scholarly journals Measuring Trends in Health Inequalities across Urban Cities in Canada: A Focus on Health System Outcomes

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Meredith Nichols ◽  
Junior Chuang ◽  
Sara Grimwood ◽  
Geoff Hynes ◽  
Jean Harvey ◽  
...  
Keyword(s):  
Public Policy ◽  
Health System ◽  
Health Inequalities ◽  
Census Data ◽  
Local Level ◽  
Relative Concentration ◽  
Income Quintile ◽  
Postal Code ◽  
Local Health ◽  
Over Time

IntroductionThe majority of Canadians live in cities, which have experienced rising income inequality. This study examines how socio-economic inequalities in health system outcomes vary across and within Canada’s major cities over time to better understand these differences and to support informed decision-making and public policy planning to reduce inequalities. Objectives and ApproachThis study links a range of hospitalization indicators with neighbourhood income quintile and city geography data using patient postal codes and Statistics Canada’s Postal Code Conversion File Plus (PCCF+). Age-standardized indicator rates were calculated and income-related health inequalities were summarized using disparity rate ratio (DRR), disparity rate difference (DRD) and relative concentration index (RCI). Data were pooled across five-year intervals and linked to Census data years (2006, 2011, and 2016). City (Census Metropolitan Areas (CMAs)) and sub-city (Census Subdivisions (CSDs)) results enabled comparisons within and across cities and provided local level information to strengthen measuring and monitoring of health inequalities. ResultsAnalysis of the age-standardized rates for the hospitalization indicators (Hospitalizations for COPD (less than 75 years), Heart Attacks, Injury, Stroke, Self-Injury, Opioid Poisoning, Ambulatory Care Sensitive Conditions, and Hospitalizations Entirely Caused by Alcohol), overall and by neighborhood income quintile revealed an income gradient and significant variations within and across the CMAs and over time. Variations in DRR, DRD and RCI results were also observed across the CMAs over time, and between the CSDs within a CMA. Income-related inequalities in some hospitalization indicators persisted in Canada’s major cities with trends showing that people from lower income neighbourhoods experienced increased rates of hospitalization compared to people from higher income neighbourhoods. Conclusion/ImplicationsThis is the first study examining socio-economic health inequalities at city and sub-city levels across Canada. The methods used are relevant to others interested in local health inequality measurement. Our analysis provides evidence for developing and targeting public policy and health interventions to improve outcomes for vulnerable populations within cities.

The Place-Based Challenge

2020 ◽  
pp. 117-165
Keyword(s):  
Health Service ◽  
Health Inequalities ◽  
Local Level ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Local Health ◽  
Healthcare Provision ◽  
Welfare Benefits ◽  
Health Service Providers ◽  
Healthcare Interventions

When considering the provision of healthcare services, it is necessary to examine action at a local level and problems that local health service providers must face. This is essentially because it is within individual communities and neighbourhoods that most public healthcare interventions take place. Local intervention is also important in order to coordinate a more even pattern of healthcare provision across the regions. There are significant disparities between regions and inter-regions of the UK. Recent cuts to public services, welfare benefits, and public employment have severely affected those regions. This chapter will thus explore health inequalities and inequity of supply across the devolved administrations, regions, and sub-regions. It will then review policy to address health inequalities and consider to what extent the current public health service governance framework, and especially health service provision at the local level, can mitigate disparities in health outcomes. It includes a short section on the response to the Covid-19 pandemic in the regions.

scholarly journals 2.I. Workshop: Implementing local health equity policies in Europe – Needs, governance and tools

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health Equity ◽  
Health Inequalities ◽  
Local Level ◽  
Health Sector ◽  
Integrated Approach ◽  
Health Impact ◽  
Local Health ◽  
Healthy Living ◽  
Entry Points ◽  
Living Environments

