Health Inequities in Manitoba: Is the Socioeconomic Gap

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Chapter 9: Summary and Conclusion Table E.4: Degree of Socioeconomic Inequality Table 9.5: Degree of Socioeconomic Inequality (as measured by Gini coefficients) in the most recent time period and the need for (as measured targeted by programs Gini Coefficients) or policies in the most recent time period, and the need for targeted programs or policies Recommendations: 188 University of Manitoba Low degree of inequality Gini Coefficient < 0.060 Medium degree of inequality Gini Coefficient 0.060-0.200 High degree of inequality Gini Coefficient > 0.200 Universal programs are needed for all indicators to ensure increasing health of the entire population universal programs and policies universal and targeted programs and policies highly targeted programs and policies to supplement universal approaches Breastfeeding (urban) PMR (rural)* PMR (urban)* IHD (urban)* PYLL (rural)* PYLL (urban)* MS Under age 5 mortality Teen pregnancy* Continuity of Care* High school completion* Dental extractions Cervical Cancer Screening* Breastfeeding (rural)* Amputation due to diabetes Cumulative mental illness (rural)* Diabetes* Hospitalizations for TB* Dementia IHD (rural)* Suicide/suicide attempts* Post–AMI beta–blocker Cumulative mental illness prescription use (urban) *Note: The asterisk indicates that, according to Table E.1, there was an increase in inequality over time in the following health indicators: PMR, PYLL, Teen pregnancy, Breastfeeding (rural only), High school completion (urban mainly), Diabetes, Ischemic heart disease, Continuity of care (rural only), Hospitalizations for TB (rural only), Cervical cancer screening, Cumulative mental illness (rural only), and Suicide deaths and suicide attempts (rural only). Source: Manitoba Centre for Health Policy, 2010 The WHO and the Commission on Social Determinants of Health, in the 2008 document “closing the gap in a generation: health equity through action on the social determinants of health”, calls us all to action. Although health inequities have been documented throughout the world, we need to understand particular areas of great inequity (i.e., unfair or avoidable inequality), or particular areas of increasing gaps, to target future resources. Given the information contained in this report, the following recommendations can be made: • For those health indicators with moderate to substantial Gini coefficients and evidence of increasing inequality over time, targeted intervention strategies along with universal approaches need to be considered. These include: • injuries (related to early death as indicated by PMR, PYLL, and to suicide/suicide attempts); • teen pregnancy reduction • prevention and primary care strategies for TB • high school completion programs • breastfeeding programs (especially in rural areas) • chronic disease management and prevention (diabetes prevention, ischemic heart disease prevention) • For those health indicators with substantial Gini coefficients and evidence of no change in inequality over time, targeted interventions along with universal approaches need to be considered knowing that the inequality seems entrenched. These include: • Prevention of the necessity of dental extractions for children under five • Prevention of the adverse outcome of lower limb amputation for people with diabetes through appropriate care • Reduction of under age five mortality through directed strategies to prevent causes of death in this group (note: in Brownell et al. 2008, the major cause of child mortality was injury, at 49% of the total deaths)
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? • For those people who are in the “neighbourhood income not found (NF)” group, further study should be done to understand their elevated risk of death at a younger age (as indicated by PYLL), under age five mortality, suicide/suicide attempts, MS, cumulative mental illness, and dementia, and their lower quality of care indicators (low cervical cancer screening and post–AMI beta–blocker use). • For a marker of good quality of care in the healthcare system, it is interesting to note that post–AMI beta–blocker prescription use shows very little disparity by neighbourhood income group. It has actually showed trends to equity or improved equity over time. This may indicate a needs–based approach, or good clinical practice guidelines, whereby all people with AMIs have similar treatment in the healthcare system no matter what the neighbourhood income group or geographical location (urban or rural). The authors realize that the results of this report are only a starting point. This research does not pick out particular programs or policies that work to reduce inequity. It merely shows where socioeconomic inequity is the most profound or increasing over time. We hope that this will lead to further discussion by planners and policy–makers throughout the province, as a catalyst to closing the gap in Manitoba. References: Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. World Health Organization. 2008. http://whqlibdoc.who.int/publications/2008/ 9789241563703_ eng.pdf. Accessed July 20, 2010. Brownell M, De Coster C, Penfold R, Derksen S, Au W, Schultz J, Dahl M. Manitoba child health atlas update. Manitoba Centre for Health Policy. November, 2008. http://mchp–appserv.cpe.umanitoba.ca/ reference/Child_Health_Atlas_Update_Final.pdf. Accessed July 20, 2010. Culyer AJ. Equity and equality in health and healthcare. Journal of Health Economics. 1993;12:431–457. Fransoo R, Martens P, Burland E, The Need to Know Team, Prior H, Burchill C. Manitoba RHA Indicators Atlas 2009. Manitoba Centre for Health Policy. 2009. http://mchp–appserv.cpe.umanitoba.ca/reference/ RHA_Atlas_Report.pdf. Accessed July 20, 2010. Rose G. The Strategy of Preventive Medicine. Oxford, UK: Oxford University Press; 1992. Manitoba Centre for Health Policy 189
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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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Figure 3.2: Premature Mortality Rat
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Figure 3.18: Under Five Mortality R
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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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CONFIDENTIAL -- NOT FOR DISTRIBUTIO
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Health Inequities in Manitoba: Is the Socioeconomic Gap

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