Health Inequalities: Composition or Context

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Health Inequalities Composition or Context?

• Health Inequalities where the chances of good
  or bad health are not evenly distributed among
  groups of people (defined either by the
  geographical area in which they live/work or by
  some other common characteristic, such as poverty)

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Overview

• Composition/Context Debate
• Saskatoon Case Studies
• Community-University Institute for Social
  Research (CUISR) QOL Module
• Respiratory Illness in Saskatoon Infants The
  Impact of Housing and Neighborhood
  Characteristics (J. Wright, SHR)
• Comprehensive Community Information System (L.
  Murphy, SHR)

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Composition (Individual Level)

• Locates the understanding of inequality at the
  individual level
• Age
• Sex
• Smoking
• Diet
• SES (social class, wealth, income)
• populations hlth. seen as an aggregate of the
  health of its individual members

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Context (Ecologic)

• Locates the understanding of health inequalities
  at the level of the physical, economic or social
  environment the setting in which people live
  their lives
• tangible fabric
• state fabric
• social fabric
• equality

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Population Health Promotion Model
Source Hamilton Bhatti, 1996
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now it's getting to the point where there is no
more small grocery stores Again one element of
stability went out of the neighborhood. That is
very, very important. (Low SES Resident)
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Respiratory Illness in Saskatoon Infants
Geographic Variation in Rates of Respiratory
Illness

• Judith Wright, M.Sc.,
• Dr. Nazeem Muhajarine
• Department of Community Health
• Epidemiology, University of Saskatchewan
• 2003

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Secondary Data Used

• Adverse Birth Outcome Study 1992-1999
• Saskatchewan Health Vital Statistics, Physician
  and Hospital Services
• 1998 City of Saskatoon Neighbourhood Profiles
• Statistics Canada census data for 1996
• City of Saskatoon data

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Contextual Variables (Ecologic level) Do children
in some neighbourhoods have greater respiratory
morbidity than children in other neighbourhoods?
Compositional (Individual level) Variables
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More babies in west side neighbourhoods were
hospitalized, and they were hospitalized more
often than babies living elsewhere in the
cityHigs found on the west side of the city
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Housing Neighbourhood Independent Variables

• Median income
• Person per household
• Low education (ltgr 9)
• Population lt 10 years
• Employment
• SGA infants
• Male infants

• Rental tenure
• Duplexes
• Apartments
• Dwellings needing major repairs
• Dwellings constructed
• lt 1971
• 1971-1985
• gt1985

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Strong concordance between low median income and
high rates of hospitalization
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Conclusions

• Children in west side neighbourhoods had more
  respiratory morbidity
• Median income, low education and employment were
  important predictors, as were housing
  characteristics
• SES variables are more important predictors to
  some respiratory illnesses than others

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Policy Implications

• Distribution of rates suggests targeted
  interventions
• Interventions must address underlying SES factors
• Decide to invest in community development or
  health service utilization?