Feature Article

Are Socially Unequal Communities Less Healthy?

Report on the Canadian Population Health Initiative Research Program

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We have long known that the rich live longer than the poor. The correlation between a person's socio-economic situation and that individual's health status has been clearly demonstrated to date. But some researchers have suggested that people's health is also affected by the socio-economic status of the broader society in which they live. Specifically, there is evidence that those societies with a wide income spread between the rich and the poor seem to be less healthy than societies with a narrow income range.

In fact, comparisons of advanced industrial nations show that people living in the wealthiest countries (such as the United States and Germany) actually have a lower life expectancy than those in poorer, more egalitarian countries (such as Ireland and Greece). Similarly, death rates for adults in New York City's Harlem are higher than in Bangladesh, even though the incomes of the poor in Harlem are much higher than that of the average Bangladeshi.

The Canadian Population Health Initiative (CPHI) supports a number of research projects that explore the relationship between social inequality and health. One promising area of research compares income range and health outcomes in American and Canadian cities.

Findings to Date

So far, CPHI researchers have drawn several early conclusions.

• Canada "bucks the trends."
  Canadian cities and provinces have much greater income equality than most U.S. cities and states, as well as much lower mortality rates. In Canada there is almost no association between income inequality and mortality.

• The distribution of public resources appears to matter.
  One of the major differences between Canada and the United States is the way health care and education are distributed. In Canada, services are publicly funded and universally available. The result is that individual income appears to be a much stronger determinant of health in the United States than in Canada.

• Canada's tax system supports population health.
  Canada's progressive income tax system appears to be very effective in redistributing income in a way that reduces the negative health impacts of inequality.

• Exploring Canada - U.S. differences holds great promise.
  The differences in urban structure and governance between Canada and the United States may be significant in explaining the inequality - health relationship.

With these results in hand, it is now time to get the word out about the determinants of health. Dissemination of research findings such as these to policy makers, researchers and members of the public is one of the functions of the CPHI. Two of the CPHI researchers - Dr. Michael Wolfson from Statistics Canada and Dr. James Dunn from the University of British Columbia - have presented their work to academics and policy makers across North America. Soon, they hope to link to a network of Canadian policy makers at all levels of government in sectors such as health, social services, human resources development, housing and urban development.

The Canadian Population Health Initiative

The Canadian Population Health Initiative (CPHI) studies determinants of health across Canada. First proposed by the National Forum on Health in 1997, it aims to generate new knowledge, develop information infrastructure, improve decision-making and report on key public policy issues.

CPHI is part of the Canadian Institute for Health Information (CIHI). In September 1998, CPHI received $20 million over four years from the 1999 federal budget to improve health information. CPHI is one of the key components of the health information strategy, the "Roadmap Initiative." The CPHI Council is made up of accomplished Canadians who represent diverse interests.

The Canadian Population Health Initiative will be linked to other CIHI information projects, to the Canadian Institutes of Health Research and to the Federal-Provincial-Territorial Advisory Committee on Population Health.

For more information, contact Carmen Connolly, Director of CPHI.

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