What is health equity? Module A

Sudbury District Health Video – Nadia’s story placeholder

What do these terms mean? Group Discussion – Please come up with definitions for each of the following terms: o Health o Health Disparity o Health Equity o Health Inequality o Health Inequity o Health Literacy o Determinants of Health 3

4 Health equity is most often defined by the absence of health inequities or disparities. Health inequities or disparities are differences in the health outcomes of specific populations that are “systemic, patterned, unfair, unjust, and actionable, as opposed to random or caused by those who become ill.”* - Margaret Whitehead *Margaret M. Whitehead, “The Concepts and Principles of Equity and Health,” 22(3) International Journal of Health Services (1992):

Canada recognizes a number of key determinants of health 5

Why does Health Equity Matter? What does it mean to you? 6

7 Why Health Equity Matters A difference of 16 km in Scotland can result in a 28 year drop in life expectancy A boy from the poor Glasgow suburb of Calton could expect to live to 54, while a boy born in nearby affluent Lenzie is likely to reach Social Factors Key to Ill Health BBC Video 2

8 Why Health Equity Matters: This map illustrates a 20 year difference in life expectancy resulting from socio- economic circumstances and poor access to healthcare Within Hamilton, the average age at death is 67 years of age in a lower income neighbourhood and as high as 86 in a higher income neighbourhood.

9 Why Health Equity Matters - Incidence of Chronic Disease increases as income decreases, regardless of disease and age The Power Study Social Determinants of Health and Populations at Risk

10 Why Health Equity Matters – Prevalence of Depression and Suicide attempts higher for lower income populations

11 Why Health Equity Matters: Average Household Income, Toronto Source: Glaizer, RH et. al. (eds.), Neighbourhood Environments and Resources for Healthy Living –A Focus on Diabetes in Toronto: ICES Atlas.Toronto: Institute for Clinical Evaluative Sciences; 2007.

12 Why Health Equity Matters: Concentration of Visible Minority Populations, Toronto Source: Glaizer, RH et. al. (eds.), Neighbourhood Environments and Resources for Healthy Living –A Focus on Diabetes in Toronto: ICES Atlas.Toronto: Institute for Clinical Evaluative Sciences; 2007.

13 Why Health Equity Matters: Age-Sex-Adjusted Diabetes Rates, Toronto Source: Glaizer, RH et. al. (eds.), Neighbourhood Environments and Resources for Healthy Living –A Focus on Diabetes in Toronto: ICES Atlas.Toronto: Institute for Clinical Evaluative Sciences; 2007.

14 Video Clip Vasanthi Srinivasan, Assistant Deputy Minister, Ministry of Health and Long- Term Care on health equity: 1:03:51-1:06:54 Applying equity principles in a very consistent, very diligent, dogged manner will get us to an improved quality in our health system for all (Reference to legal and ethical responsibilities) to integrate equity considerations into the health system. “It’s not just a nice thing to do. It’s a must do”. Shamira Madhany, Chief Officer for Diversity and Accessibility in the Ontario Public Service (OPS) 1:10:50-1:12:54 “I realized what I needed to do was to change my thinking, and change the lens I was using”.

Cost Implications of Inequity in Ontario The impact of health inequities is large. If all Ontarians had the same health as Ontarians with higher income… we estimated that 30 percent of hospitalizations for four common ambulatory care sensitive conditions (ACSCs) (heart failure, chronic obstructive pulmonary disease, diabetes, and asthma)— could potentially be avoided if the hospitalization rates observed among adults living in the highest-income neighbourhoods could be achieved across all neighbourhood income levels. These findings illustrate the enormous opportunities to improve overall population health while reducing health inequities in Ontario. Source: Bierman AS, Shack AR, Johns A, for the POWER Study. Achieving Health Equity in Ontario: Opportunities for Intervention and Improvement. In: Bierman AS, editor. Project for an Ontario Women’s Health Evidence-Based Report: Volume 2: Toronto;

Why do something? The Ontario Ministry of Health and Long-Term Care (MOHLTC) has identified equity as a key component of quality care. There are legal and ethical reasons for addressing health equity. We must address consider health equity and how we can reduce health disparities in our planning. 16