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< Measuring Health Inequalities: An Introduction >

>> In Canada, we take pride in our universal, publicly funded health system. 

As Canadian residents, we have free access to physician and hospital services, no matter what part of the country we live in, where we’ve immigrated from or where we work.

However, access to health care is one of the many factors that determine health. Health care systems also need to consider things such as social supports, healthy child development, physical environments, income and education. These factors are called determinants of health and play an important role in contributing to healthy populations.

Meet Eddy. He lives in a low income neighborhood where he is excited to start Grade 1 so he can ride the bus to school. He’s just been hospitalized with asthma…for the third time this year.

Analysis by the Canadian Institute for Health Information—also known as CIHI—shows that hospital admission rates for asthma have on average dropped by 50% over the past decade.

This is a good thing! But what about Eddy?

What if we told you that some children are admitted to hospital more often than others?

Meet Sandra. She lives in a high income neighbourhood where she walks to school with her dad and will be starting Grade 2. She also has asthma, but hasn’t been hospitalized since she was diagnosed as an infant.

According to CIHI analysis, asthma hospitalizations are one and a half times more common among children living in low income neighbourhoods, like Eddy compared to children living in high income neighbourhoods, like Sandra.

A difference in health across population groups, such as the low-income and high-income neighbourhoods, is called a health inequality.

Sometimes health inequalities are unavoidable, for instance when a health difference can be attributed to a biological factor… like your DNA.

Other times health inequalities are unfair and avoidable. This type of inequality is considered an inequity. .. like differences by income level.

By eliminating unfair and avoidable differences in health care access, for example, we can achieve a more equitable health system.

Measuring and understanding health inequalities is a critical first step towards informing action to improve health equity.

This is because averages do not tell the full story. For example, earlier we told you that the average asthma hospitalization rate has decreased in the last decade… However, looking at the overall average does not show how many more kids are being hospitalized from Eddy’s neighbourhood compared to Sandra’s.

Health care systems can use information on health inequalities as they seek to improve access to quality care and health outcomes. Ultimately, health systems strive to ensure that these improvements are shared across the entire population.

So how exactly do we measure inequalities?

We can do this by measuring and reporting on indicators by population groups, such as Canadians living in richer and poorer neighbourhoods, like Eddy and Sandra. We call this equity stratification.

At CIHI, we stratify indicators in different ways, including by age and sex, and increasingly by neighbourhood-level income and geography.

In collaboration with experts across the country, CIHI has developed standard definitions for equity stratifiers to support analysts with measuring health inequalities.

These definitions are featured in a Toolkit, which is designed to help you plan your analysis, analyze your data and report your findings.

Using this CIHI Toolkit, you can identify health differences and monitor progress towards closing the gap between sub-populations.

Equipped with information on health inequalities, you can continue to improve health and healthcare service delivery for all Canadians.

For more information and training, visit

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