In this webinar: Many factors influence the ability of individuals to perceive their need for healthcare and to seek appropriate and timely treatment. The focus of this webinar is to describe what we mean by income inequalities and to illustrate how rising levels of income inequality negatively influence the ability of people to achieve good health by impacting access to care. Presented by: Dr. Ambreen Sayani, MD, MSc, Ph.D. (c), is a surgeon by training and has worked closely with cancer patients and their families. At present, Ambreen’s research is focused on the interface between social and health equity, and its implications for cancer risk, treatment, and survival. Ambreen is a member of the Equity Advisory Committee for the Canadian Partnership Against Cancer, and she is a Community Ambassador for the Region of Peel’s Diversity, Equity and Inclusion Charter. Ambreen works at the MAP-Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto; and has recently been awarded the Skinner Agent of Change Leadership Award by the Faculty of Health at York University, Toronto. View the video here: https://youtu.be/-tt-ddMSgf0 To learn more about CCSN, visit us at survivornet.ca Follow CCSN on social media: Twitter - https://twitter.com/survivornetca Facebook - https://www.facebook.com/CanadianSurvivorNet Instagram: https://www.instagram.com/survivornet_ca/ Pinterest - https://www.pinterest.com/survivornetwork

1. The Link between Income
Inequalities and Access to
Health(care)
Dr. Ambreen Sayani, MD, MSc, PhD (c)
June 27th, 2019
MAP- Centre for Urban Health Solutions, St. Michael’s Hospital; and
York University, Graduate Program in Health Policy and Management

2. Session outline
Setting the
context
Access to
health(care)
Examples in
cancer care
1

3. Session outline
Setting the
context
Access to
health(care)
Examples in
cancer care
1
• Put lived experience into perspective;
• Use lung cancer as an example

4. Setting the
context
Access to
health(care)
Examples in
cancer care
Session outline
2

5. Setting the
context
Access to
health(care)
Examples in
cancer care
Session outline
2
• What do we mean by the term access?
• How is access in health(care) understood?

6. Setting the
context
Access to
health(care)
Income
inequalities
Session outline
3

7. Setting the
context
Access to
health(care)
Income
inequalities
Session outline
3
• How do income inequalities influence the way people
interact with the health system?
• What can and needs to be done about it?

8. The give(s) and take(s) of the session
Q/A at the end
Polls
Key
concepts
Call to
action

9. Source: Canadian Cancer Statistics Advisory Committee. (2018). Canadian cancer statistics 2018.
SETTING THE CONTEXT: Cancer

10. SETTING THE CONTEXT: LUNG CANCER
Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.

11. SETTING THE CONTEXT: LUNG CANCER
Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.

12. SETTING THE CONTEXT: LUNG CANCER
Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.

13. SETTING THE CONTEXT: LUNG CANCER
Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.

14. SETTING THE CONTEXT: LUNG CANCER
Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.

15. SETTING THE CONTEXT: LUNG CANCER
Infographic source: Government of Canada, Statistics Canada (2019, June 3). Lung Cancer in Canada, 2000 to 2016.

16. Age-standardized mortality
rates for lung cancer by
neighbourhood income,
female, urban Canada,
1971-2001
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities
SETTING THE CONTEXT: INCOME AND LUNG CANCER

17. A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S

18. A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S

19. A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S

20. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation)
A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S

21. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation)
Smoking
Smoking
cessation
Screening
Incidence
Treatment
Mortality
Source: Jarvis, M. J., & Wardle, J. (2005). Social patterning of individual health behaviours: the case of cigarette smoking. In M. Marmot & R. G. Wilkinson (Eds.),
Social Determinants of Health. Oxford: Oxford University Press.

22. SETTING THE CONTEXT: INCOME AND LUNG CANCER
Smoking
Smoking
cessation
Screening
Incidence
Treatment
Mortality
Source: Kotz, D., & West, R. (2009). Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding. Tobacco Control, 18(1), 43–46.

23. SETTING THE CONTEXT: INCOME AND LUNG CANCER
Smoking
Smoking
cessation
Screening
Incidence
Treatment
Mortality
Source: Schütte, S., Dietrich, D., Montet, X., & Flahault, A. (2018). Participation in lung cancer screening programs: are there gender and social differences? A
systematic review. Public Health Reviews, 39.

