Social inequalities in health

Material and social deprivation index 2021

In Québec, the deprivation index was created first and foremost to overcome the lack of socioeconomic data in most administrative databases. Developing an ecological proxy was the only way to monitor social inequalities related to important health issues such as mortality, hospitalization and the use of health services. The proxy’s main purpose is to assign area-based socioeconomic information to every individual by linking the geography of the census with the one found in the administrative databases. As a result, the index assists in the surveillance of social inequalities in health in Québec and Canada since the end of the 1980s. While it was shown that the deprivation index underestimates inequalities (Pampalon, Hamel, Gamache, 2009), it is the best alternative in the absence of socioeconomic information.

Wellbeing Budgeting: A Critical Public Health Perspective

In New Zealand, Wales, Scotland, and Finland, among other countries, wellbeing approaches to policy have become a growing trend over the past decade. Attention to the wellbeing and quality of life of the population has the potential to act on upstream determinants of health and, thus, to be a significant boon for healthy public policy. The National Collaborating Centre for Healthy Public Policy (NCCHPP) seeks to explore the significance of this policy turn. In this briefing note, we invite noted public health scholar, Lindsay McLaren, to assess how wellbeing approaches to policy align with public health scholarship and practice and whether there is a role for public health in this work. Dr. McLaren offers a critical perspective on the state of public health and on the opportunities and risks of embracing wellbeing budgeting as a ‘potentially radical approach to realizing some of the core values and goals’ of public health. We invite you to read her contribution bel…

Disparities in mental health and its determinants among Québec high school students by language of instruction

This paper provides a comparative analysis of several mental health indicators and determinants by language of instruction. All data discussed in this analysis is from the Québec Health Survey of High School Students 2016–2017.

For most of the indicators analyzed, there is no disparity between students in English and French high schools. When there is a gap between the two groups, it can be to the disadvantage of students taught in either language.

For example, a greater proportion of students in English high schools reported that they:

  • Had been medically diagnosed with depression
  • Had been medically diagnosed with an eating disorder
  • Did not feel healthy
  • Slept less than recommended during the school week
  • Had poor social support from their family
  • Had low overall self-efficacy
  • Had been bullied at school, on the way to school, or online during the school year
  • Had b…

Housing and Social Inequalities in Health in Times of COVID-19: Strategies for Promoting Affordable Quality Housing

The COVID-19 pandemic and the preventive and control measures put in place to protect against the associated health risk have highlighted existing social inequalities in health. The population was asked to spend more time at home to minimize the risk of coming into contact with the virus, which prompted the scientific community to examine the impact of housing conditions during the health crisis. Thus, it was observed that:

  • Housing, including its surrounding environment, is an important determinant of health, wellbeing and quality of life;
  • Living in unhealthy, unsafe or overcrowded housing can have negative effects on physical and mental health, especially during periods of confinement;
  • Safe and healthy housing can act as a protective factor against the transmission of COVID-19;
  • Disadvantaged populations that are less well housed are less well protected from COVID-19 during periods of confinement;
  • During the COVID-19 pandemic, s…
Centre de référence sur l'environnement bâti et la santé

Reducing Social Inequalities in Health (SIH): Working together Toward a More Equitable, Healthier and Resilient Society

For ministries and organizations to be better positioned to collaboratively design new ways to reduce social inequalities in health (SIH), there is a need to clarify the pivotal role of reducing social inequalities across all levels of government and cross-sectoral efforts in preventing negative impacts on population health, and the potential contribution of multiple sectors to improving the health and well-being of the Québec population.​


The health of the population is closely tied to underlying social factors. Poverty, which involves the intersection of multiple forms of social inequalities, has repercussions that often extend beyond health to impact other social determinants of health in a negative downward spiral. The rise in social inequalities undermines the health status and well-being of the population, harms economic growth, and creates the potential for a breakdown in social cohesion.

Reducing social inequalities in health (SIH) is onl…

Policy Approaches to Reducing Health Inequalities: Social Determinants of Health and Social Determinants of Health Inequalities

“The social determinants of health are the circumstances in which people are born,grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics” (World Health Organization’s Commission on Social Determinants of Health [CSDH WHO], 2016).

“The underlying social structures and processes that systematically assign people to different social positions and distribute the social determinants of health unequally in society are the social determinants of health inequities” (VicHealth, 2015, p. 6).

This paper is part of a series of short documents based on the longer Briefing Note, Policy Approaches to Reducing Health Inequalities, published by the National Collaborating Centre for Healthy Public Policy in March, 2016. The series is meant to provide a brief discussion of each of the eight policy approaches discus…

Policy Approaches to Reducing Health Inequalities

This document is intended to enable public health actors to more easily distinguish between the most widespread policy approaches that have been proposed to reduce health inequalities. The approaches that we will discuss are:

  • Political economy,
  • Macro social policies,
  • Intersectionality,
  • Life course approach,
  • Settings approach,
  • Approaches that aim at living conditions,
  • Approaches that target communities, and
  • Approaches aimed at individuals.

Health inequalities1 are understood to be unfair and systematic differences in health among and between social groups – differences which need to be addressed through action. These result from social and political circumstances and are therefore potentially avoidable.

With this document, we have set out to shed some light on the ways that various broad policy approaches attempt to account for and address health i…

Health Inequalities and Intersectionality

Intersectionality is a way to think about and act upon social inequality and discrimination. It offers a promising approach to these issues within public policy and within public health. This briefing note briefly explains intersectionality and explores the potential of an intersectional approach to reducing health inequalities.1

Work in the field of public health has recognized for some time that the social location2 of groups and individuals has a significant impact on health. When health outcomes are compared by income, gender, race or education, to name just a few, a picture emerges that clearly shows that these factors play key roles in determining health and well-being. People living in poverty, for example, have higher rates of many diseases and die younger than those in higher-income groups. Racialized groups in Canada also have poorer health outcomes than white Canadians and women often have disadvantaged h…

Pan-Canadian meeting on Health in All Policies (HiAP): Québec City, October 9, 2019 - Report

Health in All Policies (HiAP) is an increasingly important approach for systematically addressing the social determinants of health at all levels of government. HiAP refers to “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity”.1

In Canada, HiAP is on the radar of several governments, organizations and networks. Advocacy for and the momentum of a HiAP approach has been building, drawing attention to the potential impacts of this approach. Yet challenges to implementation exist across jurisdictions, including the use of a shared language, conflict of interest between sectors, and the need to ensure sustainability. Despite a clear interest, there are few spaces to share and learn from various Canadian and international initiatives and thus accelerate the dissemination and adaptat…

Policy Approaches to Reducing Health Inequalities: A practical exercise using the example of food insecurity

Health inequalities have been a preoccupation of public health for many years. They occur when some population groups enjoy better health, longer life expectancy, and a host of other health-related advantages compared to other population groups. Health inequalities are often seen among different income groups but also occur between groups defined by gender, race, or age, for example. Different policy approaches have been proposed over the years to reduce health inequalities. In the briefing note, Policy Approaches to Reducing Health Inequalities, we distinguish between approaches that act predominantly on the social determinants of health and those that act predominantly on the social determinants of health inequalities. The former include approaches that target living conditions, communities and settings, as well as individuals, while the latter consist of approaches that focus on the social, political, cultural, economic and environmental contexts, as well as the social p…