Abstract The effects of health inequalities within and between European countries are widely recognized, and reducing health inequalities is on the agenda of many countries. Despite an increasing concern and awareness on health inequalities, a wide gap exists in Europe in terms of political response. Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love. Healthy urban development has a great potential to reduce health inequalities. Healthy living environments can only be created if sectors other than the health sector are involved. Health in all policies (HiAP) is an approach promoted by WHO since the Ottawa Charta (1986). It acknowledges the need for an integrated approach to health involving different policy fields. The reduction of health inequalities is one core aim. Including HiAP is a smart - and feasible - policy choice and one concrete measure it to use prospective Health Impact Assessment focusing on equity. Working with other government sectors requires an understanding of different mandates and goals, and may involve crossing administrative and budgetary barriers between sectors. Different policy actors and professional disciplines have their own languages and approaches to the problems and opportunities in societal development. For this reason, HiAP needs to promote an understanding of the language, goals and working methods across government sectors. Municipal governments need to build trusting and collaborative relationships both between internal sector silos, and across stakeholders within society. The municipal context offers comprehensive entry points for action. Municipalities seek to provide education throughout the life course, create appropriate conditions for housing as well as for physical activity and healthy eating. Municipalities can also promote the creation of a stable ecosystem. Moreover, a focus on municipalities addresses the local political context, local political regulations and urban or rural planning and development, which are important contributions to improving living conditions. There is valid information on health, health inequalities and its determinants available, but the information is not automatically transformed to concrete policy actions and measures. Besides knowledge, policy implementation requires many other elements to be effective: political will and commitment, collaboration, resources and governance. This session presents current findings and actions in the frame of the EU Joint Action Health Equity Europe (JAHEE). The first contribution includes an analysis of specific governance aspects for healthy living environments that are being addressed in JAHEE: How is the process from needs to decision-making to actions done by the participating 13 countries? After that, 4 examples from the Netherlands, Italy and Spain will describe their needs, governance and tools while implementing local health equity policies in their own context. Key messages The local level is the place where many determinants of health can be shaped and where Health and Equity in all Policies can be realized in an innovative way. There are many existing examples for tools and governance for local health equity policies that can be transferred to other places.

The Place-Based Challenge

2021 ◽  
pp. 511-545
Author(s):  
Louise Dalingwater
Keyword(s):  
Health Service ◽  
Health Inequalities ◽  
Local Level ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Local Health ◽  
Healthcare Provision ◽  
Welfare Benefits ◽  
Health Service Providers ◽  
Healthcare Interventions

When considering the provision of healthcare services, it is necessary to examine action at a local level and problems that local health service providers must face. This is essentially because it is within individual communities and neighbourhoods that most public healthcare interventions take place. Local intervention is also important in order to coordinate a more even pattern of healthcare provision across the regions. There are significant disparities between regions and inter-regions of the UK. Recent cuts to public services, welfare benefits, and public employment have severely affected those regions. This chapter will thus explore health inequalities and inequity of supply across the devolved administrations, regions, and sub-regions. It will then review policy to address health inequalities and consider to what extent the current public health service governance framework, and especially health service provision at the local level, can mitigate disparities in health outcomes. It includes a short section on the response to the Covid-19 pandemic in the regions.

scholarly journals Institutional Facilitators and Barriers to Local Public Health Preparedness Planning for Vulnerable and At-Risk Populations

2014 ◽  
Vol 129 (6_suppl4) ◽  
pp. 35-41 ◽  
Author(s):  
Christine A. Bevc ◽  
Matthew C. Simon ◽  
Tanya A. Montoya ◽  
Jennifer A. Horney
Keyword(s):  
Public Health ◽  
At Risk ◽  
Census Data ◽  
Local Level ◽  
Evaluation Study ◽  
Local Health ◽  
Public Health Preparedness ◽  
Preparedness Planning ◽  
At Risk Populations ◽  
Facilitators And Barriers

