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Opportunities for Health Equity in Ontario: A Closer Look

Health Quality Ontario’s latest report shows inequities in people’s health risks, care and outcomes based on their income.

Including the voices of patients in the development of high quality care is essential to health system improvement. But how do we ensure that we capture the breadth of that voice?

This question becomes that much more important when we consider that the most vulnerable often struggle to be heard.

We recently gave many of those voices a platform in our latest report, Income and Health: Opportunities for health equity in Ontario, which explores health care inequities across the province in relation to income. Equity is one of the six dimensions of health quality. It’s a key framing lens for the Ministry of Health and Long-Term Care's discussion document: Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario.

Equity is understood as people being able to reach their full health potential – and that means they should receive high quality care that’s fair and appropriate to their needs, no matter where they live or who they are.

But we know this isn’t always the case. Wide variation exists between the poorest and richest in Ontario. We used 17 measures to show many differences in health risks and outcomes. For example, our report shows that the poorest in Ontario are more likely to have shorter lifespans, to be overdue for screening and tests and to suffer from multiple chronic conditions (such as diabetes and a mental illness). And only half of the poorest among us have prescription medication insurance compared to about three-quarters of the richest.

These examples take on a new meaning when we place them into the context of real-life people. We have included several such experiences in our report. There’s Jean, a woman in Parry Sound, who requires four medications to manage her asthma, allergies, stomach problems and depression, but says she can’t afford them. And George, just outside Sudbury, who, caught in a cycle of exhaustion, anxiety and poor nutrition, juggles his everyday work with managing symptoms of post-traumatic stress and hepatitis C. A healthier diet is important to his health but nutrient-rich fruits and vegetables are beyond his budget.

We’ve reported in the past that many people in Ontario are living longer. However, our latest report shows the poorest men in Ontario tend to die an average of more than four years earlier than the richest; similarly, the poorest women die an average of two years earlier than those with higher incomes. We also found that rates of colorectal cancer, for example, are nearly double for the poorest in Ontario (172 cases per 100,000 people compared to 88 per 100,000 for the richest populations). Data like this, and the lived experiences included in our report, show that the poor in Ontario pay for their lower income with their health. Health Quality Ontario’s commitment to equity in the quality agenda extends beyond Income and Health: Opportunities for health equity in Ontario. A few months ago we hosted a conference on equity to help better understand the challenges in Ontario and potential opportunities for improvement. Currently we are working on a plan that will outline how we can help in promoting health equity for all in Ontario.

It’s my hope that this report will inspire more informed discussions on equity as a key dimension of quality of care in Ontario. It’s time that we recognize and break down the barriers to better health.

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