Poverty and Health BCHLA Webinar Dr. Brian O’Connor, MD, MHSc April 17, 2013.

Poverty and Health

BCHLA WebinarDr. Brian O’Connor, MD, MHSc

April 17, 2013

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The WHO Commission on the Social Determinants (2008)

Reducing health inequities is an ethical imperative. Social injustice is killing people on a grand scale.

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What is the Principle Underlying Inequity

• Inequities are differences that are unfair, unjust, avoidable and remediable – often through the application of politicial will.

• Inequalities – sex, genetics, heredity

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The Gap – Health is Not Distributed Equitably

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The Gap – Health is Not Distributed Equally

Men

6.47.010.0

16.6

0

5

10

15

20

25

Lowest LowerMiddle

HigherMiddle

Highest

Household Income Quartiles

Ag

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Women

4.15.77.5

12.4

0

5

10

15

20

25

Lowest LowerMiddle

HigherMiddle

Highest

Household Income Quartiles

Ag

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(Data source: Statistics Canada Canadian Community Health Survey Cycle 3.1 2005; Percentages were standardized to the 2004 Canadian population as the reference with bootstrap weight valued provided by Statistics Canada. Confidence intervals for age-standardized percentages(45-64, 65+) were calculated with the method based on the gamma distribution developed by Fay and Feuer in 1997)

Heart Disease Prevalence by Income

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Pan-Canadian Age-Standardized Hospitalization Rates by SES Group*

The Gap – Health is Not Distributed Equally

Note :* For each indicator, all rates are significantly different between low-, average- and high-SES groups at the 95% confidence level.Source:CPHI analysis of 2003–2004 to 2005–2006 Discharge Abstract Database and National Trauma Registry data, Canadian Institute for Health Information.

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Implications of the Gap

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What is Happening in BC

Socio-Economic Index

Quintile Group 2002-2006 2006-2010Change in Months

Highest SES 81.26 82.45 14.31

2 80.68 81.45 9.26

3 79.76 80.39 7.56

4 79.49 79.25 -2.98

Lowest SES 77.68 77.76 0.95

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What is Happening in BC

Index of Education Concerns

Quintile Group 2002-20062006-2010

Change in Months

Highest SES 81.44 82.70 15.05

2 80.30 81.08 9.46

3 79.82 80.40 6.91

4 78.76 78.70 -0.74

Lowest SES 78.07 78.08 0.10

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What are the Reasons

• Increased rates of income inequity

• Reduction in social programs (Real or relative)

• Differences in levels of uptake of health promoting behaviours between income groups

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What Do Inequities Cost Us?

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What Do Inequities Cost Us?

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What Do Inequities Cost Us?

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The Case of Children & Families

• The cycle of poverty

• The importance of ECD – Lifelong success

• Most poor children live in families with at LEAST one parent working full time

• Need programs to assist young families so our children have equal chance for success

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So How Do We Achieve Equitable Health Status for All BC

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So How Do We Achieve Equitable Health Status for All BC

• Early Childhood Development

• Food Security• Built Environment• Connectedness• Income Security

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What are the Possible Solutions?

1) Poverty reduction plan with legislated targets and timelines, and a responsible and accountable minister

2) Sub-elements within a plan can include• ECD strategies• Income and food security strategies• Housing strategies

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Thank you

Brian O’Connor

brian.o’[email protected]