Social inequalities in health

An Act to Combat Poverty and Social Exclusion (R.S.Q., chapter L-7): History

Today, the links between poverty and health are well-established (Phipps, 2003) and the resulting inequalities in health have proven to be persistent (Whitehead & Dahlgren, 2007). Indeed, the population groups with the worst health status are materially underprivileged and socially excluded (De Koninck et al., 2008), leading many analysts to single out poverty as one of the primary determinants of health.

In 2002, the Government of Québec passed An Act to Combat Poverty and Social Exclusion (R.S.Q., c. L-7). This legislation has received interest from the public health community because it is an example of healthy public policy.

This series of background papers presents the history that preceded this legislation, and highlights main elements of its application. In this background document, we address the following question:

  • What are the events that led to the adoption of An Act to Combat Poverty and Social Exclusion?

The Québec Index of Material and Social Deprivation: Methodological Follow-up, 1991 through 2006

Since its creation in the late 1990s, the Québec index of material and social deprivation has been widely utilized in the field of public health for purposes that range from health monitoring and policy development to evaluation of services and resource allocation. More recently, a Canadian version of the index has been produced and used at that level.

There are provincial, regional, and local versions of the Québec index. Four revisions have been made over the years, in conjunction with the 1991, 1996, 2001, and 2006 censuses. While some publications have examined the index's construction for a specific census year, none of them have tracked its methodological components throughout the period from 1991 to 2006. Therefore we cannot easily follow up on modifications that pertain to basic area units, the indicators that comprise the index, or how they are combined.

The intent of this paper is to remedy that deficiency and to respond to index users' requests in this reg…

Premature mortality caused by cancer and the public health challenge it represents have given rise to a myriad of studies on the contribution of material and social living conditions to varying risks of morbidity and mortality. Thus, European and American

Premature mortality caused by cancer and the public health challenge it represents have given rise to a myriad of studies on the contribution of material and social living conditions to varying risks of morbidity and mortality. Thus, European and American studies have shown that cancer mortality—and some cancers more than others—often hits disadvantaged socioeconomic groups and regions hardest, and that this relationship persists even when individual behavior is taken into account. Numerous studies have focused mainly on men, who are easier to characterize socioeconomically than women. Indeed, it has proven difficult to determine the socioeconomic position of women, and the indicators used are often inadequate. An examination of the social health inequalities between the sexes shows that the mortality is sensitive to the inequality measure, the causes of mortality differ for men and women, these inequalities are generally less pronounced among women, and the social condition of wome…

Trauma and deprivation in Quebec

Studies show a relationship between social inequality and intentional and unintentional trauma (Marmot et al., 1999; Leclerc et al., 2000). This relationship is poorly understood in Quebec, however, since data on trauma is derived primarily from administrative files (for death and hospitalization), which contain no information on the socioeconomic status of trauma victims.

The recent development of a deprivation index that can be used with these files enables us to at least partially fill this information gap (Pampalon et al., 2000). In this brief paper, we seek to determine whether material and social deprivation is associated with death and hospitalization due to intentional and unintentional trauma in Quebec.

In Quebec, material and social deprivation are strongly associated with trauma. While UT (mostly road traffic accidents) is affected by material deprivation, IT (suicide and homicide) is affected in equal measure by the social and material components. Social…