With great inequality comes great responsibility: the role of government spending on population health in the presence of changing income distributions

Tong, Liu; Dutton, Daniel J.

doi:10.17269/s41997-020-00407-1

Cited by 3 publications

(1 citation statement)

References 27 publications

(30 reference statements)

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“…The COVID-19 pandemic has highlighted these inequities, which, by their nature, are not amenable to a single health policy change. The challenge for policymakers is to understand when these issues stop being healthcare access problems and are more adequately addressed through other policies, as increased spending on healthcare will likely not address the health needs of those already needing access (Liu & Dutton, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 pandemic on the socioeconomic composition of emergency department presentations

Hanscom

Dutton

2022

Can J Public Health

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Objectives This study highlights how socioeconomic trends in the emergency department (ED) for low-acuity visits change with the onset of COVID-19, identifies societal inequities exacerbated by the pandemic, and demonstrates the geographical regions where these inequities occur. Methods We accessed 1,285,000 ED visits from 12 different facilities across New Brunswick from January 2017 to October 2020. Using a deprivation index developed by Statistics Canada as a measure of socioeconomic status, and controlling for additional factors, we perform a logistic regression to determine the influence of the COVID-19 pandemic on low-acuity visits of individuals from the most deprived quintile (Q5). We constructed a heat map of New Brunswick to highlight regions of high deprivation. Results The proportion of Q5 individuals in the ethnocultural composition domain accessing the ED for low-acuity visits increased from 22.91% to 24.72% with the onset of the pandemic. Our logistic regression showed the log odds of being considered Q5 in the ethnocultural composition domain when visiting the ED for a low-acuity reason increased by 6.3% if the visit occurred during the pandemic, and increased by 101.6% if the visit occurred in one of the 3 major regions of New Brunswick. Conclusion Individuals visiting EDs for low-acuity reasons during the COVID-19 pandemic were more likely to be from the most diverse quintile in the ethnocultural domain, and the inequities were concentrated in the most urban regions in New Brunswick. This demonstrates that urban areas are where inequities are disproportionately faced for ethnically diverse individuals and demonstrates where policies could be focused.

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Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 pandemic on the socioeconomic composition of emergency department presentations

Hanscom

Dutton

2022

Can J Public Health

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Chasing cancer: does the social-to-medical spending ratio relate to cancer incidence and mortality in Canadian provinces? A retrospective cohort study

MacLellan,

Kershaw,

Kneebone

et al. 2024

bmjph

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IntroductionCancer is the leading cause of death in Canada, and cases are expected to rise by 83% between 2012 and 2042. Jurisdictions with higher ratios of social-to-medical spending exhibit better population health outcomes; however, the connection between the ratio and both cancer incidence and mortality is not well established. We aim to determine the association between the ratio and both age-standardised cancer incidence and mortality.MethodsUsing linear regressions with provincial and yearly fixed effects, we measured associations between the ratio and incidence of the four most common cancers in Canada (ie, lung and bronchus, colorectal, breast and prostate cancer), and mortality from any cancer, from 1992 to 2017 (incidence) and 2000 to 2019 (mortality).ResultsA one-cent increase in social spending for each dollar spent on medical services was significantly associated with a decrease in colorectal (−0.2%), breast (−0.1%), and prostate cancer (−0.6%). The relationship is statistically insignificant and negligible for lung cancer incidence and cancer mortality.ConclusionThe ratio was significantly associated with a decrease in three out of four cancer incidence categories, but not mortality. This implies that, consistent with the social determinants of health, preventing cancer incidence might be a function of social spending, whereas medical spending is more relevant for individuals already diagnosed with cancer. This analysis points to the importance of a health-in-all-policies perspective, as social spending might be more important for population health than spending on the medical care system. We provide evidence that morbidity measures are responsive to the ratio, building on a literature focused on mortality.

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Transitioning to a guaranteed annual income and the impact on activities of daily living in older adults: Evidence from public pensions in Canada using the CLSA

Jiménez,

Dutton

2024

Can J Public Health

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With great inequality comes great responsibility: the role of government spending on population health in the presence of changing income distributions

Cited by 3 publications

References 27 publications

Effect of the COVID-19 pandemic on the socioeconomic composition of emergency department presentations

Effect of the COVID-19 pandemic on the socioeconomic composition of emergency department presentations

Chasing cancer: does the social-to-medical spending ratio relate to cancer incidence and mortality in Canadian provinces? A retrospective cohort study

Transitioning to a guaranteed annual income and the impact on activities of daily living in older adults: Evidence from public pensions in Canada using the CLSA

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