Social inequalities in health

In 2011, the Canadian National Household Survey (NHS) replaced the long-form census, introducing a potential bias regarding the small-scale use of NHS data and having an incidence on the deprivation index update.

This document outlines the methodological scenarios that were tested in order to update the 2011 deprivation index.

• The replacement of the long-form census by the voluntary National Household Survey (NHS) in 2011 led to a sharp increase in the global non-response rate.
• Updating the material and social deprivation index (MSDI) with 2011 data risks to introduce a non-response bias and lead to inaccurate results.
• Four versions of the 2011 MSDI featuring various adjustments were tested to assess its quality and to identify the most comparable and accurate version for longitudinal analyses.
• Differences between versions proved to be minimal. The version without any adjustments produces similar results to the other versions. It…

This document is the final one in a series of five documents based on a literature review published in 2011. The four previous documents compared the effects of two approaches to urban traffic calming – the black-spots approach and the area-wide approach – on four determinants of health: road safety, air quality, environmental noise and active transportation. In this document, we will examine the effects of these same two approaches (described below) on health inequalities. This will enable us to identify interventions that can effectively improve population health, overall, while also reducing health inequalities. Such interventions will be distinguished from those which act on only one or the other of these dimensions.

We will begin with a brief discussion of how health inequalities are conceptualized, followed by a few Canadian examples of health inequalities associated with, among other things, past and current transportation policies. This will be followed by a summary…

Various social factors, such as education, income, work, living environment, housing, lifestyle and access to services, determine an individual’s state of health. These interact in varying combinations throughout the life course. Inequitable distribution of these factors, or health determinants, among groups generates considerable health differences among people within a community or a country, or between countries. The gaps, or unequal distribution of health status, linked to these determinants within a population are referred to as social inequalities in health (SIH). These inequalities are not inevitable and could be reduced, according to the World Health Organization (WHO). The problem of social inequalities in health is vast and complex: unequal power dynamics and exclusion, as well as certain policies and social norms and practices, generate social and health disparities.

Data on the scope of SIH in Québec speak for themselves. The differences between socioeconomic gro…

For two decades, the reduction of social inequalities in health has been on the health policy and guidance agenda in Québec. Moreover, current monitoring activities make it possible to track social determinants of health, population health status and the use of health and social services over time and space (regionally). In spite of these achievements, Québec does not have a plan for the systematic monitoring of social inequalities in health, although the existence of these inequalities is well documented.

The goal of this report is to propose a strategy and indicators for monitoring social inequalities in health. It is the result of a joint effort on the part of regional and national surveillance professionals in Québec, from the Table de concertation nationale en surveillance, the Ministère de la Santé et des Services sociaux and the Institut national de santé publique du Québec.

The report is divided into three parts: the first presents background information and…

The following summary report details policies and programs in Canada that have had some measure of success in reducing health inequalities.

The National Collaborating Centre for Healthy Public Policy asked researchers at a research centre on health inequalities, Centre Léa-Roback, to report on programs and policies in Canada whose results have been evaluated using current medical evidence-based standards, including an evaluation of the quality of published evidence used in clinical guidelines.

Public health actors interested in promoting healthy public policies are concerned that these policies be based on a rigorous application of sound methodologies. Policies and broad government programs, in other words, are ideally based on what has been proven to work. Working with actual populations in social contexts, however, is not the same as working in a laboratory where the researcher has far more control over the experiment. Working with health inequalities and the socia…

In 2003, a group of persons living in poverty compared society to a landing from which one escalator goes up and another escalator goes down. “Poverty,” they essentially told some parliamentarians, “is like having to go up a down escalator. Instead of trying so hard to help us go up escalators that are going down, just fix the escalators.”

In order to stimulate exchanges around this metaphor, the National Collaborating Centre for Healthy Public Policy (NCCHPP) presents in collaboration with Vivian Labrie a Presentation Kit for the facilitation of a workshop on inequalities using the escalators metaphor. This kit provides the following basic materials: a facilitator's guide found in the next sections of this document detailing the experience acquired relative to the “escalators workshop,” a poster template to be reproduced for use during the workshops, as well as a series of slides to be shown.

The purpose of this facilitator's guide is to share the practical experien…

The following is a descriptive analysis of the policy frames used to interpret the central concerns of two organizations in their work to improve economic, social, and physical well being in some of the lowest-income neighbourhoods in Saskatoon, Saskatchewan. The central goal is to examine how different frames impact on the definition not only of the problems to be addressed, but on the solutions which are to be favoured. Awareness of these frames and how they colour approaches may be useful to those seeking to inform partnerships between public health actors and institutions and non-governmental groups. Choosing to concentrate on those areas where the frames are compatible may lead to more successful collaborations.

Although on the surface, and often in practice, the integration of different frames into common goals can be trying, it may well be a key to intervening in complex social contexts such as those beset by poverty and its attendant difficulties. Yet partnerships an…

In 2009, a workshop on health inequalities associated with transportation policies was jointly organized by the Population Health team of Edmonton's regional health authority, the former Capital Health, and the National Collaborating Centre for Healthy Public Policy (NCCHPP). The workshop was held on May 28, 2009 in Edmonton, Alberta and brought together representatives from the NCCHPP, Edmonton-based Alberta Health Services (AHS) staff with interest in transportation issues, traffic engineers and other public and private sector transportation professionals, urban planners, academics and members of non-profit organizations in Alberta, primarily from Edmonton and Calgary. The workshop was conducted to bring together practitioners with interests in the areas of transportation, health, and health inequalities to learn about transportation as a determinant of population health and to consider effective policy responses.

These notes are not intended as a formal report or pro…

• The Canadian media's interest in health inequalities is relatively limited. A small number of large circulation media could not be included in the corpus studied; however, in all the media reviewed, a total of only 81 relevant articles or news items were found to have been published in 2008, which indicates that, collectively, the Canadian press devotes an average of 7 articles per month to this subject.
• This means that health inequalities do not receive much media coverage. Nevertheless, the high number of units of information per document identified through this study indicates that the media consider the topic to be important. For this topic, the average was 13.5 units of information per document in 2008, which greatly exceeds the average of 6.2 units, which the Laboratory has observed over the past 25 years. This indicates that the media publish in-depth articles when they cover health inequalities. A total of 1,094 units were identified…

• The Canadian media's interest in health inequalities is relatively limited. A small number of large circulation media could not be included in the corpus studied; however, in all the media reviewed, a total of only 81 relevant articles or news items were found to have been published in 2008, which indicates that, collectively, the Canadian press devotes an average of 7 articles per month to this subject.
• This means that health inequalities do not receive much media coverage. Nevertheless, the high number of units of information per document identified through this study indicates that the media consider the topic to be important. For this topic, the average was 13.5 units of information per document in 2008, which greatly exceeds the average of 6.2 units, which the Laboratory has observed over the past 25 years. This indicates that the media publish in-depth articles when they cover health inequalities. A total of 1,094 units were identified…