For our week 6 learning activity in my MHST/ NURS 601: Philosophical Foundations of Health Systems course the class was required to pair up with another classmate from a different province and search for divergence between the two provinces in terms of regional differences in prioritizing the determinants of health. We also were required to find documents that guided each province as well as the priority determinants in each region. For this activity I paired up with Jennifer Cumpsty from Manitoba and we worked together on comparing the regional differences and prioritized determinants of health between Manitoba and Ontario.
The following link is a table showing our direct comparison between the two provinces in terms of the health care system, statistics regarding the determinants of health as well as the priority determinants and how each province addresses health inequities:
https://docs.google.com/document/d/1rLl_lVx5ZCnwdVmQzu8SKuyMBXusjVQy29BcUG40OqI/edit?usp=sharing
Below you will see our key findings regarding the similarities and differences between the two provinces and our interpretations.
Summary of Provincial Health Determinant Similarities and Differences
The population in Ontario and Manitoba are impacted by all the social determinants of health (SODH ) which consist of: Income and Social Status; Social Support Networks; Education and Literacy; Employment/ Working Conditions; Social Environments; Physical Environment; Personal Health Practices and Coping Skills; Healthy Child Development; Biological and Genetic Endowment; Health Services; Gender and Culture. Key similarities and differences have been observed between the two provinces with regards to the following health inequities from these SDOH: population specifically the immigrant and aboriginal population and colonization, urbanization, unemployment and poverty, and life expectancy which all correlate with one another as described below.
The Ontarian and Manitoban Population
The population of Ontario is ten times that of Manitoba. In both provinces the majority of the population is urban versus rural. For instance, in Ontario 40.0% of its population growth occurred in the Greater Toronto Area and 57.1% of the Manitoba population growth occurred in Winnipeg both of which are or around the capital cities of each province. One difference is that while Ontario’s urban population is spread across many cities, the majority of Manitoba’s population lives in Winnipeg. Both provinces are organized similarly with local health networks or regional health authorities. However, given that the majority of the provincial population is located within the city of Winnipeg, the Winnipeg Regional Health Authority (WRHA) is responsible for the majority of health delivery for the province. The WRHA is also home to the provincial trauma center and numerous specialty services for the province. There are provincial approaches to identifying and prioritizing the SDOH but in Manitoba the WRHA also identifies and prioritizes SDOH within its catchment. On the other hand, Ontario has 14 Local Health Integration Networks (LHINs) spread out to the different regions of the province which plan, integrate and fund their local health care and improve access and patient experience.
Ontario becomes home to the majority of immigrants to Canada. Ontario has 53.3% of Canada’s immigration population compared to Manitoba’s which has 5.55%.
In Manitoba the Aboriginal Population is 17% of the provincial population, in Ontario it is 2.4% while the national average is 5.6%. For Manitoba this means that a large proportion of the population’s health has been both directly and indirectly impacted by the effects of colonization. It is a large focus for prioritizing health at both the provincial and regional level in Manitoba. In Ontario, the aboriginal population is younger than the non-aboriginal population with a median age of 31.1 years compared to 40.2 years this is too seen in Manitoba with 56% of the aboriginal population being under the age of 25 compared to only 33% of the Manitoba population overall.
The unemployment rates in Ontario are higher than the national rates of 7.1% and 13.7% respectively. In Manitoba this was 5.6% in 2015 which was below the national average. The unemployment rate for off-reserve Aboriginals in Manitoba was 10.2% however.
In Ontario over 13% of the population lives on a low income with the highest proportion under the age of 18. In Manitoba about 11-14% of the total population lives in poverty and it has been estimated that food banks provide nourishment for about 20 000 children a month in Winnipeg. Furthermore, In Manitoba, individuals of lower income are 1.9 x (for those living in urban areas) to 2.9 x (for those living in rural areas) more likely to die prematurely compared to those with higher income. Lastly. In Winnipeg, lower socioeconomic areas have a 19 year life expectancy difference compared to those in higher socioeconomic areas.
Interpretation of Health Inequities
After analyzing the data found for the health of Ontarians and Manitobans the following conclusions with regards to the populations health inequities were observed:
Living in lower socioeconomic areas is directly associated with a decrease life expectancy and living in higher socioeconomic areas is associated with an increase in life expectancy.
Living in urbanized areas can be associated with lower income and poverty as there is an increased population in these areas which can contribute to a decreased availability of jobs rate. Also, the cost of living in these areas are higher compared to rural areas.
Colonization in Manitoba has led to specific health care needs in mental health, substance abuse, homelessness, suicide, infectious disease, diabetes, disruption of attachment, sense of disconnect to the community, weakened sense of culture identity and poverty. Although the population of aboriginal’s in Ontario is significantly smaller, it does not necessarily mean that this population is not affected by these health inequities as those in Manitoba. Due to a smaller population, these individuals may not be prioritized and their health needs may be overlooked however, they all still faced colonization.
The greater immigration population in Ontario and the greater aboriginal population in Manitoba can also be associated with the increase of unemployment rates. For the Ontario population, this inequity is more multilayered as there are complications with job availability and security seen in Ontario. Also, it is widely seen that immigrants are unable to obtain work as they are told that they lack credentials. As for Manitoba the effects of colonization can be associated with the unemployment rates.
What determinants of health are prioritized in your region?
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