Inequity and Chronic Disease in Atlantic Canada a Discussion Paper
Total Page：16
File Type：pdf, Size：1020Kb
Population and Public Health Branch Atlantic Region The Tides of Change Addressing Inequity and Chronic Disease in Atlantic Canada A Discussion Paper Karen Hayward, Researcher Ronald Colman, Executive Director, GPI Atlantic The Tides of Change Addressing Inequity and Chronic Disease in Atlantic Canada A Discussion Paper Karen Hayward, Researcher Ronald Colman, Executive Director GPI Atlantic Prepared for Population and Public Health Branch Atlantic Regional Office Health Canada July 2003 The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of Health Canada. Également disponible en français sous le titre Une vague de changement. Iniquités et maladies chroniques au Canada atlantique. Document de travail. Contents may not be reproduced for commercial purposes, but any other reproduction, with acknowledgements, is encouraged. Please credit the source as follows: The Tides of Change. Addressing Inequity and Chronic Disease in Atlantic Canada. A Discussion Paper. 2003. Prepared by Karen Hayward and Ronald Colman, GPI Atlantic, for the Population and Public Health Branch, Atlantic Regional Office, Health Canada. For more information contact: Atlantic Regional Office Population and Public Health Branch Health Canada 1525 - 1505 Barrington Street Halifax NS B3J 3Y6 Tel: (902) 426-2700 Fax: (902) 426-9689 Email: pphatlantic-spspatlantique@hc-sc.gc.ca Web site: www.pph-atlantic.ca © Health Canada, 2003 At the beginning of this new millennium I was asked to discuss, here in Oslo, the greatest challenge that the world faces. Among all the possible choices, I decided that the most serious and universal problem is the growing chasm between the richest and poorest people on earth. Citizens of the ten wealthiest countries are now seventy-five times richer than those who live in the ten poorest ones, and the separation is increasing every year, not only between nations but also within them. The results of this disparity are root causes of most of the world's unresolved problems, including starvation, illiteracy, environmental degradation, violent conflict, and unnecessary illnesses that range from Guinea worm to HIV/AIDS. Jimmy Carter, former President of the United States Nobel Lecture, December 10, 2002 The growing gaps in health status between people in different groups is a serious and a major concern for the government. We cannot accept that the rich get healthier and the poor get sicker. Not in our country, nor in the world. Ingvar Carlsson, former Prime Minister of Sweden 1995 iii ACKNOWLEDGEMENTS Many individuals and organizations have assisted the research team in the process of compiling sources, analysis, and writing. For their advice and collaboration, our appreciation goes to: • Carol Amaratunga, former Executive Director, Atlantic Centre of Excellence for Women's Health, presently Chair, Women’s Health Research, Ontario Women's Health Council, University of Ottawa • George Kephart, Director, Population Health Research Unit, Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, and • Dennis Raphael, Associate Professor and Undergraduate Programme Director, School of Health Policy and Management, Atkinson Faculty of Liberal and Professional Studies, York University. Thanks also to Bill Turpin and Jeri Dawn Wine who provided administrative, editorial, and general support. Appreciation is expressed for the very helpful advice and suggestions of the project advisory committee members located throughout the four Atlantic provinces, who reviewed early drafts and outlines and provided information, knowledge of sources, and guidance: • Heather Alaverdy, Consultant, Newfoundland • Larry Baxter, Nova Scotia Advisory Commission on AIDS • Deborah Bradley, Prince Edward Island Department of Health and Community Services • Moyra Buchan, Canadian Mental Health Association, Newfoundland/Labrador Division • John Campbell, Director of Mental Health Services, Nova Scotia Department of Health • Fiona Chin-Yee, Population and Public Health Branch, Atlantic Regional Office, Health Canada • Roberta Ellingsen, Faculty of Nursing, University of New Brunswick • Lois Jackson, School of Health and Human Performance, Dalhousie University • Andrea Lebel, Population and Public Health Branch, Atlantic Regional Office, Health Canada • Laurie Ann McCardle, Women's Network, Prince Edward Island • Eleanor Swanson, Director, Planning and Evaluation, Newfoundland and Labrador Department of Health and Community Services v • Gregory Taylor, Director, Disease Intervention Division, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada • Merv Ungurain, Visiting Fellow, Unit for Population Health and Chronic Disease Prevention, Clinical