inconvenient truths about health inequalities in canada: what we know & what we don’t
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1
Inconvenient Truths about Health Inequalities in Canada: What We Know
& What We Don’t
Dr. John Frank, Scientific Director,CIHR-Institute of Population & Public Health
Canadian Public Health Association Conference
Plenary II
June 2nd, 2008
2
OutlineA. Public Health Principles
B. Linking surveillance to interventions: Illustrative examples
1) Absence of Data on Health and Functioning (vs. mortality): the example of children
2) Tobacco control – without SES data, the cup is more than half-empty
C. Where is action needed?
3
Public Health Principles
Seek the root causes of disease and disability - a focus on determinants
Consider and deal with whole populations
Understand and apply the principles of social change, over the life course
4
Health and Functioning –the Example of Children
Grade 12 (S4) Performance by SES Group Language Arts Standards Test 2001/02
Pass/Fail rates of test writers 17/18 year olds who should have written
N=221
121
98276
31
75%83%
92%87%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Low Low-Mid Middle High
SES
27%
52%
65%
77%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Low Low-Mid Middle High
SES
Withdrawn
In Grade 11(S3) or lower
In Grade 12(S4), but noLA Test Mark
Drop Course,Absent,Exempt, Incomplete
Fail
Pass
6
A Big Step Forward: the EDI and HELP (Human Early Learning Partnership)
“The Early Child Development (ECD) Mapping Project involves implementation of the Early Development Instrument (EDI) in B.C. school districts, to assess state of development at the Kindergarten level. Kindergarten teachers in B.C. began to collect EDI data in 1999/2000. As of March 2004, all 59 school districts had collected EDI data.”
7
“What the EDI Measures”
Physical health and well-being
Social competence.
Emotional maturity.
Language and cognitive development.
Communication skills and general knowledge.”
The EDI gathers data on five areas (or subscales) of children’s development:
Conclusions• Differences in outcomes across SES may be
dramatically underestimated without a population-based approach
– Disadvantaged groups are at very high risk for poor outcomes
• Not all disadvantaged children do poorly
• Of the total number of kids with poor academic outcomes, the majority are not in the most disadvantaged groups
– But low SES kids are much less likely to recover from a setback
Marni Brownell, Noralou Roos, Randy Fransoo et al.On-line Child Health Atlas: www.umanitoba.ca/centres/mhcp/reports/child_inequalities/** Partially based on the article “Is the Class Half Empty?” that appeared in the October 2006 issue of IRPP Choices. www.irpp.org
10
Tobacco Control: Differential Effects
Source: http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre9
12
20-Year Trends in Smoking: Current smokers by age, Canada, 1981-2001
A Canadian Success Story but….
13
POPULATION HEALTH KEY POLICY MESSAGE # 1
Early Life Matters
14
Interaction of Perinatal Stress & Socioeconomic Status in the Developmental Quotient
SSOOC C IIOOEECCOONNOOM M I I C C
SSTTAATTUUSS
High SesHigh Ses
Medium SesMedium Ses
Low SesLow SesDe
velo
pmen
tal Q
uo
tient
at 2
0 m
os.
De
velo
pmen
tal Q
uo
tient
at 2
0 m
os.
1010
00
8080
6060 NoneNone Mild Mild ModerateModerate SevereSevere SEVERITY OF PERINATAL STRESSSEVERITY OF PERINATAL STRESS
Source: Werner, 1989Source: Werner, 1989
15
POPULATION HEALTH KEY POLICY MESSAGE # 2
Two exposures are remediable:
Family Poverty
Lack of cognitively stimulating environment
16
POPULATION HEALTH KEY POLICY MESSAGE # 3
“Arrested national development”:
Canada’s track record on tackling family poverty is far below what it can afford.
17
Canada’s Income Gap at a Thirty Year High
In 2004, the average earnings of the richest 10% of families with children was 82 times that earned by the poorest 10%.
(ref: Yalnizyan A. The rich and the rest of us, 2007, CCPA.)
18
POPULATION HEALTH KEY POLICY MESSAGE # 4
Use feasible and durable interventions (moving beyond pilot/short-term solutions)
National policy to provide high quality early childhood education
Affordable and accessible housing
00-085
Chile
Canada
Netherlands
Sweden
170
190
210
230
250
270
290
310
330
350
0 5 10 15 20
InternationalMean
Mean scores
Parents’ Education (years)
SocioeconomicGradients forDocumentLiteracy Scores
19Source: The Founder’s Network: http://www.founders.net/
20
“Children have a first call on a nation’s resources, in bad times as well as in good.”
United Nations World Summit on Children
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