Reducing the gap between rich and poor in Canada: how are we doing?

By Andrea Bodkin

We have long known that health inequities exist between various groups in Canada, and  addressing these inequities has been a priority for Health Nexus for the last thirty years. A recent report from Canadian Institute for Health Information (CIHI) shows that Canada has made little progress in closing the gap between the health of richer and poorer Canadians. Despite the $200 billion dollars that Canada spends annually on publicly funded health care (40% of most provinces’ budgets), inequalities both in access to care and health outcomes persists.

In general, richer Canadians tend to be healthier and live longer that poorer Canadians. The report Trends in Income-Related Health Inequalities in Canada shows that not only does the gap exist, it has generally persisted or widened over time.

CIHI looked at a number of important factors over time, including income and factors influencing health, such as access to housing and food, and rates of smoking and obesity. CIHI also examined rates of injury, chronic disease and other areas. In three indicators, the gap between rich and poor has widened over time: smoking; chronic obstructive pulmonary disease (COPD) hospitalization for Canadians younger than 75; and self-rated mental health.

These inequalities are associated with significant costs, both to individuals and to society, through direct health care costs and indirect costs such as lost productivity.

So, how can we begin to close the gap in health? It is already evident that universal access to health care does not, alone, reduce health inequalities. CIHI found that a combination of universal and targeted programs is necessary to address inequalities in health. CIHI states that sustained commitment, strategic investment and attention to evidence over the long term are needed to reduce gaps in health equity.

Communities and organizations can also play a role by considering how their programs, services and initiatives affect health equity. Health Nexus has been asked by the Ministry of Health and Long Term Care to champion their Health Equity Impact Assessment tool. HEIA provides a framework for organizations to identify the unintended impacts of their programs, services and initiatives, and develop mitigation strategies to maximize the positive and minimize the negative effects. While HEIA is one part of addressing health inequities, it can play an important role of starting the conversation about equity.

To learn more about HEIA and how Health Nexus can support organizations in their efforts to use it, please visit our website.