Health inequality in Canada is growing. And nowhere is that more evident than in the health gap between indigenous and non-indigenous Canadians.
In a report released last November the Canadian Institute for Health Information concluded that Canada wasn’t likely to see any major improvements in health inequality without addressing the social determinants of health – things like income, education, housing, food security, and access to clean water.
“A big part of that isn’t our health care system, it’s that we don’t have the kind of equal society, we don’t have the social safety net that many European countries for example do. And that reflects in statistics,” said Dr. Ryan Meili, a family doctor from Saskatoon and a former provincial NDP leadership candidate.
Meili is executive director of Upstream, a Saskatchewan based health advocacy organization. The group uses HEAL, or the Health Equity Action Lens, an analysis method that encourages decision-makers to consider the health equity of policies – whether it will improve health for all people, not just those with higher incomes or better education – and urges policymakers to take a proactive approach to addressing health inequality by assessing existing policies and addressing the social determinants of health.
Upstream will present the Health Equity Action Lens at its Closing the Gap: Action for health equity conference Sunday at the Canadian War Museum. Meili will be joined by Health Minister Jane Philpott and several experts, including Sir Michael Marmot, a world renowned researcher into the social determinants of health.
On a global scale, Canada doesn’t fair too badly on health indicators – lining up ninth out of 188 countries on the United Nations 2015 Human Development Index, which ranks countries based on measures of health, education, and standards of living. But compared to the best performing countries, Canada has a long way to go, Meili said.
One of the biggest concerns is income, what he called the “determinant of the determinants” – a higher income ensures a person can afford a decent place to live, healthy foods, and higher education.
“In Canada we have growing income inequality, we have a situation where we’re seeing one segment of the population left behind while others really succeed and that’s something that leads to increased health inequities,” Meili said.
Canada’s most glaring disparity in social determinants of health, between indigenous and non-indigenous communities, is evident in the government’s community-well being index.
The index measures socio-economic well-being at the community level based on education, income, housing, and labour force activity. While average well-being scores for all communities improved slightly between 1981 and 2011, a 2011 report by Indigenous and Northern Affairs Canada shows the gap between indigenous and non-indigenous communities hadn’t changed at all in 30 years.
In 2011 First Nations scored a 59 out of 100 on income compared with 84 for non-aboriginal communities, on education it was 36 to 53, on housing 71 to 94, and on labour force activity 68 for First Nations compared with 84 for non-aboriginal communities.
“We know that in order to have food security, in order to put the heat on in the house or have transportation to go to work you need an income, and basically if that income base is not there, if communities are experiencing abject poverty and the grinding conditions of such, obviously the outcomes of health are going to be affected,” said Ontario Regional Chief Isadore Day.
But income isn’t Day’s only concern – he also pointed to issues in education, children’s health, mental health, water and housing infrastructure, and racism.
“Social status, that’s another very deep troubling area that many of us are quite concerned about,” he said, explaining that the perception some Canadians have of First Nations is based on “misconceptions,” “ignorance,” and “discrimination.”
“This is really a complex discussion,” he said. But when you look at the investments in social determinants in non-aboriginal communities and then you look at the lack of investment in First Nations “it’s pretty clear to see where the problem comes from,” he said.
It’s not just about funding though. Day sees a need for the proactive, equity lens approach Meili and Upstream are promoting.
“If we don’t move beyond just responding to the current issues we’re not going to make a dent in the problem,” said Day.
Take childhood obesity for example. There’s the issue of physical activity, but Day said there’s more at play – including the issue of Canada’s reserve system and questions about why children aren’t out on the land more, issues of poverty, and of disconnection between elders and youth.
“There’s so many complexities around just that childhood obesity issue that there needs to be a very forward thinking approach because you can’t just respond to one issue and [think] it’s actually going to resolve everything, it’s impossible,” he said.
Greater self-government will be key to addressing the social and health inequities faced by First Nations, said Day.
“We’ve got health care professionals, we’ve got young people that are being educated, but for some reason there’s a large segment of our society or our people that are not having the proper access and it has everything to with the fact that full control is in the hands of the federal government. So ultimately that’s the main thing that needs to change,” he said.
“The only way public health will become better and where we will close that gap is if we are actually bona fide partners at the table.”
Addressing the social determinants of health is the responsibility of the whole government, not just the department of health, and greater coordination between departments is something the Liberal government is striving for, said Philpott, the federal health minister
She pointed to the $8.4 billion commitment the Liberal government made in the recent budget to invest in indigenous communities, with the largest investments going to education – a key social determinant of health.
The Liberals have also committed to strengthening the government relationship with indigenous Canadians by embracing a new nation-to-nation relationship. And Philpott noted that just this week she met with Day and chiefs from northern Ontario to discuss health issues. The government also plans to consult with indigenous leaders as they work towards a new health accord with the provinces, she said.
Meili said discussions would focus on how to establish health equity as an important policy benchmark in Canada and the types of initiatives that could be taken to address social determinants and achieve healthy equity.
Today’s event will be live-streamed for those unable to attend.