Professional Documents
Culture Documents
Dennis Raphael
York University, Toronto, Canada
Presentation made at
Ryerson Polytechnic University
Toronto, Ontario, October 4, 2002
What Do We Know ?
• Population Health
• Example 1: Cardiovascular Health
• Example 2: Diabetes
• Social Determinants in Canada Today
What Do We Do?
• Governments – Policy Making
• Public Health Units - Activities
• Disease Associations, e.g., Heart and Stroke Foundation,
Diabetes Association – Messages
• Health Care Providers and Planners - Focus
Poverty and Health: Literary Perspectives
We know what makes us ill.
When we are ill we are told
That it’s you who will heal us.
When we come to you
Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. It is the same cause that wears out
Our bodies and our clothes.
-- Bertolt Brecht, A Worker’s Speech to a Doctor, 1938.
Poverty and Health:
Academic Perspectives
N e o pla sm s 3 0 .9
Inc o m e -R e la te d 2 3 .1
Injurie s 1 9 .2
C irc ula to ry 1 7 .6
Infe c tio us 5 .3
P e rina ta l 4 .9
Ill-de fine d 4 .8
C o ng e nita l 3 .8
A ll o the r 1 3 .5
Excess PYLL(0-74) by Cause, 1996
0 5 10 15 20 25 %
C ir culatory 21.6
Injur ie s 16.9
N eoplasm s 14
Infe c tious 12.2
Ill-de fine d 8.3
P erinatal 7.1
D igestive 5.4
A ll othe r 14.5
Figure 5: Cardiovascular Deaths Per 100,000, Urban Canada, 1996
280 268
236
240 218 225
203
200
160 143
119 128 118 127
120
80
40
0
1st (Highest Income) 2nd 3rd 4th 5th (Lowest Income)
Neighbourhoods by Income Quintile, Urban Canada
Males Females
Figur e 7 : Heart Attack Hospital Admissions by A rea Income, Ontario , 199 4-97
13,935
13,115
11,837
12,000
9,000 8,090
6,000
4,614
3,000
0
1st (Highest Income) 2nd 3rd 4th 5th (Lowest Income)
Neighbourhoods by Income Quintile, Ontario
Figure 9: Greater Risk of Heart Disease in Low Income Areas, USA, 1988-97
160%
160%
120%
90% 90% 90%
80%
80% 70%
60% 60%
50% 50%
40%
40% 30%
0%
White Males White Females Black Males Black Females
8 7.05 6.78
7
5.76
6 5.12
5
4
3
2
1
0
Q1 (Lowest) Q2 Q3 (Middle) Q4 Q5 (Highest)
Neighbourhoood Classified by Mean Income
Increased Risk of Diabetes in Ontario
Among Low Income Residents, 1997/97
Males Females
5
Diabetes Prevalence Ratio
4 3.8
3
2.3
2
2 1.4 1.5
1.2 1 1
1
0
Low Low-Middle Upper-Middle High
Income Level
Diabetes, Males
ASMR x 100,000
22
20
18
16
14
Q 1 - R ichest
12
10 Q2
8 Q3
6
Q4
4
Q 5 - P oorest
2
0
1971 1976 1981 1986 1991 1996
ASMR x 100,000
Diabetes, Females
22
20
18
16
14
Q 1 - R ichest
12
10 Q2
8 Q3
6
Q4
4
Q 5 - P oorest
2
0
1971 1976 1981 1986 1991 1996
Implications of Increasing Family Poverty
MS
LA
675 SC
AL
FL
550 TX
CA
ME
PEI
425 QUE NH NS
NB
NFLD
MN MAN
ONT
BC
SASK ALTA
Mortality Rates Standardized to the Canadian Population in 1991
300
0.18 0.20 0.22 0.24
Median Share of Income WAMWeightedCan&US June 16, 1999 2:40:26 PM
Working Age (25-64) Mortality by Median Share
U.S. and Canadian Metropolitan Areas
U.S. cities (n=282) with weighted linear fit (from Lynch et al. 1998)
600 Canadian cities with weighted linear fit (n=53) (slope not significant)
FlorenceSC
NewOrleansLA
AugustaGA
PineBluffAR
Rate per 100,000 Population
500
NewYorkNY
MonroeLA
400 LosAngelesCA
BryanTX
Shawinigan
SiouxCityIA
PortsmouthNH
McallenTX Barrie
Montreal
300
Vancouver AppletonWI
Toronto Oshawa
400%
300%
300%
200%
100%
100%
0%
Seniors Families Singles
%
Low Income
45
40
35
30 Q 1 -R ic h e st
Q2
25
Q3
20
Q4
15
Q 5 -P o o r e st
10
5
0
1971 1986 1991 1996
Economic Inequality and Health:
Policy Implications
• Poverty and economic inequality is on the rise in
the USA and Canada
• Poverty is bad for health
• Economic inequality is dangerous for the health of
all of us
• Policy decisions create poverty and economic
inequality
• Citizens can influence policy decisions to improve
health
Economic Inequality Affects
Health in Three Main Ways