Health Inequities in Manitoba: Is the Socioeconomic Gap

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Recommendations xxviii University of Manitoba The World Health Organization 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 inequalities 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 inequity, in order 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: • Injury prevention (related to early death as indicated by PMR, PYLL, and 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 mortality under the age of five through directed strategies to prevent causes of death in this group (note: the major cause of child mortality is injury, at 49% of the total deaths) • Strategies to address mental illness, especially in urban areas (as indicated by the cumulative mental illness indicator) • 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. Culyer AJ. Equity and equality in health and healthcare. Journal of Health Economics 1993:12;431–457. Rose, G. The Strategy of Preventive Medicine. Oxford, UK: Oxford University Press; 1992. Manitoba Centre for Health Policy xxix
Page 1 and 2: HEALTH INEQUITIES IN MANITOBA: Is t
Page 3 and 4: About the Manitoba Centre For Healt
Page 5 and 6: Dr. Patricia Martens acknowledges t
Page 7 and 8: Key findings: High School Completio
Page 9 and 10: List of Figures Figure 1.1 Distribu
Page 11 and 12: Figure 4.27 Adjusted Lorenz Curve f
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Page 15 and 16: List of Tables Table E.1 Changes in
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Page 19 and 20: Executive Summary Health status and
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Page 23 and 24: Table E.1: Continued Indicator RURA
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Health Inequities in Manitoba: Is t
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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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References: Health Inequities in Ma
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Figure 6.2: Continuity of Care Prev
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Figure 6.10: Hospitalization Due to
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CONFIDENTIAL -- NOT FOR DISTRIBUTIO
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Figure 7.2: Prevalence of Cumulativ
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Dementia Health Inequities in Manit
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Figure 7.10: Dementia Prevalence Ov
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Figure 7.18: Prevalence of Complete
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Reference Health Inequities in Mani
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Figure 8.2: Post-AMI Care: Beta-Blo
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Reference Health Inequities in Mani
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Table 9.1: Continued Indicator RURA
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Table 9.1: Continued Health Inequit
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Table A2.3: Crude Numbers of Mortal
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Table A2.5: Crude Numbers for High
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Table A2.7: Crude Numbers for Denta
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Table A2.11: Crude Numbers for Isch
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Table A2.13: Crude Numbers for Cont
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Table A2.17: Crude Numbers for Cumu
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Figure A3.2: High School Appendix C
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Health Inequities in Manitoba: Is the Socioeconomic Gap

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