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					Health Inequalities: Composition or
            Context?
Health Inequalities: where the chances of good
or bad health are not evenly distributed among
groups of people (defined either by the
geographical area in which they live/work or by
some other common characteristic, such as
poverty)
                  Overview
1. Composition/Context Debate
2. Saskatoon Case Studies:
     1. Community-University Institute for Social
        Research (CUISR): QOL Module
     2. Respiratory Illness in Saskatoon Infants: The
        Impact of Housing and Neighborhood
        Characteristics (J. Wright, SHR)
     3. Comprehensive Community Information System
        (L. Murphy, SHR)
 Composition (Individual Level)
• Locates the understanding of inequality at the
  individual level
   –   Age
   –   Sex
   –   Smoking
   –   Diet
   –   SES (social class, wealth, income)
• population’s hlth. seen as an aggregate of the
  health of its individual members
             Context (Ecologic)
• Locates the understanding of health
  inequalities at the level of the physical,
  economic or social environment – the
  setting in which people live their lives
   –   tangible fabric
   –   state fabric
   –   social fabric
   –   equality
Population Health Promotion Model




         Source: Hamilton & Bhatti, 1996
… now it's getting to the point where there is no
more small grocery stores … Again one element of
stability went out of the neighborhood. That is very,
very important. (Low SES Resident)
Respiratory Illness in Saskatoon
Infants: Geographic Variation in
  Rates of Respiratory Illness
                    Judith Wright, M.Sc.,
                   Dr. Nazeem Muhajarine

              Department of Community Health
          & Epidemiology, University of Saskatchewan

                            2003
       Secondary Data Used
• Adverse Birth Outcome Study 1992-1999
• Saskatchewan Health: Vital Statistics,
  Physician and Hospital Services
• 1998 City of Saskatoon Neighbourhood
  Profiles
• Statistics Canada census data for 1996
• City of Saskatoon data
Contextual Variables
(Ecologic level)
        Do children in some
   neighbourhoods have greater
respiratory morbidity than children
     in other neighbourhoods?



Compositional
(Individual level)
Variables
More babies in west
side neighbourhoods
were hospitalized, and
they were hospitalized
more often than babie
living elsewhere in the
cityHigs found on
the west side of
the city
      Housing & Neighbourhood
       Independent Variables
•   Median income           • Rental tenure
•   Person per household    • Duplexes
                            • Apartments
•   Low education (<gr 9)
                            • Dwellings needing major
•   Population < 10 years     repairs
•   Employment              • Dwellings constructed
•   SGA infants                    < 1971
•   Male infants                   1971-1985
                                   >1985
Strong concordance
between low median
income and high
rates of
hospitalization
              Conclusions
• Children in west side neighbourhoods had
  more respiratory morbidity
• Median income, low education and
  employment were important predictors, as
  were housing characteristics
• SES variables are more important predictors
  to some respiratory illnesses than others
          Policy Implications

• Distribution of rates suggests targeted
  interventions
• Interventions must address underlying SES
  factors
• Decide to invest in community development
  or health service utilization?

				
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posted:3/30/2013
language:English
pages:18