Health inequality widens between richer and poorer Canadians

The gap between the health of richer and poorer Canadians has widened over time for measures such as smoking and how Canadians rate their own mental health, according to a new report.

Wednesday’s report from the Canadian Institute for Health Information (CIHI) focused on inequality, or the gap between high- and low-income Canadians, related to 16 health indicators, such as smoking, hospitalizations for motor vehicle traffic injuries, heart attacks and self-rated mental health.

“The health inequalities between richer and poorer Canadians are large and they’ve persisted over time in the past decade and in some cases they’ve even widened,” said Jean Harvey, director of the Canadian Population Health Initiative, a branch of CIHI, in Ottawa. “It’s a stubborn problem.”

In the report, Canadians were divided into five groups based on average annual income from 1993 to 2011. For instance, the income was $16,000 in 2011 for those in the lowest income group, compared with $87,100 for those in the highest income group the same year.

The rich are getting richer, as those in the highest income group saw their average annual income increase 44 per cent from 1998, compared with a 27 per cent increase for those in the lowest income group.

Harvey and her colleagues listed three examples of where the rich getting richer resulted in widening health gaps:

Smoking: Adults in the highest income level smoked less over time, but there was no change among Canadian adults in the lowest income level.

Chronic obstructive pulmonary disease (COPD) hospitalization for Canadians younger than age 75 — Rates decreased for the highest income level but increased for lower-income Canadians.

Self-rated mental health — The percentage of adults who rated their mental health as “fair” or “poor” increased over time in all income levels, except the highest.

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

For example, the report’s authors estimated that if all Canadians experienced the same low rates of hospitalization for COPD as the highest income earners, there would be more than 18,000 fewer hospitalizations a year. That translates into $150 million in health-sector spending annually.

If all Canadians had the same low smoking rate as those in the highest income level, in 2013 there would have been about 1.6 million fewer Canadians who smoked.

Many sectors need to be involved to tackle poverty, create employment opportunities and improve health and safety, Harvey said.

There were also some differences between men and women, such as higher rates of hospitalization for heart attack among men and higher obesity rates among low-income women compared with high-income women.

The first step was to raise awareness about the current state of health inequalities, Harvey said. The Public Health Agency of Canada, Statistics Canada and CIHI are working on a report with more indicators.

Subsidize smoking cessation programs

Rob Cunningham, a senior policy analyst with the Canadian Cancer Society in Ottawa, called for federal tobacco legislation to be modernized, pointing out that low-income Canadians are far more likely to be smokers.

“The tobacco industry targets Canadians from lower socio-economic segments. We need to block tobacco industry marketing, such as by requiring plain packaging, and banning incentive promotional payments to retailers,” Cunningham said.

Tobacco marketers’ promotional payments to retailers include bonuses to reach sale volume targets or rebates to encourage price competition, Cunningham explained. A bill in Quebec aims to end such promotional payments.

“We should have wider availability of cessation programmes, including increased subsidies for smoking cessation products. Most of all, we need to prevent kids from starting.”