Objective. Numerous institutional facilitators and barriers to preparedness planning exist at the local level for vulnerable and at-risk populations. Findings of this evaluation study contribute to ongoing practice-based efforts to improve response services and address public health preparedness planning and training as they relate to vulnerable and at-risk populations. Methods. From January 2012 through June 2013, we conducted a multilevel, mixed-methods evaluation study of the North Carolina Preparedness and Emergency Response Research Center's Vulnerable & At-Risk Populations Resource Guide, an online tool to aid local health departments' (LHDs') preparedness planning efforts. We examined planning practices across multiple local, regional, and state jurisdictions utilizing user data, follow-up surveys, and secondary data. To identify potential incongruities in planning, we compared respondents' reported populations of interest with corresponding census data to determine whether or not there were differences in planning priorities. Results. We used data collected from evaluation surveys to identify key institutional facilitators and barriers associated with planning for at-risk populations, including challenges to conducting assessments and lack of resources. Results identified both barriers within institutional culture and disconnects between planning priorities and evidence-based identification of vulnerable and at-risk populations, including variation in the planning process, partnerships, and perceptions. Conclusions. Our results highlight the important role of LHDs in preparedness planning and the potential implications associated with organizational and bureaucratic impediments to planning implementation. A more in-depth understanding of the relationships among public institutions and the levels of preparedness that contribute to the conditions and processes that generate vulnerability is needed.

Is prostate brachytherapy a dying art? Evidence of increasing utilization in Ontario, Canada.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17608-e17608 ◽  
Author(s):  
Mark Thomas Corkum ◽  
Gerard Morton ◽  
Alexander V. Louie ◽  
Glenn Bauman ◽  
Lucas Mendez ◽  
...  
Keyword(s):  
Risk Groups ◽  
Geographic Region ◽  
Income Quintile ◽  
Local Health ◽  
Prostate Brachytherapy ◽  
Radiation Oncologist ◽  
Publicly Funded ◽  
Charlson Comorbidity Score ◽  
Multiple Health ◽  
Over Time

e17608 Background: A worldwide decline in prostate brachytherapy (BT) utilization has been reported in multiple health care settings/jurisdictions, despite strong evidence for efficacy and safety compared to other alternatives. We sought to evaluate contemporary trends in BT, EBRT and prostatectomy utilization in a publicly funded healthcare system. Methods: Men with localized prostate cancer diagnosed and treated between 2007 and 2017 in Ontario, Canada were identified using administrative data from the Institute for Clinical Evaluative Sciences. Men were coded to have received EBRT, BT (monotherapy or boost) or prostatectomy as initial definitive management. Trends were evaluated using the Cochran-Armitage test. Multivariate logistic regression was used to evaluate patient-, tumour-, and provider-factors on treatment utilization over time. Results: 57,655 men were included in our study. Prostate BT use increased from 7.5% of all treatments in 2007 to 15.4% in 2017 ( p< 0.01), primarily due to increased use of BT boost (1.7% in 2007 to 10.4% in 2017, p < 0.01). Relative to EBRT, BT use increased from 17.9% in 2007 to 28.1% in 2017 ( p< 0.01). On multivariate analysis (MVA), BT boost use increased by 28% per year (OR 1.28, 95% CI 1.26–1.31, p< 0.01) and BT monotherapy use increased by 12% per year (OR 1.12, 95% CI 1.10–1.14, p< 0.01), offset by decreasing prostatectomy use (12% per year, OR 0.88, 95% CI 0.87–0.89, p< 0.01). Comparing BT to EBRT, the strongest predictors of receiving BT were geographic residence (OR 27.6, 95% CI: 20.3–37.6, p< 0.01 between highest/lowest Local Health Integration Networks) and whether the first consulting radiation oncologist performed BT (OR 3.46, 95% CI: 3.15–3.80, p< 0.01). Other significant factors predicting BT use vs. EBRT included lower age, lower PSA, lower Charlson comorbidity score and increasing neighborhood income quintile. Low-intermediate, high-intermediate and high-risk groups were predictive of receiving BT boost, whereas BT monotherapy was predominantly used in low-risk disease. Conclusions: Contrary to trends observed in other jurisdictions, utilization of prostate BT is increasing over time in Ontario. However, substantial variation in BT utilization was found, strongly driven by both geographic region and radiation oncologist BT practice patterns. To our knowledge, this is the first study to report increasing BT utilization in the era of dose-escalated EBRT, with Ontario potentially serving as a model to promote BT utilization elsewhere.

scholarly journals Promoting equity through monitoring inequalities in the semi-rural region of Girona

