Health Inequities in Manitoba: Is the Socioeconomic Gap

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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.
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? The specific objectives of this report are a. to provide up–to–date information on several key indicators of health status; b. to determine whether the socioeconomic gaps for these indicators have changed over time, and if so, in what direction the change has occurred; and c. to provide detailed information on the population characteristics of the rural and urban neighbourhood income quintiles. A list of the chapter titles are as follows: Chapter 1: Introduction and Methods Chapter 2: A Description of the Neighbourhood Income Quintiles using Census Data Chapter 3: Mortality Chapter 4: Child Health Chapter 5: Adult Health Chapter 6: Primary Care and Prevention Chapter 7: Mental Health Chapter 8: Pharmaceutical Use Chapter 9: Summary and Conclusions: Closing the Gap The Appendices also contain useful information. • Appendix 1 is the Glossary, where various terms used in the report are defined and additional information may be given beyond what is described in the text. • Appendix 2 gives crude rate tables and population sizes, since most of the indicators in the body of the text are “adjusted” rates to reflect a fair comparison between neighbourhood income groupings that have very different age structures of their populations. What’s in this Report: Neighbourhood Income Quintile Groupings versus Regional Areas Many MCHP reports give detailed information on geographical boundaries, such as Regional Health Authorities (RHAs) or sub–divisions of these (such as the RHA districts or, within Winnipeg, the Community Areas). However, this report focuses on neighbourhood income groupings, which are an amalgamation of Statistics Canada’s dissemination areas (DA) for purposes of the census. These neighbourhood income groupings are thus geographically disparate, amalgamated into a virtual “area” that in reality represents small sections within each of the RHAs of Manitoba. Chapter 2 goes into detail as to the characteristics of R1 through to R5 (rural neighbourhood income quintile groups), U1 through to U5 (the urban, i.e., Winnipeg and Brandon, neighbourhood income quintile groups), and the not found (NF) group. The focus of this report is to give insight to policy–makers, decision–makers, and planners on socioeconomic inequities in health status, healthcare use, and social services outcome indicators. Carefully selected indicators representing a wide range of health status, healthcare use, and educational outcomes have been chosen, with the hope of illustrating both inequity and areas of possible equity. Note that there are times when “inequity” may be totally inappropriate, such as health status outcomes, but also when “inequity” may be appropriate, such as seeing greater use of healthcare services by those with the greatest underlying health needs (i.e., usually the lowest neighbourhood income quintile groups). Manitoba Centre for Health Policy 3
Page 1 and 2: HEALTH INEQUITIES IN MANITOBA: Is t
Page 3 and 4: About the Manitoba Centre For Healt
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Health Inequities in Manitoba: Is the Socioeconomic Gap

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