24. SETTING THE CONTEXT: INCOME AND LUNG CANCER
Smoking
Smoking
cessation
Screening
Incidence
Treatment
Mortality
Source: Mitra, D. (2015). Social determinants of lung cancer incidence in Canada: A 13-year prospective study. Health Reports, 26(6), 11.

25. SETTING THE CONTEXT: INCOME AND LUNG CANCER
Smoking
Smoking
cessation
Screening
Incidence
Treatment
Mortality
Source: Crawford, S. M., Sauerzapf, V., Haynes, R., Zhao, H., Forman, D., & Jones, A. P. (2009). Social and geographical factors affecting access to treatment of lung
cancer. British Journal of Cancer, 101(6), 897–901.

26. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation)
Smoking
Smoking
cessation
Screening
Incidence
Treatment
Mortality
Source: Hart, C. L., Hole, D. J., Gillis, C. R., Smith, G. D., Watt, G. C., & Hawthorne, V. M. (2001). Social class differences in lung cancer mortality: risk factor
explanations using two Scottish cohort studies. International Journal of Epidemiology, 30(2), 268–274.

27. SETTING THE CONTEXT: LUNG CANCER AND SOCIAL LOCATION (*income, education and/or occupation)
Smoking
Smoking
cessation
Screening
Incidence
Treatment
Mortality
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities

28. Age-standardized mortality
rates for lung cancer by
neighbourhood income,
female, urban Canada,
1971-2001
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities
ACCESS TO CARE: THE CANADA HEALTH ACT

29. Age-standardized mortality
rates for lung cancer by
neighbourhood income,
female, urban Canada,
1971-2001
Source: Wilkins et al. (2007), Statistics Canada; In The Chief Public Health Officer's report on the state of public health in Canada 2008: Addressing Health Inequalities
ACCESS TO CARE: THE CANADA HEALTH ACT

30. Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system:
achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8
ACCESS TO CARE: What is covered in our basket of care?

31. ACCESS TO CARE: What is covered in our basket of care?
Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system:
achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8

32. ACCESS TO CARE: What is covered in our basket of care?
Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system:
achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8

33. ACCESS TO CARE: What is covered in our basket of care?
Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system:
achieving its potential. The Lancet, 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8
Our basket of care is NARROW and DEEP

34. • 5. Accessibility (section 12)
• The intent of the accessibility criterion is
to ensure that insured persons in a
province or territory have reasonable
access to insured hospital, medical, and
surgical-dental services on uniform terms
and conditions, unprecluded or
unimpeded, either directly or indirectly,
by charges (extra-billing or user charges)
or other means (e.g., discrimination on
the basis of age, health status or financial
circumstances).
ACCESS TO CARE: How is accessibility defined in the Act?
Source: Government of Canada. (2019a). Canada Health Act Annual Report 2017-2018 [Acts]

35. • 5. Accessibility (section 12)
• The intent of the accessibility criterion is
to ensure that insured persons in a
province or territory have reasonable
access to insured hospital, medical, and
surgical-dental services on uniform terms
and conditions, unprecluded or
unimpeded, either directly or indirectly,
by charges (extra-billing or user charges)
or other means (e.g., discrimination on
the basis of age, health status or financial
circumstances).
ACCESS TO CARE: How is accessibility defined in the Act?
Source: Government of Canada. (2019a). Canada Health Act Annual Report 2017-2018 [Acts]

36. POLLING STATION
Q. Do you think the way
accessibility is described in
the Canada Health Act
matches our current basket
of care?
A. Yes/ No

37. POLLING STATION
Q. Do you think the way
accessibility is described in
the Canada Health Act
matches our current basket
of care?
A. Yes/ No
• 5. Accessibility (section 12)
• The intent of the accessibility criterion is
to ensure that insured persons in a
province or territory have reasonable
access to insured hospital, medical, and
surgical-dental services on uniform terms
and conditions, unprecluded or
unimpeded, either directly or indirectly,
by charges (extra-billing or user charges)
or other means (e.g., discrimination on
the basis of age, health status or financial
circumstances).
Source: Government of Canada. (2019a). Canada Health Act Annual
Report 2017-2018 [Acts]

38. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

39. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

40. ENTRY
Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

41. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

42. SEEK
Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

43. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

44. OUTCOME
Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

45. Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

46. NEED
UTILIZATION
Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

47. ACCESS TO CARE: A system which is responsive to needs
Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and
populations. International Journal for Equity in Health, 12, 18.

