Health Inequalities: What Do We Know About the Health Status of Canadians?

Section 3 examines significant inequalities in the health status of Canadians. Whether it is measured using self-reports of overall health status, infant mortality rates, chronic conditions, activity limitations/disability status or the Health Utility Index, health status is worse for those with lower incomes. Cut another way, the health status of groups that are particularly vulnerable to poverty (e.g. lone mothers, Aboriginal persons, Atlantic Canadians) is consistently worse than that of the general population. Evidence shows that countries with less inequality and/or less poverty than Canada have better health outcomes and fewer health inequalities.

Examples presented in this section illustrate clearly that patterns of inequality in health status correlate very closely with patterns of inequality in SES. That is, groups with the lowest SES are also the groups most likely to have poor health status. While this evidence is certainly very suggestive, such informal evidence does not prove that there is causal link between poverty and health.

Does Poverty Cause Poor Health?

Sections 4, 5, and 6 of the report examine more formal, generally multivariate analyses that attempt to establish that poverty causes poor health. Studies of this type can be divided into those with a micro or individual orientation (i.e. personal direct experience of poverty is associated with personal health status) and those with a macro or populationorientation (i.e. living in a society with a more unequal distribution of income is associated with worse population health outcomes).

The key finding from the individual/micro-level research is that there is a very clear and very robust relationship between individual income and individual health. That is, poverty leads to lower health status. Additional findings include: 

•  While increases in income are associated with increases in health status across the  full income spectrum, the gains are largest for those at the bottom of the incomedistribution scale.

•  Longer-term measures of income have larger health associations. 

•  Long-duration poverty has larger associations with health than occasional episodes  of poverty. 

•  While both income level and changes in income level are important, the former is  more important. 

•  Negative ìshocksî to income have bigger consequences than positive shocks. 

•  For children, spells with low SES in the early years are most important in terms of impact on health. At the population/macro-level, a flurry of research has tested the hypothesis that societies with more inequality have worse health outcomes. Explanations for this phenomenon vary: 

•  The absolute income hypothesis suggests that health status increases with the level of personal income but at a decreasing rate, so that countries with more equally distributed incomes will be observed to have higher average levels of health.

•  The relative position (or psycho-social) hypothesis emphasizes individual position within a social hierarchy, independent of standard of living, as the key to understanding the link between socio-economic inequality and health. 

•  The neo-materialist hypothesis argues that high levels of income inequality are simply one manifestation of underlying historical, cultural, political and economic processes that simultaneously generate inequalities, for example, in social infrastructure (e.g. medical, transportation, educational, housing, parks and recreational systems). From this perspective, inequalities in health derive from inequalities in all of the above aspects of the material environment.