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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

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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?

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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

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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Withdrawn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

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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.”

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“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

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Tobacco Control: Differential Effects

Source: http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre9

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20-Year Trends in Smoking: Current smokers by age, Canada, 1981-2001

A Canadian Success Story but….

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POPULATION HEALTH KEY POLICY MESSAGE # 1

Early Life Matters

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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

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POPULATION HEALTH KEY POLICY MESSAGE # 2

Two exposures are remediable:

Family Poverty

Lack of cognitively stimulating environment

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POPULATION HEALTH KEY POLICY MESSAGE # 3

“Arrested national development”:

Canada’s track record on tackling family poverty is far below what it can afford.

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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.)

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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/

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“Children have a first call on a nation’s resources, in bad times as well as in good.”

United Nations World Summit on Children