Research Centre, Dalhousie University. We also wish to thank Shelene Morrison, Laura MacKay, Debbie Prince, and Tricia MacKinnon for their assistance in gathering data and providing technical support. vi TABLE OF CONTENTS FORWARD .......................................................... xi 1. EXECUTIVE SUMMARY ............................................1 2. CHRONIC DISEASE PREVENTION...................................7 2.1 Changing Approaches to Health and Disease Prevention................7 2.2 Chronic Disease Prevention......................................10 2.2.1 Noncommunicable chronic diseases in the Atlantic provinces ......11 2.2.2 Communicable chronic diseases in the Atlantic provinces .........18 2.2.3 Mental health in the Atlantic provinces ........................21 2.3 Discerning Trends .............................................27 3. INEQUITY AND SOCIAL/ECONOMIC EXCLUSION ...................29 3.1 Discrimination and Racism......................................29 3.2 Social and Economic Inclusion ...................................31 4. VULNERABLE GROUPS ............................................37 4.1 Aboriginal People and African Canadians...........................38 4.2 Single Mothers................................................39 4.3 Low-income Children ..........................................40 4.4 Population Aged 65 and Over ....................................42 4.5 Rural Population ..............................................43 4.6 Implications..................................................43 5. CULTURAL, SOCIAL, AND ECONOMIC CONTEXT ...................45 5.1 Cultural and Social Context......................................45 5.2 Importance of Geographical Area.................................46 5.3 Income Distribution............................................48 6. PATHWAYS LINKING CHRONIC DISEASE AND INEQUITY ...........51 6.1 Materialist Pathway............................................52 6.1.1 Poverty and access to resources ..............................52 6.1.2 Employment .............................................54 6.1.3 Education ...............................................56 6.2 Psychosocial Pathway ..........................................58 6.3 Political/Economic Pathway .....................................62 vii 7. DISCUSSION ......................................................67 7.1 Policy Implications ............................................69 7.2 Recommendations for Action ....................................71 7.3 Specific Public Policy Initiatives ..................................75 7.3.1 Federal level.............................................75 7.3.2 Provincial level...........................................76 7.3.3 Municipal level...........................................76 7.3.4 Community health board level...............................77 APPENDIX...........................................................79 ENDNOTES ..........................................................87 REFERENCES.......................................................107 viii LIST OF FIGURES Figure 1. Changes in population health status/historical markers in public health. .....8 Figure 2. Population aged 12 and over with diabetes, Atlantic provinces and Canada, 1994/95 and 2000/01, (%) ............................................12 Figure 3. All circulatory disease deaths age-standardized rate per 100,000, Atlantic provinces and Canada, 1996, (rate) .....................................13 Figure 4. Distribution of cancer costs, Nova Scotia, 1998 .......................14 Figure 5. All circulatory disease deaths age-standardized rate per 100,000 for both genders in Newfoundland and Labrador with a rate that is at least 20% higher than Canada, 1996, (rate) .................................................15 Figure 6. Disability-free life expectancy at age 65 for Canada, Labrador, and Cape Breton, 1996, (years) ................................................16 Figure 7. Age-standardized lung cancer rate per 100,000 population in Atlantic health districts for both genders higher than Canada, 1995/96, (rate) ................18 Figure 8. Atlantic health districts with a higher percentage of the population aged 12 and over with probable risk of depression, compared to Canada, 2000/01, (%) ......26 Figure 9. Distribution of mental illness costs, Nova Scotia, 1998 ..................27 Figure 10. Atlantic health districts with highest percentages of female lone-parent families, as a proportion of all census families, 1996, (%) ...................40 Figure 11. Low-income rates of children, Canada and Atlantic provinces, 1997, 2000 . 41 Figure 12. Average wealth of households by region, 1999, (1999 constant $) ........48 Figure 13. Average wealth by