A reflection by Dr. Cory Neudorf.
Dr. Cory Neudorf’s research is focused on improving health equity.
It was clear that poverty was making people sick.
What started the Saskatchewan Health Equity research was a realization—back in the late 90s and early 2000s—that as we were looking at health indicators in different parts of our city, things were so much worse in neighbourhoods that had lower socio-economic status. In fact, when we looked at what was driving these results while trying to take into account different demographics and factors that may be associated with it, we found the strongest predictor of poor health status in many of our neighbourhoods was an ethnicity marker. The same neighbourhoods that had high proportions of new immigrants and of First Nation and Métis also had high rates of poverty and lower education and higher proportions of single parent families. As we controlled for all these different factors, the predominant factor that came out was poverty, and we happen to have racialized poverty in this province, and especially in Saskatoon.
You have to remember that a couple of decades ago when this started, it was known that poverty causes ill health in lots of parts of the world.
But it seems like unless you see it in your own neighbourhood—in your own backyard—there is a tendency to say, ‘oh, but not here, surely.’ People might think we have universal programs and we’re not showing discrimination—that certainly wouldn’t be the same here. However, what we saw is that not only are we seeing poverty at the root of illness here, but, quite frankly, in many of our western Canadian Cities, that disparity is actually worse than other parts of Canada. This forces us to look differently. Another issue is you can’t recognize it if you don’t have the data, and you don’t know where to focus quality improvement.
Are there actual programs and policies that can turn those social determinants of health around and reduce poverty, but also through reducing rates of high unemployment and improving education rates?
It was in asking this questions that we started looking at the intersection between poverty and racism and institutionalized racism and the need to actually work at these issues simultaneously. We ended up doing a lot of research on what others were doing around the world to make a change and we found 46 different policy options that have been shown to work in other regions. We ended up prioritizing 17 out of those 46 that everybody around the table—from business leaders to NGOs to government sectors—all agreed we needed to work on.
Essentially, you need to deliver this programming for everybody, but equal service for equal need.
So, where the needs are higher, we need to give extra effort and make sure that we’re designing programs and services and accessibility in such a way that it actually meets the needs of those populations—not a one-size-fits-all approach. Working in this way resulted in a lot of programs on building health equity into quality improvement programs in the health care sector.
We found as we do this systematically in quality improvement within health care, we are sometimes surprised by which subgroups aren’t getting the same access or outcomes.
It’s not always the populations that you would assume would be obvious. Once you identify this, you can design to change that—and unless you’re monitoring it, you don’t know if the thing you’ve designed is actually having the desired impact or not.
This research has also shown that in doing nothing, poverty does cost.
In fact, there are ways to change our programs and policies in a way that is both more cost effective and meets the needs of individuals more within society, so that it’s win-win.
In the end, our research might be seen as a fight for the underdog.
But it’s not just the underdog, but anyone in society that just happened to be on the other side of the way that the chips fall.
Learn more about the Poverty Reduction efforts that the Saskatchewan Health Equity Project informed.
Evidence gathered through the Saskatchewan Health Equity Project, led by Dr. Neufeld, was fundamental in the formation of the Saskatoon Poverty Reduction Partnership (SPRP), which went on to inform the Poverty Costs campaign and a commitment from the provincial government to invest in a comprehensive poverty reduction strategy.