Poverty and Health BCHLA Webinar Dr. Brian O’Connor, MD, MHSc April 17, 2013

2 The WHO Commission on the Social Determinants (2008) Reducing health inequities is an ethical imperative. Social injustice is killing people on a grand scale.

3 What is the Principle Underlying Inequity Inequities are differences that are unfair, unjust, avoidable and remediable – often through the application of politicial will. Inequalities – sex, genetics, heredity

4 The Gap – Health is Not Distributed Equitably

5 The Gap – Health is Not Distributed Equally (Data source: Statistics Canada Canadian Community Health Survey Cycle ; Percentages were standardized to the 2004 Canadian population as the reference with bootstrap weight valued provided by Statistics Canada. Confidence intervals for age-standardized percentages(45-64, 65+) were calculated with the method based on the gamma distribution developed by Fay and Feuer in 1997) Heart Disease Prevalence by Income

6 Pan-Canadian Age-Standardized Hospitalization Rates by SES Group* The Gap – Health is Not Distributed Equally Note : * For each indicator, all rates are significantly different between low-, average- and high-SES groups at the 95% confidence level. Source: CPHI analysis of 2003–2004 to 2005–2006 Discharge Abstract Database and National Trauma Registry data, Canadian Institute for Health Information.

7 Implications of the Gap

8 What is Happening in BC Socio-Economic Index Quintile Group Change in Months Highest SES Lowest SES

9 What is Happening in BC Index of Education Concerns Quintile Group Change in Months Highest SES Lowest SES

10 What are the Reasons Increased rates of income inequity Reduction in social programs (Real or relative) Differences in levels of uptake of health promoting behaviours between income groups

11 What Do Inequities Cost Us?

12 What Do Inequities Cost Us?

13 What Do Inequities Cost Us?

14 The Case of Children & Families The cycle of poverty The importance of ECD – Lifelong success Most poor children live in families with at LEAST one parent working full time Need programs to assist young families so our children have equal chance for success

15 So How Do We Achieve Equitable Health Status for All BC

16 So How Do We Achieve Equitable Health Status for All BC Early Childhood Development Food Security Built Environment Connectedness Income Security

17 What are the Possible Solutions? 1)Poverty reduction plan with legislated targets and timelines, and a responsible and accountable minister 2)Sub-elements within a plan can include ECD strategies Income and food security strategies Housing strategies

18 Thank you Brian O’Connor