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The Link between Income Inequality and Access to Health(care)

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In this webinar:
Many factors influence the ability of individuals to perceive their need for healthcare and to seek appropriate and timely treatment. The focus of this webinar is to describe what we mean by income inequalities and to illustrate how rising levels of income inequality negatively influence the ability of people to achieve good health by impacting access to care.

Presented by:
Dr. Ambreen Sayani, MD, MSc, Ph.D. (c), is a surgeon by training and has worked closely with cancer patients and their families. At present, Ambreen’s research is focused on the interface between social and health equity, and its implications for cancer risk, treatment, and survival. Ambreen is a member of the Equity Advisory Committee for the Canadian Partnership Against Cancer, and she is a Community Ambassador for the Region of Peel’s Diversity, Equity and Inclusion Charter. Ambreen works at the MAP-Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto; and has recently been awarded the Skinner Agent of Change Leadership Award by the Faculty of Health at York University, Toronto.

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The Link between Income Inequality and Access to Health(care)

  1. 1. The Link between Income Inequalities and Access to Health(care) Dr. Ambreen Sayani, MD, MSc, PhD (c) June 27th, 2019 MAP- Centre for Urban Health Solutions, St. Michael’s Hospital; and York University, Graduate Program in Health Policy and Management
  2. 2. Session outline Setting the context Access to health(care) Examples in cancer care 1
  3. 3. Session outline Setting the context Access to health(care) Examples in cancer care 1 • Put lived experience into perspective; • Use lung cancer as an example
  4. 4. Setting the context Access to health(care) Examples in cancer care Session outline 2
  5. 5. Setting the context Access to health(care) Examples in cancer care Session outline 2 • What do we mean by the term access? • How is access in health(care) understood?
  6. 6. Setting the context Access to health(care) Income inequalities Session outline 3
  7. 7. Setting the context Access to health(care) Income inequalities Session outline 3 • How do income inequalities influence the way people interact with the health system? • What can and needs to be done about it?
  8. 8. The give(s) and take(s) of the session Q/A at the end Polls Key concepts Call to action
  9. 9. Source: Canadian Cancer Statistics Advisory Committee. (2018). Canadian cancer statistics 2018. SETTING THE CONTEXT: Cancer
  10. 10. SETTING THE CONTEXT: LUNG CANCER Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.
  11. 11. SETTING THE CONTEXT: LUNG CANCER Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.
  12. 12. SETTING THE CONTEXT: LUNG CANCER Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.
  13. 13. SETTING THE CONTEXT: LUNG CANCER Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.
  14. 14. SETTING THE CONTEXT: LUNG CANCER Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.
  15. 15. SETTING THE CONTEXT: LUNG CANCER Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.
  16. 16. Age-standardized mortality rates for lung cancer by neighbourhood income, female, urban Canada, 1971-2001 Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities SETTING THE CONTEXT: INCOME AND LUNG CANCER
  17. 17. A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S
  18. 18. A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S
  19. 19. A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S
  20. 20. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation) A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S
  21. 21. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation) Smoking Smoking cessation Screening Incidence Treatment Mortality Source: Jarvis, M. J., & Wardle, J. (2005). Social patterning of individual health behaviours: the case of cigarette smoking. In M. Marmot & R. G. Wilkinson (Eds.), Social Determinants of Health. Oxford: Oxford University Press.
  22. 22. SETTING THE CONTEXT: INCOME AND LUNG CANCER Smoking Smoking cessation Screening Incidence Treatment Mortality Source: Kotz, D., & West, R. (2009). Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding. Tobacco Control, 18(1), 43–46.
  23. 23. SETTING THE CONTEXT: INCOME AND LUNG CANCER Smoking Smoking cessation Screening Incidence Treatment Mortality Source: Schütte, S., Dietrich, D., Montet, X., & Flahault, A. (2018). Participation in lung cancer screening programs: are there gender and social differences? A systematic review. Public Health Reviews, 39.
  24. 24. SETTING THE CONTEXT: INCOME AND LUNG CANCER Smoking Smoking cessation Screening Incidence Treatment Mortality Source: Mitra, D. (2015). Social determinants of lung cancer incidence in Canada: A 13-year prospective study. Health Reports, 26(6), 11.
