Deprivation and Health in Qubec Development and use of an ecological proxi of population socioeconom

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Deprivation and Health in QuébecDevelopment and
use of an ecological proxi of population
socio-economic conditions

• Robert Pampalon

Atelier stratégique Écologie sociale, santé et
géomatique Québec, 31 mai 2005
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A Deprivation Index
Its purpose Its making-up Its use Its future
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The Purpose of the Index
Why ?

• To introduce socioeconomic information into
  databases related to the fields of health and
  social services

• To account for socioeconomic disparities in
  health, disease, death and use of health and
  social services

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The making-up of the Index

• The concept of deprivation
• The geographic unit
• The socio-economic indicators
• Their combination
• A look at deprivation in Québec

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The concept of deprivation
According to P. Townsend (1987)  A state of
observable and demonstrable disadvantage relative
to the local community or the wider society or
nation to which the individual, family or group
belongs 
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The geographic unit
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The indicators

• Selected according to
• Their relation to a large number of health and
  well-being
• issues
• Their association with the material and the
  social forms of
• deprivation
• Their availability by dissemination area (DA)

Education of persons with no high school
degree Employment Ratio of employment to
population Income Average personal income, in
Marital status of persons separated,
divorced or widowed Living alone of people
living alone Single-parent families of
single-parent families
All indicators except the latter were age and sex
ajusted
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The combination of indicators
Principal Component Analysis (DA11202), with
VARIMAX rotation

• Component 1 (material)
• of persons with no high school degree
• Ratio employment / population
• Average personal income
• Component 2 (social)
• of persons living alone
• of persons separated, divorced or widowed
• of single-parent families

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The combination of indicators
By ranging DA according to their value (factor
score) on the material and social components
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The combination of indicators
By cross-tabulating the two sets of quintiles
(Q) material and social
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Deprivation in Québec
Québec population, 2001, by material and social
deprivation
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Deprivation in Québec
Cartographic illustration of material and social
deprivation in Québec
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Deprivation in Québec
Overall Québec
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Deprivation in Québec
The Québec City region
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Deprivation in Québec
The old Québec city
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The use of the Index

• Monitoring social inequalities
• Health and illness
• Well-being, social problems
• Service evaluation
• At a national scale, Québec, as a whole
• At a local scale, that of CLSC
• Resource allocation
• Policies and programs

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Monitoring social inequalities
Life expectancy (LE) and health expectancy (HE)
at birth Québec, 2000-2002
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Monitoring social inequalities
Relative risk of death (RR) by motor vehicle
accident and suicide material and social
deprivation quintile Québec, 2000-2002
RR
RR
RR 3.0
Material depivation
Social deprivation
________________ RR are ajusted by age, sex,
region and the other form of deprivation
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Monitoring social inequalities
Teenage fertility 2000-2002 Reported cases of
child abuse, neglect and behaviour
problems 1998-1999
1- Number of Births per 1000 women below 20 2-
Number of reported cases per 1000 young
people below 18
Q1 Q2 Q3 Q4
Q5
Q1 Q2 Q3 Q4
Q5
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Service EvaluationAt a national scale, Québec
Three medical specialties, expenses per capita,
in Québec, 2000



Can
Q1 Q2 Q3 Q4
Q5
Q1 Q2 Q3 Q4
Q5
Q1 Q2 Q3 Q4
Q5
Q1 Q2 Q3 Q4
Q5
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Material deprivation
Social deprivation
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Service Evaluation at a local scale, CLSC
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Service Evaluationat a local scale, CLSC
CLSCs clientèles, 2000-2002 (www.inspq.qc.ca/defa
vorisationCLSC)
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Service Evaluationat a local scale, CLSC
Summary table of inequalities in service
utilization
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Resource Allocation

• Regional resource allocation in HSS
• MHSS (2004-05) Youth program, primary care and
  social services program (CLSC)
• Local resource allocation in HSS
• (regional boards) between CLSCs
• Other governmental agencies
• Ministry of Employment and Social Solidarity, Qc,
  City of Montréal, etc.

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Policies and programs
Alas !
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In short

• The Deprivation Index has been introduced in
  several databases
• Deaths 1994 à 2002
• Births, 1994 à 2002
• Tumors, 1995 à 1997
• Hospitalizations, 1997-98 à 2001-02
• Medical services, 2000
• Youth Protection Agencies clienteles, 1998-1999
• CLSCs clienteles, 2000-2002
• Nursing homes clienteles, 1997 à 2001
• Community groups database, 1996
• Québec household survey 1998
• Social security database, 1996, 2001

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In short

• The Index has given rise to scientific
  publications
• in english and french
• Pampalon, R. Raymond, G. (2000) A deprivation
  index for Health and Welfare Planning in Québec.
• Chronic Diseases in Canada. 21(3) 104-113.
• Pampalon R. et Rochon M. (2002) Health
  Expectancy and Deprivation in Québec 1996-1998.
• In Carrière Y. et al. (eds) Selected papers
  from the 13th annual meeting of the international
  Network on
• Health Expectancies (REVES). Statistics Canada
  and Health Canada.
• Hamel, D. Pampalon, R. (2002) Trauma and
  deprivation in Québec. INSPQ. Available on the
  INSPQ
• website www.inspq.qc.ca.
• Martinez, J. Pampalon, R. Hamel, D. (2003)
  Deprivation and stroke mortality in Québec.
  Chronic
• Diseases in Canada. 24(2/3) 57-64.
• Philibert, M. Pampalon, R. Hamel, D. Thouez J.P.
  and Loiselle C. (2004) Deprivation and
  utilization of
• health and social services in Québec  A local
  scale evaluation system. Social Science and
  Medicine.
• Submited.
• Dupont, M.A. Pampalon, R. Hamel, D. (2004)
  Deprivation and cancer mortality among women and
  men,
• 1994-1998. INSPQ. Available on the INSPQ
  website www.inspq.qc.ca.
• in french only
• Pampalon, R. Raymond, G. (2003) Indice de
  défavorisation matérielle et sociale son
  application au
• secteur de la santé et du bien-être. Santé,
  Société et Solidarité. 1 191-208.

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In short
The Index is linked with many free
products available on the web (http//www.msss.gou
v.qc.ca/statistiques/atlas/index.php)

• An interactive map of the Index by DA
• A Postal code ? Index conversion SAS
• program
• Population counts by deprivation quintile
• (by age, sex, Québec, region, CLSC)
• A table linking the Index with DA

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The future of the Index
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The future of the Index
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