Health Inequities in Manitoba: Is the Socioeconomic Gap

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Chapter 9: Summary and Conclusion 186 University of Manitoba U1 to U5 neighbourhood income groupings. However, if the Gini coefficient is statistically different than 0 and the Lorenz curve bends away from the line of equality, then the health risk is unequally distributed. The more the bend, the more inequality exists, and the more a targeted policy or program (in addition to a universal program) is needed to increase the overall health of the population. An effective targeted program needs to be designed to increase the health of the least healthy group along with the rest of the population and even increase health at a more rapid pace (thereby shrinking the gap and reducing the absolute difference in inequality). For example, as illustrated in Figure 9.5, the dental extractions graph for children in the rural neighbourhood income quintile groups (and also mirrored in the urban groups) shows large disparity in dental extraction rates. This indicates a large disparity in dental health for those in the lowest neighbourhood income quintile. This may be indicative of nutritional deficiencies, lack of breastfeeding, lack of access to preventive dentistry, lack of access to fluoridated water, or a combination of these. It follows that a targeted approach to R1 and R2 may help in catching these groups up to the rest of the population, whereas universal approaches to the whole population will benefit everyone across all neighbourhood income groups through reduction of severe dental caries and, therefore, dental extractions. In contrast, the Multiple Sclerosis Gini coefficient for urban neighbourhood income quintiles is not statistically different than 0 and the Lorenz curve approximates the line of equality (see Figure 9.6). This implies that there is, at present, no need for a targeted approach to a certain socioeconomic group, but rather a universal approach when risk factors are more understood by those researching MS. Looking at our measures of inequity, when do we continue to stick with a more universal approach only and when do we approach programs and policies from both the universal and the targeted directions? Figure 9.5: Graph of Dental Extractions for Rural Areas (from Chapter 4) Cumulative Percent of Dental Extractions 100% 80% 60% 40% 20% 0% Figure 4.20: Adjusted Lorenz Curve for Dental Extractions in Rural Areas 2004/05-2007/08 Adjusted by (2004/05-2007/08) age & sex, children aged 0-5 53.6% 26.0% R1 79.4% 45.6% R2 87.1% 64.1% R3 Cumulative Percent of the Population Lorenz Curve Line of Equality 94.1% 81.6% R4 100.0% GINI = 0.383 (95% Cl 0.367, 0.398) 100% R5 Source: Manitoba Centre for Health Policy, 2010
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? Figure 9.6: Graph of Multiple Sclerosis for Urban Areas (from Chapter 5) Cumulative Percent of Multiple Sclerosis 100% 80% 60% 40% 20% 0% Figure 5.29: Adjusted Lorenz Curve for Multiple Sclerosis in Urban Areas 1984/85-1989/90 Adjusted by (2004/05-2007/08) age & sex, residents 16+ 100.0% 19.8% 20.2% U1 38.7% Lorenz curves that approximate the line of equality may demonstrate a situation best addressed through universal programs, whereas significant Gini coefficient “bends” require the targeted program approach along with any universal efforts. The following health indicators produced Lorenz curves close to the line of equality or a very small Gini coefficient values less than 6% (0.060)—so improvements would most likely be aimed at the entire population: breastfeeding (urban only), IHD (urban only), MS, continuity of care, cervical cancer screening, cumulative mental illness (rural only), dementia, and post–AMI beta–blocker prescription use. Examples of Lorenz curves with large “bends” and large Gini coefficients are evident in this report. Those health indicators with a Gini coefficient of over 0.20 (the bend in the curve contains at least 20% of the area above or below the line of equality) indicate a high degree of disparity. This may or may not have changed over time; however, despite any change overtime, the large Gini coefficient points out the need for targeted programs for the lowest neighbourhood income quintile groups, along with the universal programs. The following health indicators showed Gini coefficients of over 0.20: PMR (urban), PYLL (urban), teen pregnancy, dental extractions, amputations due to diabetes, hospitalizations for TB, and suicide/ suicide attempts. These will need to be discussed in terms of what works, but it is interesting to note how these cluster. There are the indicators related to injury (PMR, PYLL, suicide/suicide attempts), chronic and infectious disease (amputations due to diabetes, hospitalizations for TB), reproductive health (teen pregnancy), and early childhood nutrition and care (dental extractions). There are health indicators that show a medium degree of bend (Gini coefficients from 6% to 20%— 0.060 to 0.200): PMR (rural), PYLL (rural), under age five mortality, high school completion, breastfeeding (rural), diabetes, IHD (rural), and cumulative mental illness (urban). 60.7% This may give a hint to planners and policy–makers as to the continuum of universal versus targeted + universal programs, since as the Gini coefficient increases, the larger the inequality, and the more necessity for targeted programs to affect lowest neighbourhood income groups differentially. See Table 9.5. 80.4% GINI = 0.010 (95% Cl 0, 0.033, 40.7% 60.8% 80.2% 100% U2 U3 U4 U5 Cumulative Percent of the Population Lorenz Curve Line of Equality Source: Manitoba Centre for Health Policy, 2010 Manitoba Centre for Health Policy 187
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HEALTH INEQUITIES IN MANITOBA: Is t
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About the Manitoba Centre For Healt
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Dr. Patricia Martens acknowledges t
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Key findings: High School Completio
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List of Figures Figure 1.1 Distribu
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Figure 4.27 Adjusted Lorenz Curve f
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Figure 6.15 Hospitalization Due to
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List of Tables Table E.1 Changes in
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Figure A3.6 Adjusted Lorenz Curve f
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Executive Summary Health status and
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(derived from Table E.1’s columns
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Table E.1: Continued Indicator RURA
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Table E.1: Continued Indicator RURA
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Table Table E.2: E.2: Is Is the the
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This page edited May 18, 2011. Tabl
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References Commission on Social Det
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Health Inequities in Manitoba: Is t
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Table 2.1: Neighbourhood Income Qui
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Table 2.3: Neighbourhood Table 2.3:
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Figure 3.2: Premature Mortality Rat
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Figure 3.10: Potential Years of Lif
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Cumulative Percent of Potential Yea
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Figure 3.18: Under Five Mortality R
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Figure 4.2: Teen Pregnancy Rates Ov
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Figure 4.10: High School Completion
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Figure 4.18: Dental Extraction Rate
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Figure 4.26: Breastfeeding Initiati
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References: Health Inequities in Ma
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Figure 5.2: Diabetes Prevalence Ove
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Figure 5.10: Amputations Among Figu
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Figure 5.18: Ischemic Heart Disease
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Figure 5.26: Multiple Sclerosis Pre
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Figure 6.2: Continuity of Care Prev
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Health Inequities in Manitoba: Is the Socioeconomic Gap

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