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Batlle Amat ◽  
L Lazaro-Lasheras ◽  
S Oliveras ◽  
X Perafita ◽  
A Tarrés ◽  
...  
Keyword(s):  
Health Inequalities ◽  
Social Determinants ◽  
Information Needs ◽  
Local Level ◽  
Well Being ◽  
Local Health ◽  
Transfer Of Knowledge ◽  
Health And Wellness ◽  
Online Questionnaire ◽  
Health And Well Being

Abstract Problem Girona's region is a semi-rural territory with 750,000 h located in the northeast of Spain. There is no system to monitor health, well-being and health inequalities. This causes a lack of local public health equity policies. Description Design, implementation and results of participatory process, carried out over 6 months, to identify the information and data needs to be monitored locally for social determinants and health inequalities. Process has 4 phases: Selection of technical and political profiles representing coastal and inland, rural and urban municipalities linked to the fields of social determinants of health.Diagnosis: 2.1. Systematic collection of information through: i) Self-administered online questionnaire, sent to 250 policy makers and 580 technicians. ii) 6 focus groups 2.2. Data analysis to prioritize data and information needs.Evaluation and conclusions.Dissemination of results and transfer of knowledge. Results Involve actors in the identification of health information needs and their determinants permit to build a shared model of indicators. Spread the model of social determinants and their effects on health and well-being, increasing awareness of inequalities and health strategy in all policies. Identify the need to adjust some state and international indicators locally to be useful in local proximity policies. Lessons Involving local stakeholders has enabled the Girona's Observatory of Social Determinants of Health and Well-being to respond more efficiently to the information needs of technical and political decision makers. Indicators for monitoring health and inequality at the state and international levels need to be lowered at the local level so that they can be heard in the decision-making process of actors at the local level. Key messages It is necessary to adjust international health indicators to territorial realities in order to adjust local health and wellness policies. Local policies need health and wellness monitoring indicators to guide their policies.

scholarly journals No-Majority Communities: Racial Diversity and Change at the Local Level

2016 ◽  
Vol 54 (5) ◽  
pp. 866-897 ◽  
Author(s):  
Chad R. Farrell ◽  
Barrett A. Lee
Keyword(s):  
Ethnic Diversity ◽  
Census Data ◽  
Local Level ◽  
Racial Diversity ◽  
The United States ◽  
White Population ◽  
Population Declines ◽  
Large White ◽  
Asian Populations ◽  
Over Time

The United States is experiencing a profound increase in racial and ethnic diversity, although its communities are experiencing the trend differently depending on their size and location. Using census data from 1980 to 2010, we focus on a subset of highly diverse local jurisdictions in which no ethnoracial group makes up more than half of the population. We track the prevalence, emergence, and characteristics of these no-majority places, finding that they are rapidly increasing in number and are home to substantial and growing shares of the Black, Latino, and Asian populations. Transitions in no-majority places varied considerably over time. Older cohorts of places that became no-majority decades ago moved toward Latino or Black majorities, whereas those in recent cohorts tended to persist as no-majority places. Most of these communities continued to diversify in the decades after first becoming no-majority and remain quite diverse today. However, the shift toward no-majority status was often accompanied by large White population declines.

scholarly journals The Land of the ‘Fair Go’? Mapping Income Inequality and Socioeconomic Segregation Across Melbourne Neighbourhoods

2021 ◽  
pp. 229-246
Author(s):  
Michelle Sydes ◽  
Rebecca Wickes
Keyword(s):  
Income Inequality ◽  
Census Data ◽  
Local Level ◽  
Foreign Born ◽  
Ethnic Segregation ◽  
Dissimilarity Index ◽  
Middle Income ◽  
Noticeable Increase ◽  
Socioeconomic Segregation ◽  
Over Time

