Testing relationships among determinants of health, health policy, and self-assessed health status in Quebec

Health Status of Older Immigrants to Canada

Using the 2000/2001 Canadian Community Health Survey (CCHS), this paper examines the health status of the older (aged 55+) immigrant population relative to that of non-immigrants in order to identify areas where their health statuses diverge. First, we compare the health status of older immigrants (foreign-born) aged 55 and over in Canada to the Canadian-born in terms of age and gender using multiple measures of health status including self-assessed health. Second, we identify the factors associated with health status using the determinants of health framework. In both cases, the key questions are whether differences in health status exist and whether they are explained primarily by socio-economic, socio-demographic, or lifestyle factors that may point to problems with the Canadian health care system. Findings indicate that there is a relative comparability in the health status of older immigrants, even after controlling for age.

Quebec's Approach to Population Health: An Overview of Policy Content and Organization

While Canada's international leadership in the area of health promotion has been widely acknowledged in the past, Quebec's approach could be better known. Canada's second largest province has indeed developed a comprehensive public health infrastructure and adopted a population health approach which features an integrated set of legislative, organizational and programmatic policy instruments. These instruments not only ensure the core functions of public health, but also foster public intervention on the social determinants of health. In addition, Quebec's policy is supported by a solid research infrastructure, networked expertise and a mobilized workforce among health professionals. In spite of the interest it represents for the larger public health community in Canada and elsewhere, this largely French-speaking province's approach remains little known because of language and cultural barriers between Quebec and Anglo-Saxon countries, and it has yet to be systematically discussed in the English-language literature. This article provides an overview of policies and administrative structures in Quebec to support public health and address socially determined inequalities in health. It analyzes the development of these policies over the past decade and offers insight to their core content.

Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect

Set within the determinants of health framework and drawing upon Statistics Canada's longitudinal National Population Health Survey, this paper explores the self-assessed health of Canada's immigrant population. Using both descriptive and multivariate techniques, including logistic regression and survival analysis, the intent is to identify differences in self-assessed health between the immigrant and native-born populations, the factors that contribute to immigrant self-assessed health, and the factors associated with declining self-assessed health status. In each case, the key questions are whether differences in health status exist between the native- and foreign-born. Results indicate mixed support for the Healthy Immigrant Effect, with the native- and foreign-born neither more nor less likely to rank their health as fair or poor. However, results from the proportional hazards model indicated that the native-born were at lower risk to transition to poor health.

State size as measured in terms of public spending and world health, 1990-2000

OBJECTIVE

To determine the relationship between state size (measured in terms of public spending) and public health indicators in a sample of countries representing all regions of the world and from 1990-2000.

METHODS

An ecological study was performed using data on Central Government Spending (CGS) and per capita Gross National Product (GNP) obtained from the International Monetary Fund, and on life expectancy, maternal, and infant mortality, provided by the World Health Organization. A multiple linear regression model was fitted to estimate the effect of CGS on health, which also took into consideration per capita GNP and geographical region.

RESULTS

CGS varied little over the study period, with convergence around an average of 28%, but within a relatively wide range (7.80-53.0%); the countries with the strongest economies (according to per capita GNP) had the highest levels of CGS. The influence of this factor was particularly relevant for the infant mortality rate (r = 0.40; beta = -1.327; EE = 0.237; t = -5.590; p < 0.001). Per capita GNP and geographic location were also associated with variations in health; health indicators tended to be worse for poorer countries in Africa and Asia. In the adjusted model, CGS was statistically significant with regard to infant and maternal mortality rates.

CONCLUSION

The study suggests that state size (in terms of public spending) has an important influence upon health and particularly upon mortality. Although it is important to bear in mind the limitations of this study and the reduced time window used, these results should be taken into consideration in the current political and epidemiological debate.

Linking perceptions of neighbourhood to health in Hamilton, Canada

STUDY OBJECTIVE

To investigate the association between perceptions of neighbourhood physical and social characteristics and three health outcomes (self assessed health status, chronic conditions, and emotional distress).

DESIGN

Cross sectional survey data analysed in small neighbourhoods.

SETTING

Hamilton, Ontario, Canada, a medium sized industrial city, located at the western end of Lake Ontario (population at the time of the study about 380 000).

PARTICIPANTS

Random sample of 1504 adults aged 18 years and older residing in four contrasting neighbourhoods.

MAIN RESULTS

Significant differences across the four neighbourhoods are apparent in self assessed health status and emotional distress, but not in chronic conditions. Neighbourhoods with lower SES reported poorer health and more emotional distress. Perceptions of the physical environment dominated social concerns in all neighbourhoods. For all three health outcomes, individual risk factors followed expectations, with measures of poverty, age, and lifestyle all significantly associated with poor health outcomes. Physical environmental problems were positively and significantly associated with poor physical and emotional health. Specifically, people reporting they dislike aspects of their neighbourhood's physical environment are 1.5 times more likely to report chronic health conditions (OR 1.56, 95% CI 1.19 to 2.05), while those reporting physical likes with their neighbourhood are less likely to report fair/poor health (OR 0.50, 95% CI 0.28 to 0.90) or emotional distress (OR 0.45, 95% CI 0.26 to 0.80).

CONCLUSIONS

These results demonstrate the importance of neighbourhood perceptions as a determinant of health, as well as conventional factors such as low income, lifestyle, and age. The dominance of physical environmental concerns may have arisen from the industrial nature of Hamilton, but this result merits further investigation.

Health status and Canada's immigrant population

Given the framework of the 1984 Canada Health Act, the health status of immigrants should be similar to average levels within whole of Canada. Yet, assuming equality of health status between immigrant and non-immigrants, or between immigrant groups is likely an unrealistic and simplistic assumption, given unseen barriers affecting accessibility, the restructuring of the Canadian health care system, and problems with the provision of health care resources to the immigrant population. Using the National Population Health Survey, this paper focuses upon the health status of the immigrant population relative to that of non-immigrants within Canada, with reference to diagnosed conditions, self-assessed health, and the Health Utilities Index Mark 3. Findings indicate that, with the exception of the most recent arrivals, immigrants experience worse health status across most dimensions relative to non-immigrants. Multivariate analysis reveals that age, income adequacy, gender, and home ownership are dimensions upon which health status differs between the two groups.

Exploring the determinants of health for First Nations peoples in Canada: can existing frameworks accommodate traditional activities?

While much research has examined First Nations peoples' health in Canada, few studies have explored the role of traditional activities in enhancing health. Using data from the 1991 Aboriginal Peoples Survey (APS), this paper incorporates a set of measures of traditional activities within a determinants of health framework for understanding First Nations peoples' health. Results from the analyses undertaken show that many of the determinants of health identified in analyses of the Canadian population in general hold for First Nations peoples. While only a few statistically significant relationships between health status and traditional activities were identified, taking into account the limitations of the APS and other conceptual issues, we argue that there is the potential to move from the analysis of traditional activities to a more nuanced analysis of cultural attachment.

Trends in health and healthcare utilization in Manitoba

Trends in health status and healthcare utilization were examined for regions of Manitoba from 1985 to 2000. While the provincial premature mortality rate decreased, the difference between the northern and southern regions increased. Hospital admissions remained stable despite major bed closures and an aging population; a decrease in hospital days per capita was observed in all regions. Physician contact rates also remained constant despite a 40% increase in the number of seniors.