Financial Crisis and Health Equity in Ontario

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The Financial Crisis and Health Equity in Ontario: Key Pathways and Policy Challenges Arne Ruckert

Abstract
This working paper explores the impacts of the financial crisis on health equity in Ontario. It proposes a research framework and identifies key pathways by which the financial crisis has begun to impact the social determinants of health. In doing so, it attempts to contribute to a better understanding of the various ways in which global forces are shaping SDH in Ontario in the aftermath of the financial crisis. The paper first reviews the existing literature on globalization and SDH. It then discusses the impact of the financial crisis on SDH in Ontario and identifies causal pathways that link the financial crisis to SDH, especially changes in employment conditions and budgetary challenges in the realm of fiscal policy. It next assesses empirically the development of the most equity-relevant SDH since the beginning of the financial crisis in Ontario, demonstrating that a number of new health equity challenges are currently emerging as the social fabric of Ontario is being strongly undermined. It next reviews the on-going policy response of the Ontario government to the financial crisis, discussing its possible health-equity implications. It concludes by suggesting that the financial crisis and the policy response to it will largely determine the extent to which SDH will either improve or deteriorate in Ontario in the near future, with important implications for health equity. It finally raises a range of issues and questions that require further research and conceptual clarification.

Acknowledgements:
This research was made possible through the Emerging Researcher Award provided by the Population Health Improvement Research Network (PHIRN), with funding from the Ontario Ministry of Health and Long-term Care.

Introduction
Health equity has recently become a central concern in health research, as the tenacity of health disparities in countries around the world has been identified as one of the most serious public health threats of the 21st century (Edwards & Di Ruggiero, 2011). Health inequities prevent people from achieving their full potential and living healthy and productive lives. As the WHO Commission on Social Determinants of Health (CSDH) recently put it: “Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death” (CSDH, 2008, p.iii). In Canada, health equity concerns have started to receive attention from policy-makers at both the federal and provincial level, and a wide-ranging interdisciplinary field of health equity research has been established (for a scoping review of population health research in Ontario, see PHIRN, 2011). Health equity was initially introduced at the federal level of politics in Canada, for example, in the first annual report of Canada’s Chief Public Health Officer (Government of Canada, 2008), which targeted health inequities and noted the importance of policy intervention in improving health outcomes. However, health equity concerns have recently found entry into provincial health discussions, with the Government of Ontario recognizing in its Poverty Reduction Strategy social inequalities as important to health outcomes (Government of Ontario, 2008). Health equity is defined by the WHO as the absence of systematic differences in health, between and within countries that are avoidable by reasonable action (CSDH, 2008, p.1). Similarly, in a widely cited paper on The Concepts and Principles of Equity, Whitehead defines health inequities as differences in health that are unnecessary, avoidable, unfair and unjust (1992). A more operational definition of health equity was provided in 2003 by Braveman and Gruskin, which suggest that for the purpose of measurement, “health equity can be defined as the absence of systematic disparities in health (or in the major social determinants of...
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