AbstractDespite enduring political rhetoric that promotes Australia as ‘the lucky country’ and ‘the land of the fair go’, recent decades have seen a noticeable increase in levels of income inequality. This growing economic divide has driven housing prices up and left lower-income families unable to access the housing market in inner-city locations. In contrast to other countries, Australia’s socioeconomic segregation does not overlap with ethnic segregation. Australia’s highly regulated immigration program has resulted in a relatively well-educated and employable foreign-born population who largely reside in middle-income neighbourhoods. These particularities make Australia an interesting context to explore patterns of socioeconomic segregation over time. In this chapter, we will utilise both traditional measures of segregation (such as the dissimilarity index) as well more spatialised measures (such as location quotients and Local Morans I) to assess socioeconomic segregation at the local level. Drawing on four waves of census data (2001, 2006, 2011 and 2016), we explore how socioeconomic segregation has changed over time across nearly 500 neighbourhoods in Melbourne. We further examine the degree to which socioeconomic segregation aligns with ethnic segregation patterns and levels in this city. We find patterns of socioeconomic segregation remain relatively unchanging over time in Melbourne. Additionally, our findings highlight important differences in patterns and levels of socioeconomic and ethnic segregation in the Australian context.

Practices and Perceptions of Local Health Officers/Commissioners Regarding Tobacco 21 Policy Advocacy

2021 ◽  
pp. 152483992198927
Author(s):  
Ruben Juarez ◽  
Salma Haidar ◽  
Jodi Brookins-Fisher ◽  
Heidi Hancher-Rauch ◽  
Mallory Ohneck ◽  
...  
Keyword(s):  
Public Policy ◽  
Tobacco Use ◽  
Local Level ◽  
National Level ◽  
Well Being ◽  
Health Priorities ◽  
Local Health ◽  
Cross Sectional ◽  
Policy Makers ◽  
The Public

Progress has been made in reducing adolescent cigarette smoking. However, the popularity of vaping products has increased concerns regarding tobacco use. One policy recently passed at the national level is Tobacco 21 (T21), which aims to reduce adolescent’s access to tobacco products. Since local health officers/commissioners play a crucial role in the development of policies that protect their respective communities from the harms of tobacco, it is important to characterize their views on the T21 legislation and advocacy activities among them. This was a cross-sectional pilot study of three Midwestern states taken prior to a number of key tobacco-related events in 2019. Results show almost 70% of respondents had high interest in influencing public policy, more than 80% thought the public policy makers’ actions regarding T21 were highly important to the health and well-being of the public, and 89% had in some capacity acted to support a T21 initiative. Involvement with legislative efforts was not high, despite evidence showing high popularity of the measure among the public. The top perceived benefits included a decrease in tobacco use among adolescents, improvements to community or state health, and delay in tobacco use initiation. Top barriers listed were issues with enforcement, lack of money or resources, competing health priorities, and policy makers’ attitudes and values. Respondents overall had significantly lower confidence in performing activities at the state versus local level. Findings suggest there may be a need for more advocacy training on effective advocacy strategies in changing health policy.

scholarly journals 817Official small area health statistics using the stratified reweighting method

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Ian Rayson ◽  
Sean Buttsworth
Keyword(s):  
Health Survey ◽  
Small Area ◽  
Census Data ◽  
Local Level ◽  
Health Data ◽  
Local Health ◽  
Health Statistics ◽  
Data Set ◽  
Acceptable Quality ◽  
Generalised Linear Mixed Model

Abstract Background The Australian Bureau of Statistics (ABS) presently produces health data for small population groups using a Generalised Linear Mixed Model (GLMM) method. Although this method is highly effective at producing reliable local level health data, it takes several months to compile data once it’s collected. The Stratified Reweighting Method (SRM) was investigated as an innovative efficient method for producing local level health data. Methods The SRM harnesses information from both health survey and Census data. A cluster analysis of 12 Census data items creates 13 area groups with similar population demographics. A replicated survey data set is then created where each small area is bolstered by the other small areas within its area group. The survey weights from this dataset are adjusted to match Census data of each small area across several demographic variables. A final survey weight adjustment ensures consistency of the small area predictions with national survey estimates. Results Health statistics were produced for over 20 health outcomes in the latest ABS National Health Survey; and the ABS Survey of Disability, Ageing and Carers. It was found that, compared to the GLMM method: the models had lower, but still acceptable quality; the errors of prevalence estimates were similar magnitude; and the data compilation time was reduced to within two weeks. Conclusions The SRM is an efficient approach for producing acceptable quality official local health statistics. Key messages The SRM is an innovative and efficient weight-based method using health survey and population Census data to produce official local health statistics.

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