CIHI report shows health gaps between neighbourhoods in Canada’s cities

Factors potentially linked to health include a neighbourhood’s average income, as well as social and physical characteristics

November 21, 2006 – The neighbourhood you live in can play a role in your health, according to a new study by the Canadian Population Health Initiative (CPHI) of the Canadian Institute for Health Information (CIHI). The report shows that health differences between neighbourhoods can be just as big as-or sometimes bigger than-differences between Canada’s cities or even between countries.

Improving the Health of Canadians: An Introduction to Health in Urban Places is the first report of its kind to compare health outcomes and behaviours between neighbourhoods within five large cities in Canada: Vancouver, Calgary, Toronto, Montr�al and Halifax. “Eighty percent of Canadians-more than ever before-live in urban areas,” says Cory Neudorf, Chief Medical Officer of Health and Vice-President, Research, Saskatoon Health Region, and Interim Chair of the CPHI Council. “It’s important to understand what aspects of urban life can potentially influence the health and well-being of millions of Canadians.”

Using the 2001 Census from Statistics Canada, the study grouped neighbourhoods according to five characteristics (income, education, recent immigration, people living alone and lone-parent families). Among the key findings:

• In Vancouver, there was a 15-percentage-point gap between neighbourhood groups in the proportion of youth and adults who rated their health as excellent or very good in 2003 (52% to 67%). A similar health gap was observed in the city of Montr�al (53% to 68%). In both Vancouver and Montr�al, the neighbourhoods reporting better self-rated health had a higher percentage of people with postsecondary education, higher-than-average median income and a lower percentage of lone-parent families or people living alone.
• In contrast, there was an 11-percentage-point health gap between the five cities as a whole, with 67% of youth and adults in Calgary reporting their health as excellent or very good, followed by Halifax (63%), Vancouver (59%), Montr�al (58%) and Toronto (56%).
• In general across the five cities, people living in neighbourhoods with higher income and education levels were more likely to be active in their leisure time, less likely to smoke, and more likely to report excellent or very good health. Previous research shows an association between neighbourhood affluence and positive health effects over and above individual income, demographic and health-related behaviours.
• The study also found that physical characteristics of neighbourhoods, such as a neighbourhood’s location, were related to health. For example, the proportion of people reporting that they were overweight or obese (based on a body mass index of 25 or more) tended to be lower in urban neighbourhoods situated close to downtown.
• Injury rates differed by neighbourhood in two of the five cities: Toronto and Vancouver. In these cities, people living in neighbourhoods that had a higher-than-average percentage of recent immigrants and/or percentage of lone-parent families were less likely to report having had an injury in the past 12 months. These neighbourhoods also had a lower-than-average median income and an average or lower-than-average percentage of postsecondary graduates. However, rates of injury did not vary significantly between neighbourhoods in Calgary, Montr�al and Halifax.

“Canada’s life expectancy is among the best in the world, but not everyone has the same chances for a long life,” says Jennifer Zelmer, Vice President, Research and Analysis at CIHI. “Differences between regions of Canada—or even between neighbourhoods within a city—can be as large as differences between countries.”

The latest data from the Organisation for Economic Co-operation and Development (OECD) show a 13-year range in life expectancy among member countries. Across Canada, there is a 12-year range of life expectancy among provinces and territories. And previous research shows that there is a more than 10-year range between neighbourhoods within the city of Montr�al.

Today’s report also summarizes what we know and don’t know about what factors were linked to health in urban neighbourhoods. For instance, research suggests that income, social characteristics (such as whether neighbours are willing to help each other), physical characteristics (such as whether a neighbourhood is “walkable”) and housing (such as whether housing is safe, affordable and suitable in size) may all be linked with health at a neighbourhood level.

Health differences between cities

The report also examines the differences between Canada’s 27 largest census metropolitan areas (CMAs):

• Compared to the CMA average, in 2003, people living in Calgary, Edmonton, Winnipeg and St. John’s were more likely to rate their health as excellent or very good. Residents of Toronto, Kingston, Thunder Bay, Greater Sudbury and Windsor, Ontario, as well as Saguenay, Quebec, were less likely to describe their health as very good or excellent. Results for the remaining cities did not differ significantly from the CMA average.
• Residents of Montr�al, Sherbrooke and Qu�bec were more likely than the average to perceive their life as being extremely or quite a bit stressful, whereas those living in urban areas on the East and West Coasts (Halifax, St. John’s, Victoria and Vancouver), as well as in the Prairies (Saskatoon and Winnipeg) tended to report less stress in their lives. Differences were not significant between results for the remaining cities and the CMA average.

Canadian Population Health Initiative

The Canadian Population Health Initiative (CPHI) is part of the Canadian Institute for Health Information (CIHI). CPHI’s mission is to foster a better understanding of the factors that affect the health of individuals and communities and to contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca

Figures

• Figure 1. Differences at the Country, Province, CMA and Neighbourhood Level in Life Expectancy at Birth for Men and Women (Figures 1 and 2 from pages 2 and 3 of the summary report)
• Figure 2. Percentage of Population Reporting Excellent or Very Good Health by CMA, Population 12 Years and Over, 2003 (Figure 4 on page 14 of the report)
• Figure 3. Percentage of Population Reporting Their Life as Extremely or Quite a Bit Stressful, Population 18 Years and Over, 2003 (Figure 6 on page 17 of the report)

Report

• Information about: Understanding Rural Health and Its DeterminantsImproving the Health of Canadians: An Introduction to Health in Urban Places