Marc LefebvreResources, Research, Evaluation and Development Division

June , 2013

Social Inequities in Health in the City of Greater Sudbury

Data Analysis Using a Deprivation Index

Health Equity Vision - 2020

• The Sudbury & District Health Unit will work to improve the overall health equity of area citizens so that:• Systemic and avoidable health disparities are

steadily reduced and the gap in health between the best and worst off is narrowed;

• All citizens have equal opportunities for good health and well-being; and

• All citizens have equitable access to a full range of high quality public health programs and services

10 Promising Local Public Health Practices to Reduce Social Inequities in Health

Lifestyle-focused public health actions Policy-focused public health actions

1. Targeting with Universalism

4. Social Marketing

5. Early Child Development

6. Purposeful Reporting

2. Intersectoral Action

3. Equity Focused Health Impact

Assessment

7. Competencies and

Organizational Standards

8. Contribution to Evidence Base

9. Community Engagement

10. Health Equity Target Setting

Sutcliffe, Laclé, Snelling, EXTRA Fellowship Final Project Report. 2010 Canadian Health Services Research Foundation, Executive Training for Research Application

Opportunity for All A path to health equityhttp://www.sdhu.com/uploads/content/listings/SIHReport_EN_FINAL_forweb.pdf

HealthData

1998-2010

2006 Census Population

INSPQ Deprivation

Index

DA

DA

DA

Ecological Analysis

Greater Sudbury Dissemination

Areas

Our Analysis

Who• Population of Greater Sudbury

What• Ecological Analysis using Deprivation Index (DI)

When• 2006 census of population• 1998- 2010 health behaviours, utilization, vital stats

Where• Small Area / Neighbourhood (2006 census)

Why• Purposeful reporting• Understanding of population health

*Deprivation Index developed by Institut national de santé publique du Québec (INSPQ)

*

INSPQ Deprivation Index*—2 Dimensions

Material Component• Education (% <high school)• Employment (# employed/population)• Income (mean personal income)

Social Component• Marital Status (% separated, divorced or

widowed)• Family Structure (% single parent families)• Persons living along (% single-person

households)*Deprivation Index developed by Institut national de santé publique du Québec (INSPQ)

Pampalon, R.M., Hamel, D., Gamache, P., & Raymond, G. (2009). A deprivation index for health planning in Canada. Chronic Diseases in Canada, 29, 178–191.

DI - Regrouping the Quintiles (CIHI)

SOCIAL COMPONENT

MATERIAL COMPONE

NT

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5

Quintile 1 LEAST DEPRIVED 1 2 2 2

Quintile 2 1 1 2 2 2

Quintile 3 2 2 Neutral 2 2

Quintile 4 2 2 2 3 3

Quintile 5 2 2 2 3 MOST DEPRIVED

Increased deprivation

Increased deprivation

Most Deprived AreasNeutral AreasLeast Deprived Areas

Rat

e p

er 1

00,0

00 p

op

ula

tio

n

Deprivation Index Category

Rate of ‘X’ per 100,000 Population, by Deprivation Index

Key Findings

Ten promising practices to reduce health inequities include Purposeful Reporting, of which this is one clear example because it:• Uncovers neighbourhood inequities rather than masking them within

an average value for the entire City of Greater Sudbury• Can be shared with community partners to raise awareness and

prompt action

Concretely confirms what we know intuitively about our city

We have tools such as equity-focused Health Impact Assessments that are supported by this information

• Identified most deprived areas in City of Greater Sudbury using Deprivation Index

• Areas of highest deprivation have poorer health outcomes

• Profiles allow us to shape policies, programs, and services to benefit those most in need

• If everyone in the City of Greater Sudbury had the same opportunities for health as those living in its least deprived areas, each year in the City there would be:• 14,077 fewer emergency department visits for all

causes• 131 fewer residents who die before age 75• 11,231 fewer people who are obese

ANALYSIS RESULTS

Walden

Valley East

Sudbury

Nickel Centre

Capreol

Rayside-Balfour

Onaping Falls

City of Greater Sudbury Deprivation Index

Deprivation Index by Dissemination Area

CGSCommunities

Census Tracts (Neighbourhoods)

