Inequalities in health within the health sector.

Mortality among men employed in the health sector was examined using data surrounding the 1971 (1970-2) and 1981 (1979-83) censuses to assess the differences between social classes in the health service and to study changes over a decade. Relative to men in England and Wales, mortality in the 1980s was significantly lower among dentists (standardised mortality ratio 66), doctors (69), opticians (72), and physiotherapists (79) and significantly higher among hospital porters (151), male nurses (118), and ambulancemen (109). Mortality from lung cancer among hospital porters (185) was more than fivefold that seen in doctors (33) and dentists (37). Ischaemic heart disease varied twofold, being lowest in dentists (60) and doctors (70) and highest in hospital porters (138). Over the decade mortality from lung cancer and ischaemic heart disease declined in all groups except hospital porters, ambulancemen, and orderlies. Most groups showed excess deaths from suicides and cirrhosis of the liver. Differences in mortality between health workers in social class I and those in social class IV widened between the 1970s and 1980s and to a greater extent than among the general population. The high mortality of some groups within the NHS, and the fact that differentials between social classes have widened more than in the general population, suggest that the NHS needs to pay more attention to the health of its own staff.     

Latino children's health and the family-community health promotion model

A majority of Latino children in the US live in poverty. However, unlike other poor children, Latino children do not seem to have a consistent association between poverty and poor health. Instead, many poor Latino children have unexpectedly good health outcomes. This has been labeled an epidemiologic paradox. This paper proposes a new model of health, the family-community health promotion model, to account for this paradox. The family-community health promotion model emphasizes the family-community milieu of the child, in contrast to traditional models of health. In addition, the family-community model expands the outcome measures from physical health to functional health status, and underscores the contribution of cultural factors to functional health outcomes. In this paper, we applied the family-community health promotion model to four health outcomes: low birthweight, infant mortality, chronic and acute illness, and perceived health status. The implications of this model for research and policy are discussed.     

Health and the city: physical health and mental health

In France, city size has very little bearing on the mortality rate as a function of age and life expectancy and it is in large cities that these indicators are the most favorable. No increase in maternal or infant mortality rates or deaths due to cancers has been observed in large cities. The lower mortality rate linked to respiratory and cardiovascular diseases in large urban areas contradicts the fears concerning the impact of air pollution. Deaths linked to lifestyle are less frequent in big cities, which could be due to social structures (socio-professional level: the proportion of white-collar workers and professionals is higher in bigger cities than in the suburbs or small cities). However, although the overall mortality rate is lower, it should be emphasized that there is in large cities a greater incidence of sexually transmitted diseases, AIDS and certain infectious diseases (because of social diversity and the fact that certain individuals seeking anonymity and marginality are drawn to large cities). In terms of mental health, the breakdown of family structures, instability, unemployment, the lack of parental authority and failing schools render adolescents vulnerable and hinder their social integration. When the proportion of adolescents at risk is high in a neighborhood, individual problems are amplified and social problems result. In order to restore mental and social health to these neighborhoods, ambitious strategies are necessary which take into account family and social factors as well as environmental ones. At the present time, when physical health is constantly improving, the most pressing problems are those related to lifestyle and mental health which depend for a large part on social factors.     

Migration and health in Canada: health in the global village

Background:

Immigration has been and remains an important force shaping Canadian demography and identity. Health characteristics associated with the movement of large numbers of people have current and future implications for migrants, health practitioners and health systems. We aimed to identify demographics and health status data for migrant populations in Canada.

Methods:

We systematically searched Ovid MEDLINE (1996–2009) and other relevant web-based databases to examine immigrant selection processes, demographic statistics, health status from population studies and health service implications associated with migration to Canada. Studies and data were selected based on relevance, use of recent data and quality.

Results:

Currently, immigration represents two-thirds of Canada’s population growth, and immigrants make up more than 20% of the nation’s population. Both of these metrics are expected to increase. In general, newly arriving immigrants are healthier than the Canadian population, but over time there is a decline in this healthy immigrant effect. Immigrants and children born to new immigrants represent growing cohorts; in some metropolitan regions of Canada, they represent the majority of the patient population. Access to health services and health conditions of some migrant populations differ from patterns among Canadian-born patients, and these disparities have implications for preventive care and provision of health services.

Interpretation:

Because the health characteristics of some migrant populations vary according to their origin and experience, improved understanding of the scope and nature of the immigration process will help practitioners who will be increasingly involved in the care of immigrant populations, including prevention, early detection of disease and treatment.Migration is an important component of globalization. International migration is estimated at 200 million people,¹ and the volume of migration continues to increase. Between 1990 and 2005, global migrants increased by some 33 million people, with the largest growth observed in the developed world. The movement of populations of this size has important implications for health practitioners, health systems² and the health of individuals.^3,4Health status is associated with quality of life and use of formal and informal health services.⁵ Overall, immigrants appear to be healthier than the Canadian-born population, by virtue of being capable, both physically and mentally, of successfully moving themselves, and often their families, from one country to another.⁶ However, over time, this healthy immigrant effect is lost.⁷Health status is not equivalent across all subgroups of immigrants. Certain migrant populations experience a higher risk of infectious diseases, cancer, diabetes and heart disease, which has clinical implications for those providing care to migrant communities.⁶ The health of migrants is a product of environmental, economic, genetic and socio-cultural factors related to when people migrated to Canada, where and how they lived in their original home country, and how and why they migrated. Their health is also influenced by postmigration factors involving integration into their new place of residence, employment, education and poverty, as well as the accessibility and responsiveness of health practitioners and responsiveness of the Canadian health care system to immigrants’ health needs.⁸Migration medicine is complicated by the use of similar terms, such as immigrant, refugee or migrant, for what are, in reality, different populations. This article will use standard Canadian immigration terminology. To help primary care practitioners interpret the clinical preventive recommendations of the Canadian Collaboration for Immigrant and Refugee Health, we aimed to identify demographics, health status reports, access to health care and health system implications of migrant populations in Canada.     

On the measurement of health and its effect on the measurement of health inequality

We examine the extent to which self-reported health measures suffer from income-related reporting heterogeneity and then characterize how this reporting heterogeneity affects the estimation of income-related health inequality. We run a comprehensive set of tests of reporting heterogeneity using several self-reported health measures and several clinical measures of health from the National Health and Nutritional Examination Surveys. We propose the use of a multidimensional measure using clinical indicators of health in the context of measuring income-related health inequality, and we examine the extent of income-related health inequality, as measured by the concentration index, using both self-reported measures of health and the multidimensional clinical measure. Our results confirm the existence of significant, positive, income-related reporting heterogeneity and also suggest that higher income individuals react more strongly to a change in clinical health measures. Using self-assessed health suggests that income-related health inequality is about three times larger than when using more objective, self-reported health measures and ten times larger than when using the multidimensional clinical measure of health.