Health Inequalities In Canada Research Articles

Using diversity, equity and inclusion school practices to mitigate child health inequities in Canada

Abstract Background The burden of unhealthy lifestyle behaviours and mental disorders disproportionately affects children in deprived neighbourhoods. In Canada, school practices addressing diversity, equity and inclusion (DEI) are promoted to address such inequities. We aimed to assess whether DEI school practices can help mitigate the impact of neighbourhood deprivation on children’s lifestyle behaviours and mental health. Methods In 2023 we gathered survey data from 1497 grade 4-6 children (aged 9-12) in 22 elementary schools located in deprived neighbourhoods in Alberta, Canada. Children reported their diet, screen time, physical activity, and mental health. Principals reported on the implementation of DEI practices in schools (full vs. partial). School postal codes were used to derive tertiles of the Canadian Index of Multiple Deprivation, comprised of four dimensions that capture: 1) residential instability; 2) economic dependency; 3) ethno-cultural composition and 4) situational vulnerability of neighbourhoods. Results Overall, 45% of schools had fully implemented DEI practices. These schools were located in more deprived neighbourhoods for residential instability (55%), economic dependency (71%), ethno-cultural composition (60%), and situational vulnerability (64%). Children in more deprived neighbourhoods reported more sugar consumption, more screen time, and poorer mental health, compared to children in less deprived neighbourhoods. However, in those neighbourhoods where DEI practices were fully implemented, the adverse effects of neighbourhood deprivation were alleviated, whereby children reported less sugar consumption, less screen time, and better mental health. Conclusions The implementation of DEI school practices can help mitigate the adverse effects of neighbourhood deprivation on children’s physical and mental health, particularly in deprived neighbourhoods. Key messages • School practices targeting diversity, equity, and inclusion are more commonly implemented in schools located in deprived neighbourhoods. • Diversity, equity, and inclusion school practices mitigate the adverse effects of neighbourhood deprivation on children’s lifestyle behaviours and mental health.

Social determinants of long-term reported changes in physical activity and healthy eating during the COVID-19 pandemic in Canada: multiple cross-sectional surveys analysis from the iCARE study.

The long-term consequences of COVID-19 on healthy behaviours (physical activity practice and healthy eating) among Canadians remain largely unexplored. The objectives were (i) to describe the proportion of Canadians who reported a change in healthy behaviours, 9 and 20 months since the beginning of COVID-19; and (ii) to identify the social determinants associated with healthy behaviour changes. Using two representative Canadian surveys from the International COVID-19 Awareness and Responses Evaluation study (January 2021, n=3000; November 2021, n=3002), reported changes in healthy behaviours were assessed as follows: "In general, how have the following behaviours changed since the start of COVID-19?": (1) Increase; (2) No change; and (3) Decrease. The association between individual determinants and changes in healthy behaviours was analyzed using weighted univariate polytomous logistic regression models. In January 2021, 41% and 22% of respondents reported a decline in physical activity and healthy eating, respectively, while in November 2021, 34% and 20% of respondents reported a decline in physical activity and healthy eating, respectively. The main determinants associated with changes in healthy behaviours were younger age (18-25 years), area of residency, student status, changes in bodyweight, financial concerns/insecurity, anxiety/depression, and ethnicity. Changes in healthy behaviours were also associated with household composition, presence of chronic diseases, and occupation. In sum, this study depicted long-term changes in healthy behaviours during COVID-19, with differential changes according to social determinants of health. This study highlighted the presence of health inequalities in Canada during COVID-19 and supports the implementation of personalized programs in prevention of healthy behaviour degradation.

Review of current 2SLGBTQIA+ inequities in the Canadian health care system.

Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.