  25. 25. SETTING THE CONTEXT: INCOME AND LUNG CANCER Smoking Smoking cessation Screening Incidence Treatment Mortality Source: Crawford, S. M., Sauerzapf, V., Haynes, R., Zhao, H., Forman, D., & Jones, A. P. (2009). Social and geographical factors affecting access to treatment of lung cancer. British Journal of Cancer, 101(6), 897–901.
  26. 26. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation) Smoking Smoking cessation Screening Incidence Treatment Mortality Source: Hart, C. L., Hole, D. J., Gillis, C. R., Smith, G. D., Watt, G. C., & Hawthorne, V. M. (2001). Social class differences in lung cancer mortality: risk factor explanations using two Scottish cohort studies. International Journal of Epidemiology, 30(2), 268–274.
  27. 27. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation) Smoking Smoking cessation Screening Incidence Treatment Mortality Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities
  28. 28. Age-standardized mortality rates for lung cancer by neighbourhood income, female, urban Canada, 1971-2001 Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities ACCESS TO CARE: THE CANADA HEALTH ACT
  29. 29. Age-standardized mortality rates for lung cancer by neighbourhood income, female, urban Canada, 1971-2001 Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities ACCESS TO CARE: THE CANADA HEALTH ACT
  30. 30. Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system: achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8 ACCESS TO CARE: What is covered in our basket of care?
  31. 31. ACCESS TO CARE: What is covered in our basket of care? Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system: achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8
  32. 32. ACCESS TO CARE: What is covered in our basket of care? Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system: achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8
  33. 33. ACCESS TO CARE: What is covered in our basket of care? Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system: achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8 Our basket of care is NARROW and DEEP
  34. 34. • 5. Accessibility (section 12) • The intent of the accessibility criterion is to ensure that insured persons in a province or territory have reasonable access to insured hospital, medical, and surgical-dental services on uniform terms and conditions, unprecluded or unimpeded, either directly or indirectly, by charges (extra-billing or user charges) or other means (e.g., discrimination on the basis of age, health status or financial circumstances). ACCESS TO CARE: How is accessibility defined in the Act? Source: Government of Canada. (2019a). Canada Health Act Annual Report 2017-2018 [Acts]
  35. 35. • 5. Accessibility (section 12) • The intent of the accessibility criterion is to ensure that insured persons in a province or territory have reasonable access to insured hospital, medical, and surgical-dental services on uniform terms and conditions, unprecluded or unimpeded, either directly or indirectly, by charges (extra-billing or user charges) or other means (e.g., discrimination on the basis of age, health status or financial circumstances). ACCESS TO CARE: How is accessibility defined in the Act? Source: Government of Canada. (2019a). Canada Health Act Annual Report 2017-2018 [Acts]
  36. 36. POLLING STATION Q. Do you think the way accessibility is described in the Canada Health Act matches our current basket of care? A. Yes/ No
  37. 37. POLLING STATION Q. Do you think the way accessibility is described in the Canada Health Act matches our current basket of care? A. Yes/ No • 5. Accessibility (section 12) • The intent of the accessibility criterion is to ensure that insured persons in a province or territory have reasonable access to insured hospital, medical, and surgical-dental services on uniform terms and conditions, unprecluded or unimpeded, either directly or indirectly, by charges (extra-billing or user charges) or other means (e.g., discrimination on the basis of age, health status or financial circumstances). Source: Government of Canada. (2019a). Canada Health Act Annual Report 2017-2018 [Acts]
  38. 38. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  39. 39. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  40. 40. ENTRY Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  41. 41. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  42. 42. SEEK Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  43. 43. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  44. 44. OUTCOME Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  45. 45. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  46. 46. NEED UTILIZATION Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  47. 47. ACCESS TO CARE: A system which is responsive to needs Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18.
