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Barriers to health insurance and health services limit access to treatments and to accurate knowledge regarding SARS-CoV-2 transmission, prevention strategies, disease symptoms, and reasons for seeking care. 41 – 43 Interestingly, despite the positive impact of Medicaid expansion on healthcare access, mortality, and disparities, one study failed to find an association between COVID-19 ...
- Understanding Population Health and Its Determinants - The ...
For most people, thinking about health and health care is a...
- Understanding Population Health and Its Determinants - The ...
A healthcare disparity is a difference between population groups in the way they access, experience, and receive healthcare. Factors that influence healthcare disparities include social, economic, environmental, and other disadvantages, 1, 2 some of which are explored in this report. Unfortunately, Americans too often do not receive care they ...
- 2021/12
- Overview
- Related Topics
- Social determinants of health and health inequalities - Indigenous perspectives
- Findings
- Discussion and implications
- References
Health inequalities in Canada exist, are persistent, and in some cases, are growingFootnote 1 Footnote 2 Footnote 3. Many of these inequalities are the result of individuals' and groups' relative social, political, and economic disadvantages. Such inequalities affect peoples' chances of achieving and maintaining good health over their lifetimes Footnote 4. Where inequalities in health outcomes or in access to the resources that support health are systematic (that is, the patterns of difference are consistently observable between population groups) and can plausibly be avoided or ameliorated by collective action, they may be deemed unjust and inequitable Footnote 5 Footnote 6 Footnote 7.
This report describes the magnitude and distribution of key health inequalities in Canada, a critical step in facilitating action to advance health equity. It is a product of the Pan-Canadian Health Inequalities Reporting Initiative, a collaborative undertaking by the Public Health Agency of Canada, the Pan-Canadian Public Health Network, Statistics Canada, and the Canadian Institute for Health Information.
The Health Inequalities Reporting Initiative aims to strengthen health inequalities measurement, monitoring, and reporting capacity in Canada. It is intended to support surveillance and research activities, inform policy and program decision making to more effectively reduce health inequalities, and enable the monitoring of progress in this area over time.
The Health Inequalities Reporting Initiative's theoretical foundations are based on a conceptual framework originally developed by the World Health Organization Commission on Social Determinants of Health Footnote 8. This framework highlights the critical roles that broad social, economic, and political factors (e.g. systems of governance; macroeconomic, social, and public policies; and societal values and norms) play in generating and reinforcing societal hierarchies. These differences in socioeconomic positions shape the health-influencing social and physical conditions in which individuals are born, grow, live, work, and age. These conditions include material circumstances (e.g. living and housing standards, workplace conditions, neighbourhood amenities and safety); psychosocial factors (e.g. job strain, social connectedness or isolation, access to social support); health behaviours (e.g. diet, physical activity, tobacco and alcohol consumption); and biological (including genetic) factors. The interactions between these various domains are the means by which inequitable social processes are translated into inequities in health and well-being outcomes.
Building on a set of indicators proposed by the Pan-Canadian Public Health Network in 2010, the Health Inequalities Reporting Initiative brought together data on more than 70 indicators of health outcomes, risk factors, and social determinants of health. These indicators were systematically disaggregated across a range of socioeconomic and sociodemographic variables ("social stratifier groups") meaningful to health equity (see Figure 1).
(PDF format, 826 KB, 11 pages)
•Health Inequalities Data Tool
•Understanding the report on Key Health Inequalities in Canada
•Social determinants of health and health inequalities
Figure 1. Summary of the analytical approach for the Health Inequalities Reporting Initiative
The resulting portrait of the state of health inequalities in Canada is available through the Health Inequalities Data Tool, an online interactive database.
Drawing from the full set of health outcome and health determinant indicators in the Data Tool, the present report highlights results for 22 indicators that represent some of the most pronounced and widespread health inequalities in Canada, as potential priority areas for initial action (see Figure 2).
Prepared by the First Nations Information Governance Centre and Métis National Council
Traditionally, Indigenous peoples have viewed health in a balanced and holistic way, with connections between spiritual, emotional, mental and physical dimensions. Similarly, the determinants of Indigenous health are seen as closely interconnected Footnote 9 Footnote 10 Footnote 11. They include proximal determinants (e.g. health behaviours), intermediate determinants (e.g. community infrastructure, kinship networks, relationship to the land, language, ceremonies, and knowledge sharing), and structural determinants (e.g. historical, political, ideological, economic, and social foundations, including elements of strength such as Indigenous world views, spirituality, and self-determination) Footnote 11 Footnote 12. From the Métis perspective, it is important to integrate Indigenous and Western knowledge development approaches in order to draw holistically from the narratives, experiences, information and data available from both of these ancestral 'ways of knowing' Footnote 10.
In order to understand health inequalities between Indigenous and non-Indigenous peoples, it is necessary to contextualize them within the historical, political, social, and economic conditions that have influenced Indigenous health. The colonial structure, which sought to assimilate Indigenous peoples into the dominant Euro-Canadian culture, has been largely responsible for destabilizing the determinants of Indigenous health Footnote 13. The forced displacement of First Nations into remote communities and reserves that were uninhabitable and lacking in resources; the claiming of traditional areas rich in resources by colonial powers; the oppression of First Nations created by the Indian Act; the damaging legacy of Indian Residential Schools and the Sixties Scoop; systemic discrimination against all Indigenous peoples across social, criminal justice, health care, and employment environments; and the lack of public or private economic development investments for Indigenous communities are all examples of how the colonial structure have contributed to the health inequities that exist today Footnote 11 Footnote 14. In addition to this lived experience of colonialism, racism and inability to pursue self-determination, health inequalities in Métis peoples have also been particularly influenced by social exclusion and loss of Indigenous language due to cultural assimilation Footnote 10 Footnote 12.
