Health Inequities in Manitoba: Is the Socioeconomic Gap

Chapter 1: Introduction and Methods
12 University of Manitoba
all Manitobans, including First Nations on–reserve populations. Unfortunately, CCHS does not survey
people living on–reserve. Our Repository records do contain most, if not all, records for the indicators
chosen in this report.
Given the fact that rural Manitoba is more heterogeneous when measuring average household income
at the dissemination area level, compared to urban settings where DA groupings represent relatively
small numbers of city blocks and families, there is the potential for truncation of disparity within rural
neighbourhood income quintiles. In other words, the rural neighbourhood income groupings, based on
DA income, may actually represent a more diverse grouping of incomes than in the urban DA groupings.
Therefore, inequality in rural Manitoba may be understated with this approach. That being said, for most
indicators the patterns of inequality are similar for urban and rural neighbourhood income groups, and
some indicators even showed greater disparity in the rural group. Therefore, although this is not perfect,
it appears to be a useful way to measure inequality both within rural groupings over time and between
rural and urban neighbourhood income groupings. Access to person–level income data may overcome
this limitation in the future, but the Repository currently does not contain person–level income data for
all Manitobans.
By excluding institutionalized populations (and putting them into the “Income Not Found” or NF
grouping), the analyses probably understate the inequality experienced in some of the dissemination
areas. A further description of the NF group is found in Chapter 9, which shows the disparate rates of the
NF group in relationship to the two lowest neighbourhood income quintile groupings of R1 and U1 and
in comparison to the overall provincial average.
By only using average household income in the census to determine the neighbourhood income
quintile groupings, no acknowledgement of the importance of average household size is taken into
account. Presumably, this would increase the disparity in terms of income, since there are typically
larger household sizes in the lower income areas, and smaller household sizes in the highest income
areas, which would result in even poorer conditions for the R1 and U1 and even richer conditions for the
R5 and U5 groupings. Future work could consider the use of the neighbourhood income adjusted for
household size.
A Targeted Versus Population Approach: Interpreting the information
Summary
In the conclusions of Chapter 9, we discuss a population–based versus targeted approach and what
our report on inequities is telling us about each outcome indicator. Please refer to that chapter for a
brief discussion on the Rose Theorem, the meaning of population shift, and how to approach reducing
inequality while also improving the overall health of Manitobans.
There is a wealth of information in this report on outcome indicators of use to planners and decision–
makers of Manitoba who are interested in public health and health service programs and policies. The
research team hopes that this will prove useful to planners, decision–makers, and policy–makers within
our province. At the same time, we hope it will be useful in producing a methodology for other research
scientists and decision–makers to approach similar analyses throughout the world.
The information can be used in many ways. First, a region can understand intra–regional inequality
through examining the neighbourhood income quintile map in this Chapter and applying the
information to planning for certain sub–regional areas. Secondly, as a jumping off point for provincial