Reducing Health inequalities in Canada

CJPH_96_Suppl_2.pdf (application/pdf Object)
Morton Beiser, MD, FRCP, CM
Miriam Stewart, PhD
Despite Canada’s generally high standard of living and despite a system that promises universal access to high quality care, disparities in health remain a pressing national concern. These disparities are not randomly distributed. Specific subpopulations suffer a burden of illness and distress greater than other residents of Canada. For this reason, they can be characterized as “vulnerable populations”. Aboriginal peoples, immigrants, refugees, the disabled, the poor, the homeless, people with stigmatizing conditions, the elderly, children and youth in disadvantaged circumstances, people with poor literacy skills, and women in precarious circumstances are vulnerable populations – more likely than others to become ill and less likely to receive appropriate care.
Despite our commitment to equity and access – in health and opportunity – 18% of Canadians live in deep poverty, and income inequality is increasing. The wealthy live longer than the poor, and experience fewer chronic illnesses, less obesity, and lower levels of mental distress. According to the 2001 census, at least 14,000 people in Canada are homeless. Homeless people are at risk for premature death, infectious diseases, mental illness and substance abuse. The middle-aged homeless – people in their 40s and 50s – often have health disabilities more commonly seen in individuals who are decades older.
Canada’s Aboriginal population is just under 1 million, and its rate of growth is double that of the population as a whole. Although there has been progress – neonatal death rates in Aboriginal communities have dropped in recent years to a point where they now approximate the national average – equity in health for this population is still a distant goal. An Aboriginal baby, for example is almost three times more likely than a non-Aboriginal baby to die during the first year of life, and the rate of chronic illness among adult Aboriginal people is three times higher than the national average.
Canada’s newest settlers, like indigenous peoples, are subject to inequities in health and health care. The 250,000 immigrants admitted each year are, on the whole, healthier than native-born Canadians. However, during their first decade in Canada, immigrants are far more likely than the native-born to develop tuberculosis. Over their total life span, some immigrant groups experience a particularly high risk for cardiovascular disorders, obesity, and cancer of the colon. Moreover, crisis and conflict create mental suffering for refugees, who constitute about 10% of the immigrant population.
People with physical and mental disabilities constitute another subpopulation vulnerable to assaults on health. They suffer a double disadvantage, having to cope not only with the disability itself, but with the added burdens of compromised health and inaccessible, inadequate health-related services. Stigma and public censure create additional distress and erect barriers to care for persons suffering from chronic mental disorders, such as schizophrenia, and from various forms of addiction.
Almost half of all Canadian adults lack the literacy skills necessary to participate fully in our knowledge-based economy. They face high levels of unemployment and are often forced to live in unstable environments. Families face direct health risks as a result of lack of literacy, having difficulty, for example, in reading instructions for baby formulae, medications, or educational materials about health and safety.