Explaining mental illness: Sociological perspectives. By B.Brossard, A.Chandler, Bristol: Bristol University Press. 2022. pp. 198. $139.95 (cloth); $42.95 (pbk); $42.95 (ebk). ISBN: 978‐1529215069

Sociology of Health & IllnessEarly View BOOK REVIEW Explaining mental illness: Sociological perspectives. By B. Brossard, A. Chandler, Bristol: Bristol University Press. 2022. pp. 198. $139.95 (cloth); $42.95 (pbk); $42.95 (ebk). ISBN: 978-1529215069 Sarah Redikopp, Corresponding Author Sarah Redikopp [email protected] Graduate Program in Gender, Feminist and Women’s Studies, York University, Toronto, Ontario, Canada Email: [email protected]Search for more papers by this author Sarah Redikopp, Corresponding Author Sarah Redikopp [email protected] Graduate Program in Gender, Feminist and Women’s Studies, York University, Toronto, Ontario, Canada Email: [email protected]Search for more papers by this author First published: 01 May 2023 https://doi.org/10.1111/1467-9566.13647Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES Bilge, S. (2010). Recent feminist outlooks on intersectionality. Diogenes, 57(1), 58– 72. https://doi.org/10.1177/0392192110374245 O. Hankivsky (Ed.). (2011). Health inequalities in Canada: Intersectional frameworks and practices. UBC Press. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Ethnic food practices, health, and cultural racism: Diabetes risk discourse among racialized immigrants in Canada

Type 2 diabetes is more prevalent among racialized immigrant groups in Canada compared to the general population. Hence, “ethnicity” is identified as a risk factor for diabetes, focusing on ethnic differences in health behaviours. By linking ethnic differences and diabetes risk, ethnic food cultures are problematized. Using the concept of cultural racism, this paper explores the ways in which ethnic food cultures are used to explain racial inequities in health. This paper will conclude by supporting the naming of racism, rather than ethnicity, as one of the root causes of diabetes among racialized immigrant populations and health inequities in Canada.

The Challenge of Exposing and Ending Health Inequalities through Social and Policy Change: Canadian Experiences

The Canadian health system is often perceived as excellent. However, a closer examination of the political economy of health in Canada shows a radically different picture. It is a picture of persistent inequality and a history of the inability to address such inequality. Despite numerous public policy interventions to address preventable health inequalities—that is, health inequities—this societal problem persists. This research addresses how and why health inequities, especially class, race/ethnicity, and gender health inequities, persist in Canada and how to reduce such differences through public policy action. To address these questions, I performed a critical realist review, focusing on the political economy of health and policy change. Then I conducted a thematic analysis of the interview data gathered from 23 semi-structured interviews with leading Canadian policy academics, activists, and advocates. The results demonstrate that the capitalist economic system; the co-constitutives of capitalism, namely colonialism, racism, and sexism; and maldistributive public policies primarily cause health inequities in Canada. Canada's health inequities reduction requires pushing for redistributive public policies; uniting and strengthening labor unions, civil society groups, and social movements; and engaging in electoral politics. Reducing health inequities may involve struggling within and against capitalism and struggling for socialism.

Leadership and System Transformation: Advancing the Role of Community Health Nursing

It is widely recognized that structural and social determinants of health (SDoH) account for a large proportion of health inequities in Canada. According to the Public Health Agency of Canada (PHAC), many health actors are required to provide leadership and direction in tackling health inequities. In this paper we argue that community health nurses (CHNs) are well situated to play a critical role in health system transformation in Canada. CHNs are known for having a holistic and collaborative approach with competencies beneficial for the reduction of health inequities. However, to become more consistently effective advocates of health equity, CHNs require competencies in the principles of equity and social justice, community engagement, communication, coalition building, and system transformation. Having a critical mass of CHNs with appropriate leadership skills in knowledge generation and mobilization, advocacy, and collaboration is fundamental to effectively addressing health inequities in Canada.

Desperately seeking reductions in health inequalities in Canada: Polemics and anger mobilization as the way forward?

Progress in reducing health inequalities through public policy action is difficult in nations identified as liberal welfare states. In Canada, as elsewhere, researchers and advocates provide governing authorities with empirical findings on the sources of health inequalities and document the lived experiences of those encountering these adverse health outcomes with the hope of provoking public policy action. However, critical analysis of the societal structures and processes that make improving the sources of health inequalities difficult-the quality and distribution of living and working conditions, that is the social determinants of health-identifies limitations in these approaches. Within this latter critical tradition, we consider-using household food insecurity in Canada as an illustration-how polemics and anger mobilization, usually absent in health inequalities research and advocacy-could force Canadian governing authorities to reduce health inequalities through public policy action. We explore the potential of using high valence terms such as structural violence, social death and social murder, which make explicit the adverse outcomes of health-threatening public policy to force government action. We conclude by outlining the potential benefits and threats posed by polemics and anger mobilization as means of promoting health equity.

Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA)

ObjectiveTo evaluate the pattern of frailty across several of social stratifiers associated with health inequalities.Design, setting and participantsCross-sectional baseline data on 51 338 community-living women and men aged 45–85 years...

Multilevel Modeling of Health Inequalities at the Intersection of Multiple Social Identities in Canada

ABSTRACT Health inequities in Canada are pervasive. Intersectional theory and novel quantitative methods can be used to understand health inequities. Drawing on a sample of adults from the 2015 and 2016 Canadian Community Health Survey, this study uses multilevel analysis individual heterogeneity and discriminatory accuracy (MAIHDA) to examine the intersectional effect of race, sex, income and immigration status on perceived health and perceived mental health. Small variance partition coefficients of the final models suggest that most of the variance across social strata is explained by the main effects for the four variables. Intersectional interaction effects for each social strata are reported.

Monitoring health inequalities to inform action- the Pan-Canadian Health Inequalities Reporting Initiative

Abstract Improving national health inequalities monitoring and reporting systems is critical for informing effective action to improve health equity. The Pan-Canadian Health Inequalities Reporting Initiative (HIRI) provides a foundation of data and evidence to support collaborative efforts to reduce health inequalities in Canada. HIRI is led by the Public Health Agency of Canada, in collaboration with the Pan-Canadian Public Health Network, Statistics Canada, First Nation Information Governance Centre and other partners. HIRI brings together inequity measures for more than 100 indicators of health outcomes, risk factors, and social determinants of health disaggregated across a range of socioeconomic and sociodemographic variables meaningful to health equity including: sex/gender; age; income; education; employment; occupation; immigrant status; Indigenous identity; race/ethnicity; urban/rural residence; material and social deprivation, functional health/participation and activity limitation and sexual orientation. HIRI aims to strengthen health inequalities measurement, monitoring, and reporting capacity in Canada. It informs policy and program decision making to more effectively reduce health inequalities, and enables the monitoring of progress in this area. This presentation will provide an overview of the HIRI along with the key health inequalities in Canada. It will elaborate on the importance of the engagement with multiple partners in creating a broad range of data and knowledge translation products, and discuss how making it accessible to others: Allows for a comprehensive and systematic assessment of the state of health inequalities in CanadaSupports focused action through increased access to health inequalities knowledgePromotes collaboration and accountability for the reduction of health inequalities in order to achieve SDGs

The Muslimah Project: A Collaborative Inquiry into Discrimination and Muslim Women's Mental Health in a Canadian Context.

Prior research in Europe and North America demonstrates that religious discrimination against Muslim people, commonly known as Islamophobia, results in many negative mental health impacts, including depression, anxiety, isolation, and feelings of exclusion (Awan & Zempi, 2015). In Canada, Muslim women face a unique form of discrimination based on their religious, racial, and gender identities (Helly, 2012; Zine, 2008). Grounded in feminist intersectional theory and practice (Hill Collins & Bilge, 2016), the present manuscript emerges from a community-based project centered on Muslim women's experiences of discrimination and resulting adverse mental health impacts. Through a series of five focus groups (N=55), the research team engaged with Muslim women from diverse backgrounds in order to gain a more complete understanding of mental health inequities in Canada. Thematic analyses of focus group data revealed that Muslim women participants regularly experience Islamophobic discrimination and face multiple barriers when attempting to access culturally relevant and responsive supports. Results illuminate the potential of reciprocal, community-based research to investigate and respond to mental health disparities experienced by Muslim women in Canada.

Trends in mortality inequalities among the adult household population.