  48. 48. ACCESS TO CARE: The interface between patient need and systems supply Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
  49. 49. ACCESS TO CARE: What constitutes need? Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
  50. 50. ACCESS TO CARE: What does David need? Source: (i) Sayani, A and Lofters, A (Work in progress) Barriers and facilitators to lung cancer screening for high-risk individuals living with low income in downtown Toronto, Canada; and (ii) Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64. A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S
  51. 51. INCOME INEQUALITY AND CANCERS: The social location influences access to care • Breast cancer Sayani, A. (2017). Socially based inequities in breast cancer care: intersections of the social determinants of health and the cancer care continuum. Women’s Health & Urban Life: An International and Interdisciplinary Journal, 13(1) • Hereditary breast cancer Sayani, A. (2018). Inequities in genetic testing for hereditary breast cancer: Implications for public health practice. Journal of Community Genetics, 1–5. • Lung cancer Sayani, A and Lofters, A (Work in progress) Barriers and facilitators to lung cancer screening for high-risk individuals living with low income in downtown Toronto, Canada • Social class and health inequalities Sayani A. (in press), Social Class and Health Inequalities, Bryant, T., Raphael, & Rioux, M. H. (Eds), In Staying Alive: Critical Perspectives on Health, Illness and Healthcare, 3rd edition. Toronto: Canadian Scholars Press Inc.
  52. 52. POLLING STATION Q. Which of the following statements about income inequality resonates most with you? a. I am not familiar with the topic of income inequality; b. I have come across the term income inequality; c. Income inequality is a pressing challenge of our times; d. It is an academic concept with little to no relevance in the real world.
  53. 53. Income inequality is the extent to which income is distributed unevenly in a country. INCOME INEQUALITY
  54. 54. Source: Government of Canada, Statistics Canada. (2017b, September 13). Household income in Canada: Key results from the 2016 Census. INCOME INEQUALITY: How is our Canadian income pie split? $$$$$ 49% $$$$ 22% $$$ 14% $$ 9% $ 6% HOUSEHOLD WEALTH BY INCOME QUINTILE $$$$$ $$$$ $$$ $$ $
  55. 55. Source: Government of Canada, Statistics Canada. (2017b, September 13). Household income in Canada: Key results from the 2016 Census. $$$$$ 49% $$$$ 22% $$$ 14% $$ 9% $ 6% HOUSEHOLD WEALTH BY INCOME QUINTILE $$$$$ $$$$ $$$ $$ $ INCOME INEQUALITY: How is our Canadian income pie split?
  56. 56. Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story. INCOME INEQUALITY: Whose income has increased?
  57. 57. Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story. INCOME INEQUALITY: Did we all gain equally?
  58. 58. Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story. INCOME INEQUALITY: Did we all gain equally?
  59. 59. Source: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story. INCOME INEQUALITY: What is driving the gap?
  60. 60. Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010). The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58. INCOME INEQUALITY: What is driving the gap?
  61. 61. INCOME INEQUALITY: What is driving the gap? Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010). The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.
  62. 62. INCOME INEQUALITY: What is driving the gap? Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010). The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.
  63. 63. Source: Conference board of Canada. (2011). Canadian Income Inequality, Is Canada becoming more unequal? INCOME INEQUALITY: The GINI index
  64. 64. INCOME INEQUALITY: What’s the problem?
  65. 65. SHI GDP Social Health Index: • Infant mortality • Child abuse • Child poverty • Teen suicide • Drug abuse • School drop-out • Unemployment • Weekly earnings • 65+yrs in poverty • Out-of-pocket health expense • Homicides • Alcohol-related fatalities • Social assistance use • Affordable housing • Gap between rich and poor Source: Raphael, D. (2000). Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health, 10(2), 193–216. INCOME INEQUALITY: The Social Health Index (SHI) and Gross Domestic Product (GDP)
  66. 66. INCOME INEQUALITY: Increasingly visible
  67. 67. INCOME INEQUALITY: Increasingly visible
  68. 68. INCOME INEQUALITY: Increasingly visible
  69. 69. INCOME INEQUALITY: Increasingly visible
  70. 70. Trust Social capital Social unrest Volatility “The social compact is starting to unravel in many countries…..Uncertainty and fears of social decline and exclusion have reached the middle classes in many societies.” OECD Secretary-General Angel Gurría. Health inequities INCOME INEQUALITY: What’s the problem?
