Northern Saskatchewan August 2016 Health Indicators Social Determinants of Health: Living and Working Conditions Northern Saskatchewan Health Indicators Table of Contents Table of Contents .................................................................................................................................................. 2 Key Messages .......................................................................................................................................................... 3 Determinants of Health ...................................................................................................................................... 5 Living and Working Conditions by Health Authority .............................................................................. 7 Living and Working Conditions by Community ..................................................................................... 15 Appendix A – Data Notes ................................................................................................................................. 25 1. Data Sources ........................................................................................................................................... 25 2. Definitions ............................................................................................................................................... 25 3. NHS Global Non-response Rate (GNRs) and Data Suppression, 2011 ............................. 28 4. Data Suppression for Northern Saskatchewan Census Subdivisions, 2011 Census of Population ......................................................................................................................................................... 30 Appendix B – Glossary of Acronyms ........................................................................................................... 31 Appendix C – Index of Figures ...................................................................................................................... 32 Appendix D - References ................................................................................................................................. 33 Refer to A Guide to the Reports: Understanding the Presentation of Data for an explanation of the variety of ways data is presented. Suggested reference: Irvine J, Quinn B. Northern Saskatchewan Health Indicators, Social Determinants of Health: Living and Working Conditions. Athabasca Health Authority, Keewatin Yatthé Health Region and Mamawetan Churchill River Health Region. Population Health Unit, La Ronge, 2016. Copies of this document and related reports can be downloaded from the Population Health Unit website www.pophealthnorthsask.ca Social Determinants of Health: Living and Working Conditions August, 2016 2 Northern Saskatchewan Health Indicators Key Messages Income Median after-tax income in those aged 15 years and over in northern Saskatchewan in 2010 was $16,860, around 40% lower than the province as a whole. The proportion of total income coming from government transfers in northern Saskatchewan health authorities ranges from 18.7 to 28%, compared to 11.5 to 12.4% in Saskatchewan and Canada, respectively. The northern health authorities have greater proportions of their populations in the first two adjusted after-tax Canadian family income deciles, and smaller proportions of their populations in the last six deciles compared to either Saskatchewan or Canada, who have very similar proportions. Overall, this indicates that a greater proportion of northerners have much lower income levels then their provincial and national counterparts. The prevalence of low income in off-reserve private households in northern Saskatchewan in 2010 was between 24 and 48%, across various age groups. This was between 1.5 and 2.3 times greater than the corresponding provincial rate. Education Northern Saskatchewan had three times the provincial rate of individuals aged 25-64 years without a certificate, diploma, or degree. Northern Saskatchewan also had lower rates of individuals with all other types of educational qualifications (e.g. high school, trades, college, and university) compared to the province. Employment The employment rate in Saskatchewan, 65%, is between 55 and 97% higher than the employment rates in the northern Saskatchewan health authorities. The long-term unemployment rates in the northern Saskatchewan health authorities range between 3.3 and 15.6%, which are between 3.3 and 5.2 times higher than the provincial rate of 3%. Gradients in socioeconomic indicators There appear to be gradients in many socioeconomic indicators such as income, education and employment rates in which northerners tend to attain lower levels compared to the province and country. Subsequently, within each of these geographic areas, individuals who self-identify as Aboriginal tend to attain lower levels then the regions as a whole. Housing In Saskatchewan and Canada, around 70% of private dwellings are owned by the household. In the northern Saskatchewan health authorities, this number drops to between 21 and 44%. Northern Saskatchewan health authorities had between 2.5 and 4.3 times the proportion of dwellings requiring major repair, and between 4.8 and 11.4 times the rates of crowding. Social Determinants of Health: Living and Working Conditions August, 2016 3 Northern Saskatchewan Health Indicators Language Between 44 and 84% of the population in the northern health authorities reported having an Aboriginal language as their mother tongue, and between 28 and 71% reported that an Aboriginal language was the language they spoke most often at home. Variations among communities Northern communities share many commonalities; however they also vary greatly among one another in terms of their social determinants of health such as income, education, and employment levels, as well as their housing conditions and use of Aboriginal languages. For many of these indicators, some communities score as good, or better, than the province as a whole, while other communities struggle with rates that are up to 25 times worse than the province. Social Determinants of Health: Living and Working Conditions August, 2016 4 Northern Saskatchewan Health Indicators Determinants of Health In Canada, there are 12 factors recognized as the key determinants of health, including income and social status, social support networks, education and literacy, employment and working conditions, social environments, physical environments including both the natural and built environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender and culture 1. It is recognized that the determinants of health do not act in isolation from one another, but rather interact with each other to have combined and interrelated effects on the health of the population 2. This is most notable for chronic diseases such as diabetes, heart disease and cancer, which have multiple risk factors and usually require many years to develop. This extended development period provides ample time for the determinants of health to be involved in complex interactions with each other, the individual, and the environment in the development of the disease. Therefore, care must be taken to look at a variety of health determinants to get a more complete picture of the root causes of diseases. Research has illustrated that the impact between the social determinants of health and health status is not just between the advantaged and disadvantaged, but rather there is a clear social gradient that is seen at each level throughout society 3. It has been suggested that part of this gradient-effect may be explained by a person’s ‘control over (their own) destiny 4. According to Syme 4,5, a person with lower social class has fewer opportunities, resources, skills and training to influence events that affect their lives. Regardless of exactly how income and social status impact health, it is clear the relationship is strong and very complex. There are many models and frameworks that visually depict the determinants of health 6. One of the most widely used is the “Wider determinants of health model” created by Dahlgren and Whitehead 7. Although there are slight differences between the various models, they all show how the determinants of health are connected to society as a whole. Figure 1: Wider determinants of health Social Determinants of Health: Living and Working Conditions August, 2016 5 Northern Saskatchewan Health Indicators There are also determinants of health that are more closely linked to the Aboriginal peoples, including factors such as self-determination, culture, language and heritage, and colonization. The First Nations Wholistic Policy and Planning Model pictured below highlights some of these key characteristics 8. Figure 2: First Nations Wholistic Policy and Planning Model Social Determinants of Health: Living and Working Conditions August, 2016 6 Northern Saskatchewan Health Indicators Living and Working Conditions by Health Authority Figure 4: Median after-tax income, population aged 15 and over, by region, 2010 35,000 30,000 28,792 27,334 25,000 20,000 tax income ($) - 17,320 16,860 16,850 15,000 13,374 Median after 10,000 populationaged 15 yrs andover 5,000 0 Sask Canada KY North MCR AHA Source: Statistics Canada 2011 NHS Health profile Catalogue no. 82-228-XWE, Prepared by PHU, May 2014 Figure 3: Percent of total income from government transfers by