The routine measurement of population health status indicators like mortality is important to assess progress in the reduction of inequalities. Previous studies of mortality inequalities have relied on area-based measures of socioeconomic indicators. A new series of census-mortality linked datasets has been created in Canada to quantify mortality inequalities based on individual-level data and examine whether these inequalities have changed over time. This study used the 1991, 1996, 2001, 2006, and 2011 Canadian Census Health and Environment Cohorts (CanCHECs) with five years of mortality follow-up. It estimated age-standardized mortality rates by sex according to income quintile and highest level of educational attainment categories for the household population aged 25 or older. Absolute and relative measures of mortality inequality were also estimated. Men had a greater reduction in mortality rates over time compared with women, regardless of income or education level. Absolute income-related mortality inequality decreased for men but increased for women over time, while relative income-related inequality increased for both sexes. Education-related mortality inequality for women followed the same pattern as income, though the absolute mortality difference for men remained roughly unchanged over the period. Mortality inequalities by income and education persist in Canada, and have increased for women. Further research to determine the mechanisms underlying these trends could help address the complex challenge of reducing health inequalities in Canada.

The RIPPLES of Meaningful Involvement: A Framework for Meaningfully Involving Indigenous Peoples in Health Policy Decision-Making

Indigenous Peoples experience the greatest health inequities in Canada and other colonized countries, yet are routinely excluded from health-related policy decisions. Those advocating for Indigenous health equity are often left wrestling with the question: What constitutes, and what can foster, meaningful involvement of Indigenous Peoples in the contemporary health policy climate? Twenty (n = 20) in-depth, open-ended interviews with Indigenous and non-Indigenous leaders in health and health policy were conducted with a view to understanding what constitutes meaningful involvement of Indigenous Peoples in health policy decision-making. The analysis suggests meaningful involvement requires attuning to underlying power dynamics inherent in policy making and taking action to decolonize and transform the policy system itself. Based on these findings, the authors offer a framework for meaningful involvement.

Asian-White Health Inequalities in Canada: Intersections with Immigration.

Three approaches to addressing factors associated with immigration were applied in a cross-sectional investigation of Asian-White health inequalities in Canada. Ten cycles of the Canadian Community Health Survey (2001-2013) were combined to produce a sample of 8122 Asian women, 365,702 White women, 6830 Asian men and 298,461 White men aged 18 and older. Binary logistic regression modelling was applied to self-reported hypertension, diabetes, fair/poor self-rated health and fair/poor self-rated mental health. Before adjusting for factors associated with immigration, Asian Canadians had relatively low risks of hypertension and diabetes and relatively high risks of fair/poor mental health. After adjustment Asian Canadians had relatively high risks of diabetes, fair/poor health and fair/poor mental health. The inequalities in fair/poor mental health applied primarily to the immigrant population. Risks of fair/poor health and fair/poor mental health were especially high for Asian women born in China and White women born in Italy. Use of stark racial identity categories that ignore country of birth or origin can obscure notable racial-ethnic health inequalities.

Widening health inequalities between the employed and the unemployed: A decomposition of trends in Canada (2000-2014).

Recent developments in the social epidemiological literature indicate that health inequalities between the employed and the unemployed are widening in many advanced capitalist countries. At present, we know relatively little about why these inequalities are worsening. Drawing on nationally-representative data from the largest health survey in Canada, we explored this question by analyzing changes in self-rated health inequalities between employed and unemployed Canadians from 2000 to 2014. Using a regression-based method that decomposes a given inequality into its component sources, we investigated the extent to which risk factors that account for unemployment-related health inequalities at a single point in time can also explain the extent and direction of change in these unemployment-related health inequalities over time. Our results indicate that relative and absolute health inequalities between employed and unemployed Canadians widened over the study period. Between 2000 and 2014, the prevalence of poor self-rated health among unemployed Canadians increased from 10.8% to 14.6%, while rates among employed Canadians were stable at around 6%. Our findings suggest that the demographic, socioeconomic, and proximal risk factors that are routinely used to explain unemployment-related health inequalities may not be as powerful for explaining how and why these inequalities change over time. In the case of unemployment-related health inequalities in Canada, these risk factors explain neither the increasing prevalence of poor self-rated health among the unemployed nor the growing gap between the unemployed and their employed counterparts. We provide several possible explanations for these puzzling findings. We conclude by suggesting that widening health inequalities may be driven by macrosocial trends (e.g. widening income inequality and declining social safety nets) which have changed the meaning and context of unemployment, as well as its associated risk factors, in ways that are not easy to capture using routinely available survey data.

