Health Inequities in Manitoba: Is the Socioeconomic Gap

Chapter 1: Introduction and Methods
2 University of Manitoba
the Province of Manitoba for use by the local, national, and international research community. MCHP
promotes a collaborative environment to create, disseminate, and apply its research. The work of MCHP
supports the development of policy, programs, and services that maintain and improve the health of
Manitobans.
Background Literature on Health Inequity
It has long been recognized that health outcomes vary according to social factors, such as income level
and ethnicity. Life expectancy is shorter and illness levels are higher for those with lower socioeconomic
status (Adler, Boyce, Chesney, Folkman & Syme, 1993; Marmot, Kogevinas, & Elston, 1987; Marmot et al.,
1991; Mustard et al., 1995; Syme & Berkman, 1976). The relationship between health and socioeconomic
status is generally referred to as a “socioeconomic gradient” (Marmot et al., 1991; Willms, 2003). The term
“gradient” emphasizes the idea that the change in outcomes is gradual and occurs across the full range
of socioeconomic status. It is not just the case that individuals living in poverty have poorer outcomes
when compared to individuals not living in poverty, but that each increase in socioeconomic status is
associated with an increase in positive outcomes (Marmot et al., 2008).
The socioeconomic gradient in health outcomes has also been well documented in Manitoba (Brownell
et al., 2008; Fransoo et al. 2009; Martens et al., 2002, 2003, 2004; Mustard et al., 1995; Roos et al., 2001).
Roos et al. (2001) found that while the health of Manitobans in general improved from 1985 through
1998, gaps in health status appeared to increase between those Manitobans living in the northern
regions of the province compared to the rest of Manitoba, as well as between those living in areas
with the lowest neighbourhood income levels compared to areas with higher neighbourhood income.
Further research demonstrated that these gaps increased due to improvements in health status for
those living in southern regions of the province, and in higher neighbourhood income areas, with
little change in health status occurring for those in the north and in low neighbourhood income areas
(Brownell et al., 2003).
For purposes of this report, we are using two definitions of health inequity:
Health Inequity is unfair and avoidable or remediable differences in health among social groups
(Bonnefoy, Morgan, Kelly, Butt, & Bergman, 2007).
Health Equity suggests that all people can reach their full health potential and should not be
disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class,
socioeconomic status, or other socially determined circumstance (Dahlgren & Whitehead, 2006).
However, it is important to note that inequality is what we can measure (i.e., gaps or differentials in
outcomes); and if we deem these to be unfair and avoidable, these inequalities essentially become
inequity (which brings upon it a judgment). Therefore, in most places in this report, we refer to the gap
measurements as inequalities.
Objectives of this Report
The purpose of the current deliverable is to focus on key indicators of health status (including measures
of health, the social determinants of health, and healthcare services which presumably are related
to health—such as prevention or quality of care) and examine whether socioeconomic gaps in these
indicators have changed over time.