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?
Pages to are hidden for
"Mar 2"Please download to view full document