Monitoring and reporting on health inequalities in Canada

Monitoring and reporting on health inequalities in Canada

Monitoring and reporting on health inequalities in Canada

Monitoring and reporting on health inequalities in Canada

Advancing the measurement of health inequalities in Canada with linked health and social data

IntroductionLinking health and socio-demographic data is providing new opportunities for measuring health inequalities in Canada. Measuring inequalities across relevant population sub-groups is a key step for understanding progress towards achieving health equity and informing interventions to reduce inequities.
 Objectives and ApproachThis study uses two linked national datasets (excluding Quebec): 1) Statistics Canada’s linkage of the 2006 long-form Census to hospital data from the Canadian Institute for Health Information’s 2006-2008 Discharge Abstract Database (DAD); 2) hospital data linked to area-level income using Statistics Canada’s Postal Code Conversion File tool. Study objectives are to compare hospitalization rates between the linked census cohort and the general population and to inform the measurement of inequalities by income and education. Analysis was based on three hospitalization indicators: chronic obstructive pulmonary disease (COPD) among
 ResultsThe linked cohort weighted to the population represented 67\% of DAD cases for asthma, 77\% for COPD and 80\% for heart attack. The lower coverage for asthma was because babies born after Census day were not linked. For all three indicators, rates were lower in the linked cohort than the DAD, likely because the linked cohort and DAD capture somewhat different populations (e.g., institutionalized population is in DAD but not Census).
 Large income and education-related inequalities were observed for all three indicators. Further analyses revealed inequalities of similar magnitude using before and after-tax income data, and larger inequalities by individual-level income compared to area-level (for COPD only). Inequalities were similar using individual and household education, with a clear gradient using multiple education categories.
 Conclusion/ImplicationsUpdating and expanding existing linkages to include recent data has the potential to expand and integrate health inequalities measurement into routine health system performance reporting. Challenges include measuring inequalities for smaller populations (e.g., health regions) and gaps in Census coverage (e.g., newborns/newcomers, urban indigenous populations, people experiencing homelessness, institutionalized population).

Canadian trends in the social determinants of health inequalities, a census-mortality linkage approach

IntroductionMortality inequalities by income and education levels have historically been estimated using an area-based approach in Canada. Although useful in measuring socioeconomic inequalities overtime, this method underestimates the level of inequality and only allows the examination of a single dimension at a time.
 Objectives and ApproachTo create a series of census linked datasets that allowed for the examination of health inequalities across different socioeconomic dimensions. Specifically, five census cycles (beginning with the 1991 Census) were probabilistically and deterministically linked to different health outcomes (mortality, cancer, hospitalization) to create the Canadian Census Health and Environment Cohort (CanCHEC). Each dataset was created using a similar methodological approach which allowed for the measurement of these health inequalities over time. Mortality inequalities by both income and education level (including multidimensional) for all causes and cause-specific groups were examined.
 ResultsFive census linked datasets were constructed that followed mortality for a period of up to 20 years. The 1991 CanCHEC includes 2.6 million adults, the 1996 and 2001 CanCHECs include 3.5 million adults respectively, and the 2006 and 2011 CanCHECs include 5.9 and 6.5 million people respectively. Findings revealed a stair-stepped gradient in all-cause and cause-specific mortality by educational attainment and income quintile across each time period. The lowest mortality rates were among the university educated and richest income quintile and highest mortality rates among those with less than high school graduation and the poorest income quintile. The gradient differed by cause of death groupings. Over the 25-year time period, the mortality gradient trend varied by socioeconomic dimension and cause of death.
 Conclusion/ImplicationsThese data show clear mortality inequalities by socioeconomic position across the different time periods. These linked datasets can help advance knowledge in understanding health inequalities in Canada as well as provide a tool for on-going surveillance of health inequalities by different socioeconomic dimensions.