Elsevier

Health Policy

Volume 79, Issues 2–3, December 2006, Pages 132-143
Health Policy

Review
Health disparities in Canada today: Some evidence and a theoretical framework

https://doi.org/10.1016/j.healthpol.2005.12.010Get rights and content

Abstract

This paper documents contemporary evidence on patterns of health disparities in Canada and suggests theoretical mechanisms that give rise to these patterns. The overall health of Canadians, as measured by life expectancy or mortality, has improved dramatically over the past 30 years and some disparities have diminished slightly (e.g., life expectancy by income group for men), while others have increased (e.g., diabetes for Aboriginal peoples). Arguably the most egregious health disparities in Canada are those existing between Aboriginals and the rest of the Canadian population. This paper focuses specifically on three social determinants and their effects on disparities in health; Aboriginal status, income, and place. Overall we take the approach that disparities in health could be alleviated by reducing inequities in the distribution of these determinants. We further argue that these social determinants are proxies for opportunities, resources and constraints; all of which influence health outcomes. We suggest that policies focus on reducing the social inequities that lead to health disparities in Canada, rather than focusing on the disparities in health alone. Since the social determinants described here have been found to influence an array of disease outcomes, tackling them, rather than their outcomes, may have a greater overall influence on the health of the population.

Introduction

Health disparities are a major public health and social justice concern as even in the most affluent of countries, less well off members of populations suffer from a disproportionate amount of morbidity, and live shorter lives, than those who are better off [1]. Canada has been a policy development leader in this area with a history of discussions regarding the non-medical determinants of health and social disparities in health. This legacy includes the Lalonde Report in the 1970s [2], the Ottawa Charter for Health Promotion [3], as well as Achieving Health for All: A Framework for Health Promotion, in 1986 [4], and the Federal, Provincial and Territorial Advisory Committee on Population Health Report published in 1994 [5]. Despite this legacy, there has been little actual policy uptake of these ideas and no development of concrete strategies to reduce health disparities in Canada [6]. Lavis has argued that the lack of policy uptake is due to research having delivered little in the way of policy-relevant findings informative for policy choices in non-medical arenas.

As a step towards delivering some policy-relevant findings on health disparities in Canada, this paper summarizes and analyses research findings in relation to health disparities in Canada today. While one could argue that each country's health disparity portrait is unique due to distinct history, demography, economy, and political system, we suggest that there are several important lessons to be learned from the state of Canadian health disparities that have implications well beyond Canadian borders.

These lessons are detailed by broaching a few issues in relation to health disparities. We draw attention and discuss not only some of the main Canadian disparities in health outcomes, but also the differential distribution of both social and economic resources that underlie them. As such, this paper explores in detail some of the most critical Canadian determinants1 of health disparities. We do so with the aim of highlighting that health disparities in Canada are largely the result of the inequitable distribution of opportunities and resources within Canadian society; inequities2 in opportunities and resources captured by the critical examination of several determinants of health.

We focus specifically on the following determinants of health disparities: Aboriginal status, income and place. These three determinants play a particularly important role in the shaping of health disparities in Canada and are exemplary of our main theoretical argument.

Section snippets

The main health disparities in Canada today

One of the major findings within the health disparities literature over the past 15 years is that disparities in health exist over a vast array of health and disease outcomes, including risk factors and behaviours [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. Whether the health outcome is a measure of health status such as life expectancy, a subjective appraisal of health (such as self rated health), a disease outcome such as diabetes, or a health behaviour such as

The theoretical framework

In an effort to explain the underlying origins of health disparities, we propose the following theoretical framework. In August of 1980 the United Kingdom Department of Health and Social Security published the Report of the Working Group on Inequalities in Health, also known as the Black Report [25]. Based on this report, a large part of the debate on the explanation of socio-economic disparities in health has concentrated on the contribution of “cultural/behavioural” versus

Aboriginal status

In the years following the release of the report of the Royal Commission on Aboriginal Peoples [34] – a national Inquiry that identified the structures needed to transform political, economic and social relations between aboriginal and the rest of Canadian society – the health of Canada's Indigenous peoples has become a priority among Canadian health researchers. The results of this research have described widespread disparities in morbidity and mortality between aboriginal and non-aboriginal

Conclusion

While the determinants chosen for analysis here differ in terms of their overall impact on the health of Canadians, they each play a role in shaping health disparities in Canada today. Importantly, however, they share some commonalities (especially those related to the distribution of power and resources related to health), and these commonalities lie in the theoretical mechanisms that lead from each of them to health disparities. We focused specifically on inequities related to Aboriginal

Acknowledgements

The authors would like to acknowledge the diligent work of Sarine Lory Hovsepian who did much of the groundwork for the bibliography of this piece as well as the helpful comments made by Louise Potvin.

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