A public health care system aims to eliminate health disparities. Canadian provinces provide universal coverage for basic medical care, but does this eliminate socioeconomic disparities in health and medical care use? We here evaluate the importance of socioeconomic characteristics of individuals and their residential neighbourhoods on health outcomes. We obtained individual-level socioeconomic status (SES) and risk factor information from the 1990 Nova Scotia Nutrition Survey (N=2198) and neighbourhood SES characteristics from the 1991 Canada Census. Data on mortality and medical care use were available through linkage to the vital statistics registry and province-wide hospital and physician services databases (1990-1998). Our multivariate and multilevel analyses revealed that individuals of higher SES (income and education) experienced lower mortality and used less medical care (differences were statistically significant and adjusted for age and sex). Variations in health and medical care use were differential for low and high SES neighbourhoods; in particular, the importance of individual SES characteristics for mortality and medical care use was stronger in high SES neighbourhoods. These findings support the suggestion that persons of higher SES fare better healthwise and use less medical care because of better personal preventive strategies. We speculate that these personal preventive strategies have a stronger impact in higher SES neighbourhoods than in lower SES neighbourhoods. Overall, a public health care system may eliminate the major financial barriers to access but does not in itself eliminate disparities in health.
Learning Objectives: 1. Describe general association between socioeconomic indicators and health and medical care use; 2. Recognize that socioeconomic differences in health and medical care use are determined by both individual and neighborhood characteristics; 3. Discuss the challenges faced by public policy makers in reducing health disparities among socioeconomic groups
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.