Researchers from the University of Manitoba’s faculty of medicine released a new report last month, revealing that the poor continue to suffer from worse health than richer Manitobans.
The report, entitled “Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing over Time?” documents how to measure health inequities over time and determines where the inequities are most profound in Manitoba.
The report was put together by a group of researchers from the Manitoba Center for Health Policy (MCHP), a research unit in the faculty of medicine.
The report separated the province into rural and urban residents, which includes Winnipeg and Brandon, before dividing those populations into five income groups.
Levels of inequality were very high for some indicators.
The greatest difference occurred for tuberculosis in urban Manitoba. Fifty-two per cent of recent hospitalizations for tuberculosis occurred in the 20 percent of people in the lowest income group, read the report.
The socioeconomic gap in suicide or suicide attempts is also widening over time for both rural and urban Manitobans, according to the report. From 2005-07, “42.4 per cent of persons committing or attempting suicide were accounted for in 19.7 per cent of the population in the lowest neighborhoods income quintile group.”
“We put about 20 per cent of the population in the lowest income,” explained Dr. Patricia Martens, director of the MCHP and the principle investigator of the report. The report gives rates over time for all Manitobans and for each income group in rural and urban Manitoba.
The report suggests that the poor are worse off than ever before, stating that the gap in average household income has more than doubled in just 20 years for both rural and urban communities. In Winnipeg and Brandon, the wealthiest urban households earn $114,000 on average, while the poorest households make about $34,000.
Researchers looked at the distribution of disease, death and the use of preventative healthcare to see if the spread was equal across income groups in Manitoba.
Martens said that they were surprised to find that most of the clustering occurred in five major areas: teen pregnancy, dental extraction, amputations due to diabetes, tuberculosis hospitalization and suicide or suicide attempts.
She said that the research found that the lowest income group accounted for “about half of the events occurring [. . .].”
Other diseases, such as multiple sclerosis and dementia, saw a much more equal distribution.
“Many of the diseases in life have causes way beyond the health care system, by the conditions that people live in and poverty conditions. For example, housing, unemployment, not good access to sanitation or clean water,” she said.
The results emphasized the importance of prevention programs and other initiatives to target the lower income groups, explained Martens. She said that preventative approaches are beginning in Manitoba, but felt that “we really have a long way to go.”
“We still have one of the highest teen pregnancy rates in Canada in our province,” she pointed out.
She added that what is discouraging is that many of the conditions affecting lower income groups saw little improvement over long periods of time.
“What we really hope out of this report is that we can start seeing these inequities shrink over the next five to 10 years,” she said. Martens said the report gives the provincial government a baseline to start figuring out how to shrink inequities over the next decade.
What is encouraging is that Manitoba’s healthcare system is able to respond to disease in an equitable manner. By looking at the use of healthcare services such as the prescription of beta-blockers after a heart attack, a person’s income group made no difference as to the likelihood of getting the treatment drug.
The report has gained a lot of attention from other provinces in Canada who are interested in conducting similar studies. In addition, Martens said that the report has gotten huge interest from the World Health Organization.
“They want to potentially try to reproduce the way we did this so that they can look at health inequities worldwide,” she said.
The report was funded by the Canadian Institute of Health Research as well as the Public Health Agency of Canada. Martens said that each year she negotiates which topics to conduct research on with the minister of health, Theresa Oswald.
“We’re directly linked to policy makers who really want to answers to these questions,” said Martens.
Oswald said the province requested the report knowing that there has been research linking health and economic status.
“The report identifies where government can help to improve these health outcomes,” said Oswald.
“This report helps us develop services that will best address the needs of Manitobans,” she continued.
The minister listed several programs that have already been developed which will not only help people improve their lives from an economic standpoint, but also result in improvements in their health, such as the Student Success Initiative to improve the high school graduation rate.
“Healthcare is a solution to a problem. We’ve got to prevent the problems. We’ve got to work what we call upstream [ . . . ] where you prevent them from ever becoming problems,” said Martens.