Major Hwy

Lakes

Deprivation Index

Least Deprived

Neutral

Most Deprived

No Data

0 10 20 30

km

.Source: INSPQ 2011; Statistics Canada 2006 Census of Population

69

Elm

Lasalle

Par

is

Re

ge

nt

Froo

d No

tre

Da

me

Bar

rydo

wn

e

Hwy 17

City of Greater Sudbury (Core) Deprivation Index

Deprivation Index by Dissemination Area

Census Tracts (Neighbourhoods)

Major Roads

Lakes

Deprivation IndexLeast Deprived

Neutral

Most Deprived

No Data

0 2.5 5 7.5

km

.Source: INSPQ 2011; Statistics Canada 2006 Census of Population

INSPQ DEPRIVATION INDEX GREATER THAN THE SUM OF ITS PARTS

ANALYSIS RESULTS

% French Mother Tongue

08

1624

3240

Per

cent

(%

) of

the

Pop

ulat

ion

Least Deprived Most DeprivedDeprivation Index - 3 Categories

Source: INSPQ 2011; Statistics Canada 2006 Census of Population

% Aboriginal Identity

02

46

810

Per

cent

(%

) of

the

Pop

ulat

ion

Least Deprived Most DeprivedDeprivation Index - 3 Categories

Source: INSPQ 2011; Statistics Canada 2006 Census of Population

WORSE OUTCOMES IN MOST DEPRIVED AREAS WHERE DIFFERENCES ARE STATISTICALLY SIGNIFICANT

ANALYSIS RESULTS

Self-Rated Health(Excellent/Very Good)

Least Deprived Most Deprived

Excellent/Very Good Health 68.37516 62.32607 54.65572

5

15

25

35

45

55

65

75

Deprivation Index

Per

cen

t (%

) o

f th

e P

op

ula

tio

n 1

2+

Source: Ontario Share File, Canadian Community Health Survey 2005-10, Statistics Canada Age Standardized using the 1991 Canadian Population

Premature Mortality (Dying Before Age 75)

Least Deprived Most Deprived

Premature Mortality 193.1 266 359.5

25

75

125

175

225

275

325

375

Deprivation Index

Dea

ths

per

100

,000

P

op

ula

tio

n p

er Y

ear

Source: Vital Statistics Data (2003–2007), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Infant Mortality

Least Deprived Most Deprived

Infant Mortality 2.8 3.7 6.7

1

2

3

4

5

6

7

8

Deprivation Index

Cru

de

Rat

e p

er 1

,000

Liv

e B

irth

s

Source: Vital Statistics Data (1998–2007), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Maternal Age (% of Live Births to Teenage Mothers)

Least Deprived Most Deprived

Live Births Born to Teenage Mothers 2.1 2.9 6.4

1.0

3.0

5.0

7.0

9.0

Deprivation Index

Pe

rce

nt

of

Liv

e B

irth

s

Source: Vital Statistics Data (1998–2007), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Hospitalizations (All Causes)

Least Deprived Most Deprived

All-Cause Hospitalization 94.6 98 114.7

10

30

50

70

90

110

130

Deprivation Index

Dis

ch

arg

es

pe

r 1

,00

0

Po

pu

lati

on

pe

r Y

ea

r

Source: Inpatient Discharge Data (2005–2009), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; and 2006 Census, Statistics Canada Age Standardized using the 1991 Canadian Population

Emergency Department (ED) Visits (All Causes)

Least Deprived Most Deprived

All-Cause ED Visits 303.3 368.4 519.5

50

150

250

350

450

550

Deprivation Index

Vis

its

per

1,0

00

Po

pu

lati

on

per

Yea

r

Source: Ambulatory Care Data (2005–2009), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Mental Health EpisodesHospitalizations

Least Deprived Most Deprived

Hospitalizations Mental Health Episodes 164.9 256.4 639.1

50

150

250

350

450

550

650

750

Deprivation Index

SR

ate

per

10

0,00

0 P

op

ula

tio

n

Source: Inpatient Discharge Data (2005–2009), IntelliHEALTH Ontario, Ontario MOHLTC, Extracted July 2011; Geography Division, Statistics Canada, Postal Code Conversion File 2011 (PCCF); and 2006 Census, Statistics Canada. Age Standardized using the 1991 Canadian Population

Thank youMiigwech

Merci

This presentation was prepared by staff at the Sudbury & District Health Unit.

This resource may be reproduced, for educational purposes, on the condition that full credit is given to the Sudbury & District Health Unit.

This resource may not be reproduced or used for revenue generation purposes.

© Sudbury & District Health Unit, 2013