Health Inequities in Manitoba: Is the Socioeconomic Gap

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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
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? initiatives, this report gives us fertile ground on which to base future policies, programs, and evaluations of initiatives both provincially and regionally. We hope that this information will be a useful tool in the effort to improve the health and well–being of Manitobans and more importantly, to reduce inequity in our province. If you would like to access an electronic version of this report, which may help you in creating your own summary presentations, you will find this on the website of the Manitoba Centre for Health Policy, under Publications. You will also find Excel spreadsheets for the graphs in this report by looking under the MCHP link called “Data Extras.” The MCHP website address is http://www.umanitoba.ca/faculties/medicine/units/mchp/ References: Adler NE, Boyce WT, Chesney MA, Folkman S, Syme SL. Socioeconomic inequalities in health: No easy solution. Journal of the American Medical Association. 1993;269:3140–3145. Bonnefoy J, Morgan A, Kelly MP, Butt J, Bergman V. Constructing the evidence base on the social determinants of health: A guide. Measurement and Evidence Knowledge Network (MEKN) of the WHO Commission on Social Determinants of Heath. November, 2007. http://www.jenniferbutt.co.uk/images/ constructing_evidence_base_mekn.pdf. Accessed July 20, 2010. Brownell M, Lix L, Ekuma O, Derksen S, De Haney S, Bond R, Fransoo R, MacWilliam L, Bodnarchuk J. Why is the health status of some Manitobans not improving? The widening gap in the health status of Manitobans. Manitoba Centre for Health Policy. 2003. http://mchp–appserv.cpe.umanitoba.ca/ reference/hlthgap.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. 2008. http://mchp–appserv.cpe.umanitoba.ca/reference/ Child_Health_Atlas_Update_Final.pdf. Accessed July 20, 2010. 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. Dahlgren G, Whitehead M. Levelling up (part 2): A discussion paper on European strategies for tackling social inequities in health. WHO Regional Office for Europe. 2006. http://www.euro.who.int/__data/ assets/pdf_file/0018/103824/E89384.pdf. Accessed July 20, 2010. 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. Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S, on behalf of the Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372:1661–1669. Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337:1387–1393. Marmot MG, Kogevinas M, Elston MA. Social/economic Status and disease. Annual Review of Public Health.1987;8;111–135. Manitoba Centre for Health Policy 13
Page 1 and 2: HEALTH INEQUITIES IN MANITOBA: Is t
Page 3 and 4: About the Manitoba Centre For Healt
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Page 7 and 8: Key findings: High School Completio
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Dementia Health Inequities in Manit
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