1. Invest in Measures to Reduce Health Inequities by Addressing the Social Determinants of Health

In September 2009, BCHLA launched its report Healthy Futures for BC Families – Policy Recommendations for Improving the Health of British Columbians which included 45 recommendations to help improve health outcomes in BC and ease the burden on the health care system by addressing the underlying social determinants and health inequities which continue to persist.

The social determinants of health include the basic financial resources and supportive environments necessary for a healthy life. Access to income, affordable housing, healthy food, education, early childhood development, and recreational opportunities influence our ability to make healthy choices and ultimately the state of our physical and mental health as well as life expectancy. These ‘social determinants’ are responsible for almost half of the variation in health outcomes within society and therefore act as a significant driver of health care costs.¹  

1.1 Establish targets, investments and actions to improve health equity

BCHLA recommends that the BC government establish targets, investments and actions directed by an integrated plan that works toward improving health equity in BC.

BCHLA recommends that the BC government commit to reducing the burden of chronic disease by addressing health inequities with the establishment of targets for improving health outcomes of British Columbians of lower socio-economic status. A good start would be to establish the following targets:

• By 2017, a 50% reduction in the number of children and their families living in poverty; and
• By 2017, an improvement of 20% in the health status of children in BC (0 to 16 years) as measured by infant mortality, morbidity, premature mortality, and healthy weights and reduction in risk factors which contribute to childhood disease and ill health.

By supporting conditions in which today’s and tomorrow’s children can aspire to healthier lives, it should be possible to lessen the load on the health care system itself and reduce the rate of growth of health care spending. Specific targets, an action plan, investments and designated leadership are required to reach this goal.

1.2 Subject all new policies, spending and programs to an equity lens

BCHLA recommends that the BC government require all ministries to subject new policies, spending and programs to a health equity assessment.

At present in Vancouver there can be a ten year difference in life expectancy between the lowest income and the highest income neighbourhoods. BCHLA believes that in order to close this gap and ensure that health outcomes for British Columbians of lower socio-economic status are at the same level as those of higher socio-economic status BC government policies and spending must be subject to a health equity assessment.

The policies and programs of all Ministries whether they be healthy living or agriculture, finance or forestry may impact on some individuals and communities differentially. Just as policies and programs are subject to an environmental impact assessment, they should also be reviewed to highlight how they may impact on the health outcomes of individuals or groups in the province and whether there could be changes in such policies or programs which would improve the more equitable distribution of health and health outcomes for all British Columbians. There are existing methodologies for undertaking such assessment such as the 2004 framework published by the Australasian Collaboration for Health Equity Impact Assessment.²  

1.3 Establish a Poverty Reduction Strategy

BCHLA proposes that the BC government commit to and fund a poverty reduction strategy.

Sufficient income allows access to adequate housing, nutritious foods, safe communities and participation in recreation, educational and cultural opportunities as well as other essentials for a healthy life.³

Within an overall integrated health equity plan, it will be necessary to implement a strategy to reduce poverty in British Columbia. It is important to note that five other provinces (Quebec, Ontario, Nova Scotia, Manitoba and Newfoundland and Labrador)  have all adopted poverty reduction strategies which would not only reduce the number of children and families living in poverty but would have, as anticipated outcomes, improved health for their citizens.

A recent study⁴  highlights that “Quebec’s antipoverty strategy, formalized as law in 2002, has led to social and health care policies that appear to give its low-income residents advantages in chronic disease prevention”. It reviews that while British Columbia is the healthiest province in Canada overall, “the significant differences in risk of hypertension, diabetes, and heart disease in favour of British Columbia over Quebec for the entire population disappear when considering only the low-income subset”.