48. ACCESS TO CARE: The interface between patient need and systems supply
Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable
populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.

49. ACCESS TO CARE: What constitutes need?
Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable
populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.

50. ACCESS TO CARE: What does David need?
Source: (i) Sayani, A and Lofters, A (Work in progress) Barriers and facilitators to lung cancer screening for high-risk individuals living with low income in
downtown Toronto, Canada; and (ii) Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to
primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S

51. INCOME INEQUALITY AND CANCERS: The social location influences access to care
• Breast cancer Sayani, A. (2017). Socially
based inequities in breast cancer care: intersections of the
social determinants of health and the cancer care
continuum. Women’s Health & Urban Life: An
International and Interdisciplinary Journal, 13(1)
• Hereditary breast cancer Sayani, A.
(2018). Inequities in genetic testing for hereditary breast
cancer: Implications for public health practice. Journal of
Community Genetics, 1–5.
• Lung cancer Sayani, A and Lofters, A (Work
in progress) Barriers and facilitators to lung cancer
screening for high-risk individuals living with low
income in downtown Toronto, Canada
• Social class and health
inequalities Sayani A. (in press), Social Class
and Health Inequalities, Bryant, T., Raphael, & Rioux,
M. H. (Eds), In Staying Alive: Critical Perspectives on
Health, Illness and Healthcare, 3rd edition. Toronto:
Canadian Scholars Press Inc.

52. POLLING STATION
Q. Which of the following statements
about income inequality resonates
most with you?
a. I am not familiar with the topic of
income inequality;
b. I have come across the term
income inequality;
c. Income inequality is a pressing
challenge of our times;
d. It is an academic concept with little
to no relevance in the real world.

53. Income inequality is the extent to which income is distributed unevenly in a country.
INCOME INEQUALITY

54. Source: Government of Canada, Statistics Canada. (2017b, September 13). Household income in Canada: Key results from the 2016 Census.
INCOME INEQUALITY: How is our Canadian income pie split?
$$$$$
49%
$$$$
22%
$$$
14%
$$
9%
$
6%
HOUSEHOLD WEALTH BY INCOME QUINTILE
$$$$$ $$$$ $$$ $$ $

55. Source: Government of Canada, Statistics Canada. (2017b, September 13). Household income in Canada: Key results from the 2016 Census.
$$$$$
49%
$$$$
22%
$$$
14%
$$
9%
$
6%
HOUSEHOLD WEALTH BY INCOME QUINTILE
$$$$$ $$$$ $$$ $$ $
INCOME INEQUALITY: How is our Canadian income pie split?

56. Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.
INCOME INEQUALITY: Whose income has increased?

57. Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.
INCOME INEQUALITY: Did we all gain equally?

58. Retrieved from: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.
INCOME INEQUALITY: Did we all gain equally?

59. Source: Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story.
INCOME INEQUALITY: What is driving the gap?

60. Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010).
The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the
social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.
INCOME INEQUALITY: What is driving the gap?

61. INCOME INEQUALITY: What is driving the gap?
Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010).
The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the
social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.

62. INCOME INEQUALITY: What is driving the gap?
Sources: (i) Heisz, A. (2015). Trends in Income Inequality in Canada and Elsewhere. In Income Inequality: The Canadian Story; (ii) Yalnizyan, A. (2010).
The Rise of Canada’s Richest 1%; (iii) Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the
social determinants of health. Health Policy (Amsterdam, Netherlands), 101(1), 44–58.

63. Source: Conference board of Canada. (2011). Canadian Income Inequality, Is Canada becoming more unequal?
INCOME INEQUALITY: The GINI index

64. INCOME INEQUALITY: What’s the problem?

65. SHI
GDP
Social Health Index:
• Infant mortality
• Child abuse
• Child poverty
• Teen suicide
• Drug abuse
• School drop-out
• Unemployment
• Weekly earnings
• 65+yrs in poverty
• Out-of-pocket health
expense
• Homicides
• Alcohol-related
fatalities
• Social assistance use
• Affordable housing
• Gap between rich
and poor
Source: Raphael, D. (2000). Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health, 10(2), 193–216.
INCOME INEQUALITY: The Social Health Index (SHI) and Gross Domestic Product (GDP)

66. INCOME INEQUALITY: Increasingly visible

67. INCOME INEQUALITY: Increasingly visible

68. INCOME INEQUALITY: Increasingly visible

69. INCOME INEQUALITY: Increasingly visible

70. Trust
Social
capital
Social
unrest
Volatility
“The social compact is starting to unravel in many countries…..Uncertainty and
fears of social decline and exclusion have reached the middle classes in many
societies.” OECD Secretary-General Angel Gurría.
Health
inequities
INCOME INEQUALITY: What’s the problem?

