A Health Perspective: Inequalities in Cities

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A Health Perspective Inequalities in Cities

• Urban Sociology
• 5 March 2008

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Todays class

• Lecture
• Neighbourhood inequalities in the causes of
  health
• The determinants of health upstream and
  downstream
• The priorities of a urban public health
  department

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Readings

• Trends in mortality by neighbourhood income in
  urban Canada from 1971 to 1996.  Statistics
  Canada Report, Catalogue 82-003.  Supplement to
  Health Reports, Vol 13, 2002 
• Fitzpatrick, Kevin M. and Mark LaGory. "Placing"
  Health in an Urban Sociology Cities as Mosaics
  of Risk and Protection.
• What health issues are on the Toronto Public
  Health departments radar screen?
• 5th anniversary of SARs what have we learned?

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Patterns of Mortality

• Trends in Mortality by Neighbourhood Income
  1971-1996
• Measure of mortality?
• Geographic unit examined?
• How were neighbourhood divided for analysis?
• How have socioeconomic disparities changed? By
  what causes of death?

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Risks and Protections

• Fitzpatrick/LaGory Sociologists
• Focuses on the multiple dimensions of place
• Cities have a topography of risk and protection
  (p6).
• Place matters because
• Levels and types of hazard and risk
• Source of identity, culture, relative comparison
• Levels and types of resources
• Difference between place and space
• Difference between hazard and risk
• What is the role of segregation on health
  inequalities?

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Risks and Protections

• Health is affected by four forces which usually
  reinforce one another
• Life chances
• Risk
• Subcultures
• Social Networks
• Role of territorial functioning in reducing the
  urban health penality

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How Do we Understand Urban Health
Inequality?Other Perspectives on the Causes of
Health

• Following Slides not from the readings

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Upstream and Downstream

• Perspective of George Kaplan Social
  Epidemiologist /School of Public Health
• Viewpoint existing research puts too much
  emphasis on upstream/proximal causes
• A more complete understanding requires a
  multilevel approach
• Examples of inequalities Historical, Persistent
• Pathways Biological, Behavioral/Psychosocial,
  Communities/Neighbourhoods
• What is it about upstream causes that matter?

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Toronto Public Health

• Toronto NAs 5th largest city
• 50 of population born outside Canada
• Health risk are higher among immigrants and
  refugee populations (though there is also a
  healthy immigrant effect)
• City also has higher than average proportions of
  low-income families, single parent families,
  seniors, and those receiving social assistance
• City has low birth rates and HIV infection rates
  higher than national average
• Pollution
• Focus on poverty, link to food security and
  environmental contaminant exposure
• Role of globalization on spreading infectious
  diseases (e.g. SARS)
• Keeping up with infrastructure
• Public health infrastructure, response plans,
  etc.
• Hospital and Clinic infrastructure