  71. 71. Trust Social capital Social unrest Volatility “The social compact is starting to unravel in many countries…..Uncertainty and fears of social decline and exclusion have reached the middle classes in many societies.” OECD Secretary-General Angel Gurría. Health inequities INCOME INEQUALITY: Focus on health
  72. 72. INCOME INEQUALITY AND ACCESS: It is a double-edged sword ~ Cuts to supply, and complex needs Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
  73. 73. INCOME INEQUALITY AND ACCESS: It is a double-edged sword ~ Cuts to supply, and complex needs Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
  74. 74. INCOME INEQUALITY AND ACCESS: It is a double-edged sword ~ Cuts to supply, and complex needs Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
  75. 75. Source: (i) Sayani, A and Lofters, A (Work in progress) Barriers and facilitators to lung cancer screening for high-risk individuals living with low income in downtown Toronto, Canada; and (ii) Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64. INCOME INEQUALITY AND ACCESS: What does David need? A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S
  76. 76. Source: (i) Sayani, A and Lofters, A (Work in progress) Barriers and facilitators to lung cancer screening for high-risk individuals living with low income in downtown Toronto, Canada; and (ii) Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64. INCOME INEQUALITY AND ACCESS: What does David need? A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S Living and working conditions
  77. 77. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64. Living and working conditions
  78. 78. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64. Living and working conditions
  79. 79. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64. Living and working conditions
  80. 80. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64. Living and working conditions
  81. 81. Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy- moving-from-equality-to-liberation/equality-equity-liberation/ THINKING OF ACCESS IN DIFFERENT WAYS
  82. 82. 1. Are we thinking about input and giving everyone the same? Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy- moving-from-equality-to-liberation/equality-equity-liberation/ THINKING OF ACCESS IN DIFFERENT WAYS
  83. 83. 1. Are we thinking about input and giving everyone the same? 2. Are we thinking about outcomes and considering different needs? Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy- moving-from-equality-to-liberation/equality-equity-liberation/ THINKING OF ACCESS IN DIFFERENT WAYS
  84. 84. 1. Are we thinking about input and giving everyone the same? 2. Are we thinking about outcomes and considering different needs? 3. Are we thinking structurally and aiming to remove structural barriers? Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy- moving-from-equality-to-liberation/equality-equity-liberation/ THINKING OF ACCESS IN DIFFERENT WAYS
  85. 85. In summary • Income inequality is a measure of the uneven distribution of wealth and is structured by the social and economic policies of the jurisdiction where we live; • Income inequalities cause social inequalities and these eventually influence the risk factors for disease, as well as hinder the ability to access healthcare; • In Canada, lower income groups suffer distinctly poorer cancer-related health outcomes; and whilst there are a variety of reasons for this, healthcare access (utilization) is an important determinant of outcomes and must be contextualised as such. INCOME INEQUALITY AND ACCESS TO HEALTHCARE
  86. 86. Remember • Income inequality is NOT inevitable, it occurs as result of social and political choices. • This means that we can make better choices moving forward. CALL TO ACTION
  87. 87. What can we do? • Recognise the forces that create income inequality; • Understand how income inequality runs through the whole of society impacting everyone not just the most deprived; • Improve communication between different sectors regarding the implications of income inequality; • Use the media to educate Canadians about the consequences of income inequality; • Lobby governments to maintain community, health and social services that positively affect health and well-being; • Resist cut in public health and social spending; • Advocate for a health-in-all policies approach. Source: Raphael, D. (2000). Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health, 10(2), 193–216. LETS WORK TOGETHER
  88. 88. Thank you • Q/A • Email: asayani1@yorku.ca TOGETHER WE CAN MAKE TOMORROW BETTER
  89. 89. Canadian Cancer Survivor Network Contact Info 1750 Courtwood Crescent, Suite 210 Ottawa, ON K2C 2B5 Telephone / Téléphone : 613-898-1871 E-mail: jmanthorne@survivornet.ca or info@survivornet.ca Website: www.survivornet.ca Twitter: @survivornetca Facebook: www.facebook.com/CanadianSurvivorNet Instagram: @survivornet_ca Pinterest: http://pinterest.com/survivornetwork/
  90. 90. Shop4Charity Thank you so much for tuning into our webinar today. If you enjoyed it and would like to further support CCSN, please consider participating in our Shop4Charity initiative!

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