Abstract
ContextSubstantive equity-focused policy changes in Ontario, Canada have yet to be realized and may be limited by a lack of widespread public support. An understanding of how the public attributes inequalities can be informative for developing widespread support. Therefore, the objectives of this study were to examine how Ontarians attribute income-related health inequalities.MethodsWe conducted a telephone survey of 2,006 Ontarians using random digit dialing. The survey included thirteen questions relevant to the theme of attributions of income-related health inequalities, with each statement linked to a known social determinant of health. The statements were further categorized depending on whether the statement was framed around blaming the poor for health inequalities, the plight of the poor as a cause of health inequalities, or the privilege of the rich as a cause of health inequalities.ResultsThere was high agreement for statements that attributed inequalities to differences between the rich and the poor in terms of employment, social status, income and food security, and conversely, the least agreement for statements that attributed inequalities to differences in terms of early childhood development, social exclusion, the social gradient and personal health practices and coping skills. Mean agreement was lower for the two statements that suggested blame for income-related health inequalities lies with the poor (43.1%) than for the three statements that attributed inequalities to the plight of the poor (58.3%) or the eight statements that attributed inequalities to the privilege of the rich (58.7%).DiscussionA majority of this sample of Ontarians were willing to attribute inequalities to the social determinants of health, and were willing to accept messages that framed inequalities around the privilege of the rich or the plight of the poor. These findings will inform education campaigns, campaigns aimed at increasing public support for equity-focused public policy, and knowledge translation strategies.
Highlights
Income-related health inequalities in Canada are well recognized by the health, policy, and research communities, as is the role of the social determinants of health (SDOH), such as education, housing, and job security, in producing and maintaining these inequalities [1,2,3,4,5,6,7,8,9]
The World Health Organization (WHO) Commission on the Social Determinants of Health endorsed the incorporation of the SDOH into governmental policies and programs [13]
In Canada, there has been a move towards addressing health inequalities at the local, provincial, and national levels, including the promotion of the SDOH by select local public health units in the province of Ontario (e.g. Sudbury and District Health Unit and Peterborough County-City Health Unit), the use of health equity impact assessment tools to improve decision-making in Ontario [14] and cross-sectoral policies in the province of Quebec [15], and the establishment of equity-focused research priorities within federal research funding bodies such as the Canadian Institutes of Health Research [16]
Summary
Income-related health inequalities in Canada are well recognized by the health, policy, and research communities, as is the role of the social determinants of health (SDOH), such as education, housing, and job security, in producing and maintaining these inequalities [1,2,3,4,5,6,7,8,9]. In Canada, there has been a move towards addressing health inequalities at the local, provincial, and national levels, including the promotion of the SDOH by select local public health units in the province of Ontario (e.g. Sudbury and District Health Unit and Peterborough County-City Health Unit), the use of health equity impact assessment tools to improve decision-making in Ontario [14] and cross-sectoral policies in the province of Quebec [15], and the establishment of equity-focused research priorities within federal research funding bodies such as the Canadian Institutes of Health Research [16] Despite these initial steps, substantive policy change has yet to be realized in most Canadian jurisdictions, including Ontario, the country’s most populous and diverse province. The WHO Commission endorsed raising public awareness regarding the SDOH as a key step to ‘‘closing the gap’’ in health ‘‘within a generation’’, suggesting that public awareness may serve as a significant motivating factor for policymakers if it existed [13]
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