Marc Lefebvre Resources, Research, Evaluation and Development Division June, 2013 Social Inequities in Health in the City of Greater Sudbury Data Analysis Using a Deprivation Index

Health Equity Vision The Sudbury & District Health Unit will work to improve the overall health equity of area citizens so that: Systemic and avoidable health disparities are steadily reduced and the gap in health between the best and worst off is narrowed; All citizens have equal opportunities for good health and well-being; and All citizens have equitable access to a full range of high quality public health programs and services

10 Promising Local Public Health Practices to Reduce Social Inequities in Health Lifestyle-focused public health actionsPolicy-focused public health actions 1. Targeting with Universalism 4. Social Marketing 5. Early Child Development 6. Purposeful Reporting 2. Intersectoral Action 3. Equity Focused Health Impact Assessment 7. Competencies and Organizational Standards 8. Contribution to Evidence Base 9. Community Engagement 10. Health Equity Target Setting Sutcliffe, Laclé, Snelling, EXTRA Fellowship Final Project Report Canadian Health Services Research Foundation, Executive Training for Research Application

Opportunity for All A path to health equity

Health Data Census Population INSPQ Deprivation Index DA Ecological Analysis Greater Sudbury Dissemination Areas

Our Analysis Who Population of Greater Sudbury What Ecological Analysis using Deprivation Index (DI) When 2006 census of population health behaviours, utilization, vital stats Where Small Area / Neighbourhood (2006 census) Why Purposeful reporting Understanding of population health

*Deprivation Index developed by Institut national de santé publique du Québec (INSPQ) *

INSPQ Deprivation Index*—2 Dimensions Material Component Education (% <high school) Employment (# employed/population) Income (mean personal income) Social Component Marital Status (% separated, divorced or widowed) Family Structure (% single parent families) Persons living along (% single-person households) *Deprivation Index developed by Institut national de santé publique du Québec (INSPQ) Pampalon, R.M., Hamel, D., Gamache, P., & Raymond, G. (2009). A deprivation index for health planning in Canada. Chronic Diseases in Canada, 29, 178–191.

DI - Regrouping the Quintiles (CIHI) SOCIAL COMPONENT MATERIAL COMPONENT Quintile 1Quintile 2Quintile 3Quintile 4Quintile 5 Quintile 1LEAST DEPRIVED1222 Quintile Quintile 322Neutral22 Quintile Quintile 52223MOST DEPRIVED Increased deprivation

Most Deprived Areas Neutral Areas Least Deprived Areas Rate per 100,000 population Deprivation Index Category Rate of ‘X’ per 100,000 Population, by Deprivation Index

Key Findings Ten promising practices to reduce health inequities include Purposeful Reporting, of which this is one clear example because it: Uncovers neighbourhood inequities rather than masking them within an average value for the entire City of Greater Sudbury Can be shared with community partners to raise awareness and prompt action Concretely confirms what we know intuitively about our city We have tools such as equity-focused Health Impact Assessments that are supported by this information Identified most deprived areas in City of Greater Sudbury using Deprivation Index Areas of highest deprivation have poorer health outcomes Profiles allow us to shape policies, programs, and services to benefit those most in need If everyone in the City of Greater Sudbury had the same opportunities for health as those living in its least deprived areas, each year in the City there would be: 14,077 fewer emergency department visits for all causes 131 fewer residents who die before age 75 11,231 fewer people who are obese

ANALYSIS RESULTS

INSPQ DEPRIVATION INDEX GREATER THAN THE SUM OF ITS PARTS ANALYSIS RESULTS

% French Mother Tongue Percent (%) of the Population Least DeprivedMost Deprived Deprivation Index - 3 Categories Source: INSPQ 2011; Statistics Canada 2006 Census of Population

% Aboriginal Identity Percent (%) of the Population Least DeprivedMost Deprived Deprivation Index - 3 Categories Source: INSPQ 2011; Statistics Canada 2006 Census of Population

WORSE OUTCOMES IN MOST DEPRIVED AREAS WHERE DIFFERENCES ARE STATISTICALLY SIGNIFICANT ANALYSIS RESULTS

Self-Rated Health (Excellent/Very Good) Source: Ontario Share File, Canadian Community Health Survey , Statistics Canada Age Standardized using the 1991 Canadian Population

Premature Mortality (Dying Before Age 75) Source: Vital Statistics Data (2003–2007), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Infant Mortality Source: Vital Statistics Data (1998–2007), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Maternal Age (% of Live Births to Teenage Mothers) Source: Vital Statistics Data (1998–2007), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Hospitalizations (All Causes) Source: Inpatient Discharge Data (2005–2009), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; and 2006 Census, Statistics Canada Age Standardized using the 1991 Canadian Population

Emergency Department (ED) Visits (All Causes) Source: Ambulatory Care Data (2005–2009), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Mental Health Episodes Hospitalizations Source: Inpatient Discharge Data (2005–2009), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Thank you Miigwech Merci

This presentation was prepared by staff at the Sudbury & District Health Unit. This resource may be reproduced, for educational purposes, on the condition that full credit is given to the Sudbury & District Health Unit. This resource may not be reproduced or used for revenue generation purposes. © Sudbury & District Health Unit, 2013