Reducing Health Disparities - Roles of the Health Sector: Discussion Paper

[Back] [Table of Contents]

Introduction: Why Disparities Matter

Canadians are among the healthiest people in the world, but some groups of Canadians are not as healthy as others. Major health disparities exist throughout the country. These health disparities are not randomly distributed; they are differentially distributed among specific populations (e.g. Aboriginal peoples) by gender, educational attainment and income, and other markers of disadvantage or inequality of opportunity.

Large health disparities are not inevitable: some gaps in Canada are wider than elsewhere, and some are narrower. As in other countries around the world, there is an increasing emphasis in Canada on the need to adopt policies and take action to reduce disparities. The main purpose of this paper is to explore the role of the health sector in addressing health disparities in Canada.

The reasons are many for increased health sector action on reducing health disparities. First, the health sector has a clear mandate in this area:

• The 2002 and 2003 First Ministers' Health Accords have made national commitments to reducing health disparities. As part of the 2004 First Ministers' Meeting a special meeting with Aboriginal leaders resulted in specific measures to address disparities in the health status of Aboriginal peoples.
• Ministers of Health have approved the strategic framework of the Healthy Living Strategy, establishing the reduction of health disparities as one of its two goals * .

Second, health disparities are a major burden for individuals and groups. For individuals, poor health creates an uphill battle to participate fully in the social, cultural and economic life of their communities. When ill-health clusters in identifiable groups, the adverse effects can be compounded to include exclusion, stigma and hopelessness.

Third, health disparities are health system cost drivers. Because they are more often and more severely sick or injured, people in the lowest quintile of income groups use approximately twice as much in the way of health care services as those in the highest quintile. On the basis of an estimation of health care resources used by Canadian households, approximately 20% of total health care spending may be attributable to income disparities.1 Despite this higher overall use of health services, health disparities persist among lower SES groups.

Finally, health disparities are inconsistent with Canadian values, challenge overall quality of life, including the cohesiveness of community and society, and place a burden on the economy.

Evidence and experience have shown that health sector action on reducing health disparities has many potential benefits - for the health system, health outcomes and the overall quality of life of Canadians.

• The overall health of the community can be improved by reducing disparities.
• Because there is a gradient of health status across the entire range of socio-economic status, addressing health disparities will improve the health of all of society.
• Reducing the health care needs of low SES populations and other disadvantaged groups can decrease cost drivers and result in reduced pressures on the delivery of health services.
• Better health enables more people to participate in the economy, reducing the costs of lost productivity.

Now is the time for health sector leadership and action to realize these benefits. At this juncture, there are several opportunities for addressing health disparities.

• Thirty years of policy development culminating in the 2003 Health Accord have positioned Canada's health sector to play a strong role in developing and implementing strategies for reducing health disparities, and promoting this agenda within all governments.
• Some promising initiatives, ranging from research, to targeted community programming, to issue-based intersectoral collaboration, are already in place.
• The framework for the development of the Integrated Pan-Canadian Healthy Living Strategy provides one key opportunity to advance the health disparities reduction agenda. Research and non-government partners are engaging in this issue in a variety of ways, including highlighting the extent of disparities, analyzing and developing policy options, and delivering innovative, on-the-ground programs.
• The current environment of change in the health sector has also created opportunities for new structures and mechanisms to promote the reduction of health disparities. The transition to new organizations, including the Health Council, the Public Health Agency of Canada, the Pan-Canadian Public Health Network and the National Collaborating Centre for Determinants of Health, provides opportunities to incorporate a health disparities focus into these new entities as an essential element of their work.

Health disparities are avoidable and can be successfully addressed. This paper will explore the role of the health sector in addressing health disparities in Canada by:

• Presenting some facts of health disparities - how and why they occur and persist, the nature, extent and costs of health disparities in Canada and, where possible, comparisons between Canada and other countries;
• Reviewing how Canadian and international thinking on health disparities has evolved and current Canadian and international strategies for reducing health disparities;
• Suggesting policy directions and actions for the health sector to take to reduce health disparities, both within its sphere of direct control and through partnerships and promotion, and knowledge development and exchange.

A note about terms used in this paper

Health disparities is a term central to the discussion in this paper. Health disparities refer to differences in health status that occur among population groups defined by specific characteristics. For policy purposes, the most useful categorizations are those consistently associated with the largest variations in health status. The most prominent factors in Canada are socio-economic status (SES), Aboriginal identity, gender and geographic location.

Other terms used internationally to refer to differences in health status include health inequalities and health inequities. Definitions and distinctions between these terms can be found in the “Key Terms and Definitions” section at the end of the paper.

Another key term used in this paper is health sector. It refers to the policies, laws, resources, programs and services that fall under the jurisdiction of Health Ministries. The sector spans health promotion and preventive health, public health, primary health care, including primary care, community health services such as home care, drugs and devices, mental health, long-term residential care, hospitals, and the services generally provided by health care professionals (doctors, nurses, therapists, pharmacists, etc.).

[Back] [Table of Contents]

---

* It should be noted that although Quebec shares the general analysis of this document, it was not involved in developing it because it intends to remain solely responsible for developing and implementing programs for reducing health disparities within its territory. However, Quebec does intend to continue exchanging information and expertise with other governments in Canada.