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Poverty and Health
BCHLA WebinarDr. Brian O’Connor, MD, MHSc
April 17, 2013
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The WHO Commission on the Social Determinants (2008)
Reducing health inequities is an ethical imperative. Social injustice is killing people on a grand scale.
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What is the Principle Underlying Inequity
• Inequities are differences that are unfair, unjust, avoidable and remediable – often through the application of politicial will.
• Inequalities – sex, genetics, heredity
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The Gap – Health is Not Distributed Equitably
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The Gap – Health is Not Distributed Equally
Men
6.47.010.0
16.6
0
5
10
15
20
25
Lowest LowerMiddle
HigherMiddle
Highest
Household Income Quartiles
Ag
e-S
tan
da
rdiz
ed
P
erc
en
tag
e
Women
4.15.77.5
12.4
0
5
10
15
20
25
Lowest LowerMiddle
HigherMiddle
Highest
Household Income Quartiles
Ag
e-S
tan
da
rdiz
ed
P
erc
en
tag
e
(Data source: Statistics Canada Canadian Community Health Survey Cycle 3.1 2005; Percentages were standardized to the 2004 Canadian population as the reference with bootstrap weight valued provided by Statistics Canada. Confidence intervals for age-standardized percentages(45-64, 65+) were calculated with the method based on the gamma distribution developed by Fay and Feuer in 1997)
Heart Disease Prevalence by Income
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Pan-Canadian Age-Standardized Hospitalization Rates by SES Group*
The Gap – Health is Not Distributed Equally
Note :* For each indicator, all rates are significantly different between low-, average- and high-SES groups at the 95% confidence level.Source:CPHI analysis of 2003–2004 to 2005–2006 Discharge Abstract Database and National Trauma Registry data, Canadian Institute for Health Information.
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Implications of the Gap
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What is Happening in BC
Socio-Economic Index
Quintile Group 2002-2006 2006-2010Change in Months
Highest SES 81.26 82.45 14.31
2 80.68 81.45 9.26
3 79.76 80.39 7.56
4 79.49 79.25 -2.98
Lowest SES 77.68 77.76 0.95
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What is Happening in BC
Index of Education Concerns
Quintile Group 2002-20062006-2010
Change in Months
Highest SES 81.44 82.70 15.05
2 80.30 81.08 9.46
3 79.82 80.40 6.91
4 78.76 78.70 -0.74
Lowest SES 78.07 78.08 0.10
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What are the Reasons
• Increased rates of income inequity
• Reduction in social programs (Real or relative)
• Differences in levels of uptake of health promoting behaviours between income groups
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What Do Inequities Cost Us?
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What Do Inequities Cost Us?
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What Do Inequities Cost Us?
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The Case of Children & Families
• The cycle of poverty
• The importance of ECD – Lifelong success
• Most poor children live in families with at LEAST one parent working full time
• Need programs to assist young families so our children have equal chance for success
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So How Do We Achieve Equitable Health Status for All BC
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So How Do We Achieve Equitable Health Status for All BC
• Early Childhood Development
• Food Security• Built Environment• Connectedness• Income Security
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What are the Possible Solutions?
1) Poverty reduction plan with legislated targets and timelines, and a responsible and accountable minister
2) Sub-elements within a plan can include• ECD strategies• Income and food security strategies• Housing strategies
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