Social inequalities in health : Description

Title: Measuring social inequalities in health: Going beyond description to support intervention.

Project description
The relationship between health and social inequalities is now largely acknowledged by those responsible for population health, including the Direction de santé publique de Montréal, the Public Health Agency of Canada and the Direction de santé publique du Québec. The World Health Organization (WHO) recently published the conclusions of the Commission on Social Determinants of Health. Its Website summarizes them as follows: "The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries."  However, Québec does not have a strategy to monitor social inequalities in health (SIH) that would measure inequalities in living conditions (lifestyle habits, conditions at home and at work, socioeconomic status, financial insecurity, and physical and built environments) and inequalities related to prevention methods and remediation.  Such a strategy is particularly important on local levels since Health and Social Services Centres (CSSS) assume many health-related responsibilities in the territories they serve but do not have all the data to detect disparities among subgroups. Data on sub-populations are often non-existent due to insufficient samples. Yet, SIH surveillance would allow to target the most vulnerable subgroups.
  1. Develop a provincial SIH surveillance strategy that would lead to effective local and societal interventions to reduce SIH and to track the effects of such interventions.    
  2. Propose a set of indicators to measure SIH.
  1. Create the conceptual framework; 
  2. Perform a literature review on SIH and the social determinants of health in seven areas (chronic illnesses, mental health, occupational health, children's development, infectious diseases, ethnicity, and access to health care), as well as on indicators that have been used or that are desirable for measurement of SIH in these seven areas.  
  3. Operationalize indicators reviewed according to the conceptual framework. 
  4. Using the review, compile an annotated selection of health indicators for each area and of socioeconomic indicators; identify possible data sources and calculation methods for the indicators chosen. 
  5. Present the strategy to CSSS and public health departments, and to governmental stakeholders for knowledge transfer purposes and to enhance the model. 
  6. Formulate recommendations on the expansion of existing surveillance systems to better document the evolution of SIH, including ethical, methodological and training aspects.
This strategy will use a longitudinal perspective that includes indicators of critical periods in the life cycle; it will also attempt to shed light on local disparities while adding to the understanding of economic realities and their impacts; and it will render interprovincial comparisons possible. The indicators chosen must be "sustainable" in terms of costs and feasibility. Three pilot scoreboards will be produced: for the province as a whole, for the Direction de santé publique de Montréal (DSP), and for a university-affiliated centre serving large, low-income immigrant populations. We will also produce a guide to generate scoreboards for semi-urban and remote regions.  
This study is funded by Fonds de recherche sur la société et la culture du Québec.