Administrative databases in the Canadian health sector do not contain socio-economic information. To facilitate the monitoring of social inequalities for health planning, this study proposes a material and social deprivation index for Canada. After explaining the concept of deprivation, we describe the methodological aspects of the index and apply it to the example of premature mortality (i.e. death before the age of 75). We illustrate variations in deprivation and the links between deprivation and mortality nationwide and in different geographic areas including the census metropolitan areas (CMAs) of Toronto, Montréal and Vancouver; other CMAs; average-size cities, referred to as census agglomerations (CAs); small towns and rural communities; and five regions of Canada, namely Atlantic, Quebec, Ontario, the Prairies and British Columbia. Material and social deprivation and their links to mortality vary considerably by geographic area. We comment on the results as well as the limitations of the index and its advantages for health planning.

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ObjectiveEnvironmental exposure to food sources may underpin area level differences in individual risk for overweight. Place of residence is generally used to assess neighbourhood exposure. Yet, because people are mobile, multiple exposures should be accounted for to assess the relation between food environments and overweight. Unfortunately, mobility data is often missing from health surveys. We hereby test the feasibility of linking travel survey data with food listings to derive food store exposure predictors of overweight among health survey participants.MethodsFood environment exposure measures accounting for non-residential activity places (activity spaces) were computed and modelled in Montreal and Quebec City, Canada, using travel surveys and food store listings. Models were then used to predict activity space food exposures for 5,578 participants of the Canadian Community Health Survey. These food exposure estimates, accounting for daily mobility, were used to model self-reported overweight in a multilevel framework. Median Odd Ratios were used to assess the proportion of between-neighborhood variance explained by such food exposure predictors.ResultsEstimates of food environment exposure accounting for both residential and non-residential destinations were significantly and more strongly associated with overweight than residential-only measures of exposure for men. For women, residential exposures were more strongly associated with overweight than non-residential exposures. In Montreal, adjusted models showed men in the highest quartile of exposure to food stores were at lesser risk of being overweight considering exposure to restaurants (OR = 0.36 [0.21–0.62]), fast food outlets (0.48 [0.30–0.79]), or corner stores (0.52 [0.35–0.78]). Conversely, men experiencing the highest proportion of restaurants being fast-food outlets were at higher risk of being overweight (2.07 [1.25–3.42]). Women experiencing higher residential exposures were at lower risk of overweight.ConclusionUsing residential neighbourhood food exposure measures may underestimate true exposure and observed associations. Using mobility data offers potential for deriving activity space exposure estimates in epidemiological models.

la fin des années 1990, un indice régional de défavorisation matérielle et sociale a été élaboré pour le Québec. Plus tard, en 2007 et 2008, on l'a étendu à l'ensemble du Canada. L'objectif initial de l'indice était de pallier l'absence d'information socioéconomique dans les bases administratives du secteur de la santé et de décrire, à l'aide de ces bases de données, l'existence et l'ampleur des inégalités sociales de santé. L'indice a été créé, puis développé par des chercheurs du ministère de la Santé et des Services sociaux et de l'Institut de santé publique du Québec. Pour eux, l'indice devait être adapté aux besoins de la recherche, de la planification et des interventions en santé publique. L'indice a été abondamment utilisé au Québec et au Canada au cours de la dernière décennie. Notre intention, dans cet article, est d'en donner une vue d'ensemble en décrivant sa construction et ses nombreux usages. Premièrement, nous présentons le concept, les méthodes et les produits connexes. Deuxièmement, nous soulignons l'adaptation de l'indice aux besoins des utilisateurs. Troisièmement, nous en examinons l'acceptation et l'utilisation. Enfin, nous en décrivons les avantages et les limites, ainsi que les projets en cours qui y sont associés; le tout est suivi d'une brève conclusion. Concept, méthodes et produits apparentés à l'indice Les fondements conceptuels de l'indice de défavorisation trouvent leur origine dans les idées de Peter Townsend 1 , selon qui la défavorisation est « un état de désavantage observable et démontrable par rapport à la communauté locale, à la société ou à la nation à laquelle une personne, une famille ou un groupe appartient » (traduction libre). Selon Townsend, la défavorisation comporte deux dimensions : matérielle et sociale. La première a trait au manque d'accès aux biens et aux commodités de tous les jours (un logement décent, une voiture, un téléviseur), tandis que la seconde exprime la fragilité des réseaux sociaux, de la famille à la communauté. Nos données proviennent des Recensements du Canada de 1991, 1996, 2001 et 2006 et couvrent pratiquement toute la population du Québec et du Canada (±98 % des personnes vivant dans un ménage privé) 2-4. L'unité d'observation est de nature géographique; elle correspond au plus petit secteur statistique pour lequel on dispose de données du Recensement. Cette unité était le secteur de dénombrement (SD) en 1991 et 1996 et l'aire de diffusion (AD) en 2001 et 2006, soit des unités qui comptent en moyenne entre 400 et 700 personnes 5. Sur la base de ces secteurs statistiques, nous avons sélectionné six indicateurs socioéconomiques pour leurs liens connus avec la santé et leurs affinités avec les deux dimensions de la défavorisation (matérielle et sociale) : la proportion de personnes sans diplôme d'études secondaires; le ratio emploi/population; le revenu moyen

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Background: Identification of socioeconomic and health inequalities at the local scale is facilitated by using relevant small geographical sectors. Although these places are routinely defined according to administrative boundaries on the basis of statistical criteria, it is important to carefully consider the way they are circumscribed as they can create spatial analysis problems and produce misleading information. This article introduces a new approach to defining neighbourhood units which is based on the integration of elements stemming from the socioeconomic situation of the area, its history, and how it is perceived by local key actors.

The interest in measuring social inequalities in health in Québec is relatively recent and has been hampered by the lack of socioeconomic information in the administrative databases on health. To compensate for this lack of data, a material and social deprivation index has been introduced into a dozen of these databases, making it possible to carry out numerous analyses. The present article describes the design and uses of this index and underlines the importance of social inequalities in terms of population health (healthy life expectancy), certain health and social problems (intentional or unintentional injuries, problems experienced by youth), use of health and social services at the national (hospitalization, day surgery and long-term care facilities) and local (services offered by local community service centres) levels, and allocation of public resources (physician compensation and funding of community organizations). The advantages and limitations of this index are also put into perspective, as are the possibilities it offers for research and decision-making.