The indicators selected for this report are useful for highlighting health inequalities that exist between Indigenous and non-Indigenous peoples and for gauging progress towards the elimination of such inequalities. However, on their own, these quantitative and largely deficit-based indicators do not adequately incorporate Indigenous concepts of health and wellness; are insufficient for creating programs and policies that contribute to improving the health of the Indigenous population; and may even be harmful if used incorrectly, as they risk continuing to label Indigenous peoples with negative stereotypes Footnote 15 Footnote 16. Moreover, without adequate explanatory context about the structural factors that have impacted Indigenous communities (e.g. inadequate infrastructure funding, discriminatory policies that limited access to loans or mortgages), indicators that focus solely on the problems in these communities can reinforce discriminatory attitudes towards Indigenous peoples. Ultimately, for health planning and action to be effective, indicators must be Indigenous-specific and community-driven, taking into consideration Indigenous peoples' holistic worldviews, histories, and resources Footnote 16. A balanced approach that identifies protective factors such as resilience, self-determination, and identity provides a more complete understanding of the issue and can be more effective in empowering and mobilizing individuals or a community towards improving health.
Overall, significant health inequalities were observed among Indigenous peoples, sexual and racial minorities, immigrants, and people living with functional limitations, and a gradient of inequalities by socioeconomic status (income, education levels, employment, and occupation status) could be seen for many indicators. Some populations (in particu...
Canadians are among the healthiest people in the world. However, as this report shows, the benefits of good health are not equally enjoyed by all Canadians. Some of these observed inequalities are consistent with what is known from other research on the social determinants of health and health equity, while others remain to be more fully explored. Regardless, the persistence, breadth, and depth of health inequalities in Canada constitute a call to action across all levels and sectors of society. In recent decades, the global evidence on what works to reduce health inequities has grown, making it possible to identify key principles for action and promising practices that can be adapted to advance health equity within the Canadian context.
1.Adopt a human rights approach to action on the social determinants of health and health equity. A human rights approach recognizes that equitable access to opportunities for health, well-being, and their determinants is an issue of fairness and justice. The right to health in particular is recognized in a number of United Nations covenants and conventions to which Canada is a party, including the International Covenant on Economic, Social and Cultural Rights. Implementation of a human rights approach to health can be supported by evidence-based, participatory, and coherent action across governments and sectors, including working with communities most affected by health inequalities to design interventions that are both relevant and effective.
2.Intervene across the life course with evidence-informed policies and culturally safe health and social services. Advantages and disadvantages in health and the distribution of its social determinants accumulate over an individual's life course and over generations. Interventions at different life stages, particularly during critical or sensitive periods (e.g. early years) can substantially affect health outcomes and health equity.
3.Intervene on both proximal (downstream) and distal (upstream) determinants of health and health equity. Public health actions that focus on individual-level behavioural determinants may inadvertently increase health inequalities in the absence of accompanying efforts that target "upstream" socioeconomic, political, cultural, and environmental factors.
4.Deploy a combination of targeted interventions and universal policies/interventions. Policy and program interventions may be specifically targeted towards those with the poorest health outcomes and greatest social disadvantage or they may be designed for universal delivery across the whole population but implemented at different levels of intensities depending on the varying needs of specific sub-groups ("proportionate universalism"). Pairing targeted and universal interventions helps ensure that the targeted intervention effects are not "washed out" by broader conditions that may sustain social inequalities.
5.Address both material contexts (living, working, and environmental conditions) and sociocultural processes of power, privilege, and exclusion (how social inequalities are maintained across the life course and across generations). Both material deprivation and sociocultural processes that maintain privilege and disadvantage and inclusion and exclusion play important roles in generating and reinforcing social and health inequities. In addition to addressing material conditions, effective action on health equity must also include efforts to empower disadvantaged communities and tackle the harmful processes of marginalization and exclusion (e.g. systemic discrimination and stigmatization) embedded in hierarchies of power and privilege.
References 1
Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security. Reducing health disparities: Roles of the health sector. 2005.
Return to References 1 referrer
References 2
Butler-Jones D. The Chief Public Health Officer's report on the state of public health in Canada: 2008. Ottawa, ON: Public Health Agency of Canada; 2008.
Return to References 2 referrer
Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health. The main determinants of health include: Income and social status. Employment and working conditions. Education and literacy. Childhood experiences. Physical environments.
Dec 21, 2023 · Health disparities research was launched by the landmark Report of the Secretary’s Task Force on Black and Minority Health that documented disparities in life expectancy as well as selected causes of death (1979-1981) by race. 2 One major finding was that 80% of the excess mortality observed among Black or African American and other racial and ethnic minoritized populations was due to ...
Whereas health differences are just that—differences—disparities are measures of inequities, or differences in health access and/or outcomes between socially advantaged and socially disadvantaged or marginalized population groups (Agency for Health Care Research and Quality, n.d.; Braveman, 2006).
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For most people, thinking about health and health care is a very personal issue. Assuring the health of the public, however, goes beyond focusing on the health status of individuals; it requires a population health approach. As noted in Chapter 1, America's health status does not match the nation's substantial health investments. The work of assuring the nation's health also faces dramatic ...
