Income

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"Newsflash: it's unhealthy to be poor" This is the title of a news item in a 1998 issue of the journal of the Canadian Medical Association. It refers to the release of the annual report of the Regional Council for Health and Social Services that indicated that "poor Montrealers can expect to live 5 fewer years than those with higher incomes" (Wharry 1998).

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The geography of income distribution in Canada can be illustrated in many different ways (refer to Income Measures: Methodological Note). Elsewhere in the Atlas, median income measures are shown. Here, average values, derived from the 1996 Census of Population, are mapped for males and females. In addition, the proportions of private-household Canadians (as reported in the 1996 Census) who fall below the low income cut-off (LICO) values are mapped.

Health and Income Relationships

Canada does not have an official measure of poverty (Fellegi 1997). However, many government and non-government agencies and groups use various measures of individual or family income as a surrogate measure of poverty. Income is widely accepted as one of the most influential non-medical determinants of health. While the precise mechanisms for income-health relationships are less well known, common threads of these relationships have been identified.

• income is the single most important modifiable determinant of health
• the link between poverty and ill-health is clear: with few exceptions, the financially worst-off experience the highest rates of illness and premature death
• greater income inequality within society may be associated with increased overall mortality
• health improves at each step up the income ladder
• health improves with both a higher absolute average income and a more even income distribution
• higher incomes somehow act as a shield against disease

Illustrations of some of these relationships can be drawn from the 1996 to 1997 National Population Health Survey. For these analyses, five income adequacy categories have been collapsed to three: Low = lowest income and lower middle income; Medium = middle income; High = upper middle income and highest income. Respondents were asked to rate their health in terms of whether it was poor to excellent. Figure 1 (Self-rated Health Status and Income Adequacy Classes) indicates that Canadians generally consider that their health is very good to excellent. Notably, this self-rated health status improves from low to high income adequacy. That pattern is common for Canada as a whole and by province (Figure 2 Proportion of Population Whose Self-Rated Health Status is Very Good/Excellent by Income Adequacy Classes).

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Figure 1. Self-Rated Health Status and Income Adequacy Classes

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Figure 2. Proportion of Population Whose Self-Rated Health Status is Very Good/Excellent by Income Adequacy Classes

This pattern is confirmed when one examines the occurrence of most illnesses. The 1996 to 1997 National Population Health Survey asked respondents to indicate, among other things, whether they suffered from a chronic health condition (e.g. chronic bronchitis or emphysema, heart disease, arthritis, diabetes). As one might expect, the highest proportions of Canadians with chronic conditions occur in the low income adequacy category (Figure 3 Proportion of Population with Chronic Conditions by Income Adequacy Classes).

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Figure 3. Proportion of Population with Chronic Conditions by Income Adequacy Classes