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Inconvenient Truths about Health Inequalities in Canada: What We Know & What We Don’t

Inconvenient Truths about Health Inequalities in Canada: What We Know & What We Don’t. Canadian Public Health Association Conference Plenary II June 2 nd , 2008. Dr. John Frank, Scientific Director, CIHR-Institute of Population & Public Health. Outline. Public Health Principles

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Inconvenient Truths about Health Inequalities in Canada: What We Know & What We Don’t

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  1. Inconvenient Truths about Health Inequalities in Canada: What We Know & What We Don’t Canadian Public Health Association Conference Plenary II June 2nd, 2008 Dr. John Frank, Scientific Director, CIHR-Institute of Population & Public Health

  2. Outline • Public Health Principles • Linking surveillance to interventions: Illustrative examples • Absence of Data on Health and Functioning (vs. mortality): the example of children • Tobacco control – without SES data, the cup is more than half-empty • Where is action needed?

  3. Public Health Principles • Seek the root causes of disease and disability - a focus on determinants • Consider and deal with whole populations • Understand and apply the principles of social change, over the life course

  4. Health and Functioning –the Example of Children

  5. Grade 12 (S4) Performance by SES Group Language Arts Standards Test 2001/02 31 276 98 121 N= 221 17/18 year olds who should have written Pass/Fail rates of test writers

  6. A Big Step Forward: the EDI and HELP (Human Early Learning Partnership) “The Early Child Development (ECD) Mapping Project involves implementation of the Early Development Instrument (EDI) in B.C. school districts, to assess state of development at the Kindergarten level. Kindergarten teachers in B.C. began to collect EDI data in 1999/2000. As of March 2004, all 59 school districts had collected EDI data.”

  7. “What the EDI Measures” The EDI gathers data on five areas (or subscales) of children’s development: • Physical health and well-being • Social competence. • Emotional maturity. • Language and cognitive development. • Communication skills and general knowledge.”

  8. Conclusions • Differences in outcomes across SES may be dramatically underestimated without a population-based approach • Disadvantaged groups are at very high risk for poor outcomes • Not all disadvantaged children do poorly • Of the total number of kids with poor academic outcomes, the majority are not in the most disadvantaged groups • But low SES kids are much less likely to recover from a setback Marni Brownell, Noralou Roos, Randy Fransoo et al. On-line Child Health Atlas: www.umanitoba.ca/centres/mhcp/reports/child_inequalities/ ** Partially based on the article “Is the Class Half Empty?” that appeared in the October 2006 issue of IRPP Choices. www.irpp.org

  9. Tobacco Control: Differential Effects

  10. Source: http://www.esrcsocietytoday.ac.uk/ESRCInfoCentre 9

  11. 20-Year Trends in Smoking: Current smokers by age, Canada, 1981-2001 A Canadian Success Story but….

  12. POPULATION HEALTH KEY POLICY MESSAGE # 1 Early Life Matters

  13. SOC IOECONOM I C STATUS 10 High Ses Medium Ses Low Ses Developmental Quotient at 20 mos. 0 80 60 None Mild Moderate Severe SEVERITY OF PERINATAL STRESS Source: Werner, 1989 Interaction of Perinatal Stress & Socioeconomic Status in the Developmental Quotient

  14. POPULATION HEALTH KEY POLICY MESSAGE # 2 • Two exposures are remediable: • Family Poverty • Lack of cognitively stimulating environment

  15. POPULATION HEALTH KEY POLICY MESSAGE # 3 “Arrested national development”: Canada’s track record on tackling family poverty is far below what it can afford.

  16. Canada’s Income Gap at a Thirty Year High In 2004, the average earnings of the richest 10% of families with children was 82 times that earned by the poorest 10%. (ref: Yalnizyan A. The rich and the rest of us, 2007, CCPA.)

  17. POPULATION HEALTH KEY POLICY MESSAGE # 4 Use feasible and durable interventions (moving beyond pilot/short-term solutions) • National policy to provide high quality early childhood education • Affordable and accessible housing

  18. 00-085 Socioeconomic Mean scores 350 Gradients for Document 330 Literacy Scores 310 290 International Mean 270 Sweden 250 230 Netherlands 210 Canada 190 170 Chile 0 5 10 15 20 Parents’ Education (years) 19 Source: The Founder’s Network: http://www.founders.net/

  19. “Children have a first call on a nation’s resources, in bad times as well as in good.” United Nations World Summit on Children

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