The Unequal City: Income and Health Inequalities in Toronto (2008)

Yesterday, Toronto's Medical Officer of Health unveiled a report on health inequities in the City of Toronto.

The report can be viewed here: http://www.toronto.ca/health/map/pdf/unequalcity_20081016.pdf

Here is the Executive Summary of the report:

This report presents new data for Toronto showing a clear link between health and income across our city. Those areas of Toronto that have a greater proportion of people living with low income experience greater risk factors for illness, higher rates of disease, and death at an earlier age. Areas with a smaller proportion of low income - areas that are relatively richer - have better health. These differences are referred to as health inequalities.

A number of the health inequalities in this report are cause for concern. For example, when compared to residents of high income areas, lung cancer incidence was 1.5 times higher for males in the lowest income quintile; the gonorrhoea rate among female youth was 3.5 times higher in the lowest income quintile; and the percentage of female adults whose last visit to the dentist was more than three years ago was about 4 times greater in the lowest income group.



The report also shows that males in the highest income areas were expected to live 4.5 years longer than males in the lowest income areas. The difference for females was 2.0 years.

The relationship between income and health in Toronto exists for a wide range of health indicators and is consistent with trends found in other jurisdictions. While the picture that emerges from the data is one of significant inequality, for reasons explained in the report, the true differences in health associated with income in Toronto are likely even greater than those documented here.

While the focus in this report is on income, health inequalities are also associated with other social determinants such as racialization, immigration and settlement status, and education. These determinants are linked to and interact with income to influence health. Evidence showing the racialization of poverty in Toronto is one important example of other related factors.

The relationship between income and health in Toronto is not just about the extremes of wealth and poverty. As the data in this report show, for most indicators there is a continuous gradient of health in relation to income - health status improves through each income increment. Toronto residents who live in high income areas are healthier than those living in middle income areas, and those who live in middle income areas are healthier than those living in low income areas. This means that health inequalities affect all Torontonians.

One way of illustrating the impact of health inequalities on the overall health of Toronto’s population is to calculate the effect if everyone was as healthy as those with the highest income and best health. Based on the methods used, this would result in:

• nearly 1,100 (18%) fewer premature deaths;
• about 1,300 (20%) fewer low birth weight babies;
• about 1,600 (30%) more children ready to learn at school entry;
• nearly 1,000 (46%) fewer teen pregnancies; and
• more than 30,000 (about 13%) fewer male smokers.

Recent trends toward increasing polarization of income distribution in Toronto raise concerns that the health inequalities documented here may lead to a decline in the overall health status of the city’s population.

The health inequalities documented in this report should be seen as unacceptable in a society that places a high value on equal access to good health. These differences represent a missed opportunity to achieve better health for the city as a whole. The reduction of income inequality and measures to reduce poverty should be pursued as priority health strategies. Services such
as those provided by Toronto Public Health should be designed to mitigate the impact of income on health by ensuring equal access to universal services and by focusing on reaching people with greater health needs. More information about health inequalities in Toronto must be gathered and analyzed to help guide service delivery, to monitor trends, and to evaluate the effectiveness of interventions.

Changing the patterns of health and income that are described in this report is not the purview of any single agency or level of government. Toronto Public Health will advocate for urgent and comprehensive public policy responses and will collaborate with many others to continue to address the health inequalities that are linked to income and other determinants of health.

Recommendations:

1. The Medical Officer of Health report regularly to the Board of Health on key health inequality indicators for the City of Toronto;

2. The Medical Officer of Health consult with community partners and the Board of Health to incorporate appropriate strategies to reduce health inequalities in the next Toronto Public Health Strategic Plan (2010- 2014) and annual service plans, including measures to monitor progress on reducing health inequalities;

3. The Toronto Board of Health send this report to the Premier of Ontario and strongly urge the government to maintain its stated commitment to poverty reduction in Ontario as a public health measure; and

4. The Medical Officer of Health review Toronto Public Health data collection practices and collaborate with partners to strengthen the monitoring of the impact of social determinants on health, including racialization, immigration and settlement status, education and income.