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Despite dramatic improvements in health in general, significant inequalities in health among Canadians persist.[85][86][87][88] Access to essential medical procedures is guaranteed by Medicare in Canada. Nevertheless, access to care issues are common[89] and this is particularly the case in regards to required prescription medicines where income is a strong determinant of such access.[90] It is believed however that health care issues account for a relatively small proportion of health status differences that exist among Canadians.[91] As for differences in health behaviours (e.g., tobacco and alcohol use, diet, and physical activity, etc.), studies from as early as the mid 1970s—reinforced by many more studies since then—find their impact upon health to be less important than social determinants of health such as income and other social determinants of health.[92][93][94] Instead, evidence indicates that health differences among Canadians result primarily from experiences of qualitatively different living conditions associated with the social determinants of health. As just one example, consider the magnitude of differences in health that are related to the social determinant of health of income. Income is especially important as it serves as a marker of different experiences with many social determinants of health.[95] Income is a determinant of health in itself, but it is also a determinant of the quality of early life, education, employment and working conditions, and food security. Income also is a determinant of the quality of housing, need for a social safety net, the experience of social exclusion, and the experience of unemployment and employment insecurity across the life span. Also, a key aspect of Aboriginal life and the experience of women in Canada is their greater likelihood of living under conditions of low income.[96] Income is a prime determinant of Canadians’ premature years of life lost and premature mortality from a range of diseases.[95][97] Numerous studies indicate that income levels during early childhood, adolescence, and adulthood are all independent predictors of who develops and eventually succumbs to disease.[98][99][100][101] In Canada almost a quarter of excess premature years of life lost (mortality prior to age 75) can be attributed to income differences among Canadians.[88] These calculations are obtained by using the mortality in the wealthiest quintile of urban neighbourhoods as a baseline and considering all deaths above that level to be “excess” related to income differences. These analyses indicate that 23% of premature years of life lost to Canadians can be accounted for by differences existing between wealthy and other Canadians.[88] What are the diseases that differentially kill people of varying income levels? Income-related premature years of life lost can be correlated with death certificate cause of death.[88] Among the not-wealthy, mortality by heart disease and stroke are especially related to income differences. Importantly, premature death by injuries, cancers, infectious disease, and diabetes are also all strongly related to not being wealthy in Canada. These rates are especially high among the least well-off Canadians. In 2002, Statistics Canada examined the predictors of life expectancy, disability-free life expectancy, and the presence of fair or poor health among residents of 136 regions across Canada.[102] The predictors included socio-demographic factors (proportion of Aboriginal population, proportion of visible minority population, unemployment rate, population size, percentage of population aged 65 or over, average income, and average number of years of schooling). Also placed into the analysis were daily smoking rate, obesity rate, infrequent exercise rate, heavy drinking rate, high stress rate, and depression rate. Consistent with most other research, behavioural risk factors were rather weak predictors of health status as compared to socio-economic and demographic measures of which income is a major component.[98][103][104] For life expectancy, the socio-demographic measures predicted 56% of variation (total variation is 100%) among Canadian communities. Daily smoking rate added only 8% more predictive power, obesity rate only another 1%, and exercise rate nothing at all! For disability-free life expectancy, socio-demographics predicted 32% of variation among communities, and daily smoking rated added only another 6% predictive power, obesity rate another 5%, and exercise rate another 3%. Differences among Canadians communities in numbers of residents reporting poor or fair health were related to socio-demographics (25% predictive power) with smoking rate adding 6%, obesity rate adding 10%, and exercise rate adding 3% predictive power.[further explanation needed] Income-related effects are seen therefore in greater incidence and mortality from just about every affliction that Canadians experience. This is especially the case for chronic diseases. Incidence of, and mortality from, heart disease and stroke, and adult-onset or type 2 diabetes are especially good examples of the importance of the social determinants of health.[105][106] While governments, medical researchers, and public health workers emphasize the importance of traditional adult risk factors (e.g., cholesterol levels, diet, physical activity, and tobacco and alcohol use), it is well established that these are relatively poor predictors of heart disease, stroke, and type 2 diabetes rates among populations.[107][108][109] The factors making a difference are living under conditions of material deprivation as children and adults, stress associated with such conditions, and the adoption of health threatening behaviours as means of coping with these difficult circumstances.[110] In fact, difficult living circumstances during childhood are especially good predictors of these diseases.[100][111][112][113] In addition to predicting adult incidence and death from disease, income differences — and the other social determinants of health related to income — are also related to the health of Canadian children and youth. Canadian children living in low-income families are more likely to experience greater incidence of a variety of illnesses, hospital stays, accidental injuries, mental health problems, lower school achievement and early drop-out, family violence and child abuse, among others.[114] In fact, low-income children show higher incidences of just about any health-, social-, or education-related problem, however defined. These differences in problem incidence occur across the income range but are most concentrated among low-income children.[115][116][117] |
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