers were also asked if their health was affected by the difficulties they experienced in seeking appropriate programs for their children.

The second phase of the study consisted of a survey of 'accessibility' policies or programs offered to low-income families in selected urban centres across Canada. A survey was prepared for distribution to nine municipal governments across Canada in order to compare their programs, policies and costs with those of Winnipeg's. Information was requested on whether or not an urban government had a publicized program that functioned to assist low-income families access recreation or enrichment programs (fee subsidy, fee reduction or credit program). Nine cities, including Winnipeg, participated in the study.

In Winnipeg, approximately, one in every four families live under Statistic's Canada's Low- income Cut-offs (LICO). Most of these families have at least one member in the workforce. (Frankel, 2000) Furthermore, 62.6% of Winnipeg's single parents live under the LICO. These families are less likely to receive benefits from social assistance than single parent families who lived in the other cities included in our survey; for instance, 35.5% of single parents in Winnipeg receive some social assistance compared to 50% of single parents in Hamilton. (Lee, 2000) In this study, half of the participants were in the workforce and, approximately, half were on social assistance or disability insurance. Young mothers were under represented, while 67% had some post-secondary education. Twenty-five percent of the participants were Aboriginal, and 62% were single parents. There were 108 children ,12 years-of-age or younger, included in the study.

Key Findings

1. Forty-seven of the 49 participants in this study indicated that they experienced negative psychological or physical changes in their health when they were dealing with the difficulties of getting their children into recreation programs or activities. Ten of the 49 women attributed the causation for a physiological problem to be at least partially due to the stress they experienced when they were struggling to get their children into activities.

2. Thirty-six of the 49 women stated that they had made lifestyle or budget changes in order to get their children into programs. Fifteen of the 36 women were taking money out of their food budgets in order to find the funds necessary for their children to participate in an enrichment or recreation programs.

3. In the early 1990's, the City of Winnipeg adopted a user pay model for recreation programs which led to a sharp increase in fees for children's and family programs. For example, the cost for children's swimming lessons increased by 130% from 1991 to 2001.

Results

All of the women agreed to participate in the study because they thought children benefited from participating in recreational activities. Forty-three of the 49 women described positive benefits that their children had received from being in a program. In order to learn whether the participants perceived that their health was affected when they experienced difficulty in finding accessible programming for their children, the following question was asked:

"If you could not, or if you cannot get your child/children into programs, how does or would this affect you?"

Forty-seven of the participants perceived changes in their psychological or physical well being when they attempted to find recreation activities in which their children could participate. Their responses were grouped into four categories:

Effects	Participant Responses
Anger / frustration	19
Decreased self-esteem	12
Stress	11
Depressed / despair	14

After the above question, the women were also asked if they had felt stressed over the problems they were experiencing in getting their children into activities. Two women did not respond to this question. Three of the participants said "no"; two of these women stated that they were dealing with so many issues that they could not separate the stress they felt over finding activities for their children from the stress caused by other concerns. Forty-four of the respondents replied that they had been stressed over the difficulties of finding programs for their children. Their answers dealt with both the emotional and physiological effects of the stress they were experiencing. Their responses were grouped into three descriptive categories:

Effects of Stress	Participant Responses
Temper / Anger (emotional volatility)	18
Sleep disorders / fatigue, Changes in appetite, Headaches	14
Depression / Unhappiness	12

The survey of Canadian cities yielded some surprising results. Seven of the nine urban centres had a publicized city-wide program to assist low-income people to access city run programs and facilities?" Winnipeg and Hamilton did not publicize their programs or policies; fee waivers or subsidies were available for children's programs in Winnipeg, but Winnipeg was the only urban centre that did not offer fee waivers or subsidies to low-income residents of all ages. Moreover, in 1992, the City of Winnipeg had moved toward a cost recovery model for establishing program fees. This method led to costs increasing substantially more for family and children's programs than for adult activities. For example, a child's admission for public skating went up 80% between 1994 and 2000, while an adult admission went up only 12% for the same period. The cost of recreation programs have risen across Canada, and the cities that were surveyed had made moves to create programs and policies that would facilitate low-income families participating in recreation programs. This has also happened in Winnipeg, but not to the same extent that it has in the other cities sampled.

A comparison of admission fees for Winnipeg's leading cultural and enrichment venues with a sample of similar venue across Canada revealed some significant differences. The fee structures and admission policies for Winnipeg's leading museums do not contain time-periods with reduced admission rates that would facilitate low-income people accessing these venues.

The results of this research are important as they can be used by all three levels of government to develop policies and programs to increase access to recreation programs for the children of low-income families. This would help to reduce the stress experienced by low-income mothers, improve the mental and physical well-being of their children and decrease use of social and health care services by low-income women and their families. (Brown, 1998)

PARTICIPATORY RESEARCH AND RECOMMENDATIONS

In participatory research, the ideas for policy change come from the participants themselves. Each participant was asked, "How would you improve programs in order to make them more accessible for the children of low income families?" The responses received were as many and varied as were circumstances of the participants themselves. Recommendations in this report were drawn from the responses to this question, and to comments made at any point during the interview by the participant. The recommendations contained in this report have been divided into two categories: first, recommendations that have wide spread policy implications are contained in the recommendation section below; and, second, recommendations that are specific to a particular program or organization appear in Appendix A.

Recommendations:

1. It is recommended that the Province of Manitoba recognize the importance of accessible recreation programs to the well being of its residents and as a determinant of health. There needs to be links between the Department of Health and the Department of Culture and Heritage in which access to recreation activities can be discussed as a determinant of health when developing policy.

2. Although, the City of Winnipeg recognizes the importance of recreation to the health of a community in Section 5D, Promoting Vitality and Culture of the Draft; Plan Winnipeg 2020 Vision, this section would be enhanced by a more detailed description of its vision. (City of Winnipeg, 1999) It is recommended that the City of Winnipeg develop a long-term strategic plan for providing recreation opportunities to its citizens, and that the planning process involve all levels of government and the citizens of Winnipeg.

3. Although, conclusions cannot be drawn from the limited amount of data gathered in this study, it is recommended that that further investigation be carried out to explore the relationship between individuals on social assistance, and psychological and behavioral characteristics such as levels of self-esteem, decision-making ability, and use of the health care system. A long-term study should be designed that measures the use of health care and / or social services by low-income parents when they are provided with financial support through social assistance or an alternative government agency such as Revenue Canada.

4. It is recommended that that the province establish a comprehensive health benefits program that meets the needs of low-income families. The government should initiate a group health plan for those individuals whose workplace may not offer drug or dental plans; in particular, low-income persons.

5. It is recommended that a publicly or privately funded program be developed in which parents could apply for the program or transportation funds necessary to keep their children involved in recreational activities.

6. It is recommended that there be more free or low-cost days / time-slots at recreation or cultural institutions reliant on public funding. All three levels of government need to consider how to make these venues accessible to low-income people.

7. It is recommended that that there be programs developed in which children with behaviour problems can participate. These programs need to be developed in cooperation with the schools and a Community Advisory Group, and they need to be directed at all children three years of age and older. The City of Winnipeg and the Province of Manitoba need to work together in order to enhance the comprehensiveness of such programming.

8. According to Statistics Canada's National Longitudinal Survey of Children and Youth (NLSCY), Manitoba's children are involved in unorganized recreation activities less often than children in other parts of Canada. It is recommended that there be further investigation into these statistics and their long-term implications for the health of Manitoba's residents.

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