71. Trust
Social
capital
Social
unrest
Volatility
“The social compact is starting to unravel in many countries…..Uncertainty and
fears of social decline and exclusion have reached the middle classes in many
societies.” OECD Secretary-General Angel Gurría.
Health inequities
INCOME INEQUALITY: Focus on health

72. INCOME INEQUALITY AND ACCESS: It is a double-edged sword ~ Cuts to supply, and complex needs
Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable
populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.

73. INCOME INEQUALITY AND ACCESS: It is a double-edged sword ~ Cuts to supply, and complex needs
Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable
populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.

74. INCOME INEQUALITY AND ACCESS: It is a double-edged sword ~ Cuts to supply, and complex needs
Source: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to primary healthcare for vulnerable
populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.

75. Source: (i) Sayani, A and Lofters, A (Work in progress) Barriers and facilitators to lung cancer screening for high-risk individuals living with low income in
downtown Toronto, Canada; and (ii) Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to
primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
INCOME INEQUALITY AND ACCESS: What does David need?
A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S

76. Source: (i) Sayani, A and Lofters, A (Work in progress) Barriers and facilitators to lung cancer screening for high-risk individuals living with low income in
downtown Toronto, Canada; and (ii) Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F., & Gunn, J. (2016). Equity of access to
primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International Journal for Equity in Health, 15(1), 64.
INCOME INEQUALITY AND ACCESS: What does David need?
A L L I M A G E S A N D N A M E S A R E B E I N G U S E D F O R S T O R Y - T E L L I N G A N D D O N O T R E F L E C T R E A L P A T I E N T S
Living and working conditions

77. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply
This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F.,
& Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International
Journal for Equity in Health, 15(1), 64.
Living and working conditions

78. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply
This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F.,
& Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International
Journal for Equity in Health, 15(1), 64.
Living and working conditions

79. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply
This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F.,
& Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International
Journal for Equity in Health, 15(1), 64.
Living and working conditions

80. ACCESS TO HEALTH(CARE): Living conditions; patient need; and health system supply
This framework is an adaptation of the access to healthcare framework found in: Richard, L., Furler, J., Densley, K., Haggerty, J., Russell, G., Levesque, J.-F.,
& Gunn, J. (2016). Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations. International
Journal for Equity in Health, 15(1), 64.
Living and working conditions

81. Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy-
moving-from-equality-to-liberation/equality-equity-liberation/
THINKING OF ACCESS IN DIFFERENT WAYS

82. 1. Are we thinking about input and giving everyone the same?
Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy-
moving-from-equality-to-liberation/equality-equity-liberation/
THINKING OF ACCESS IN DIFFERENT WAYS

83. 1. Are we thinking about input and giving everyone the same?
2. Are we thinking about outcomes and considering different needs?
Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy-
moving-from-equality-to-liberation/equality-equity-liberation/
THINKING OF ACCESS IN DIFFERENT WAYS

84. 1. Are we thinking about input and giving everyone the same?
2. Are we thinking about outcomes and considering different needs?
3. Are we thinking structurally and aiming to remove structural barriers?
Image source: National Academy of Medicine. (n.d.). Equality-Equity-Liberation. Retrieved June 14, 2019, from https://nam.edu/the-case-for-health-literacy-
moving-from-equality-to-liberation/equality-equity-liberation/
THINKING OF ACCESS IN DIFFERENT WAYS

85. In summary
• Income inequality is a measure of the uneven
distribution of wealth and is structured by the social
and economic policies of the jurisdiction where we live;
• Income inequalities cause social inequalities and these
eventually influence the risk factors for disease, as well
as hinder the ability to access healthcare;
• In Canada, lower income groups suffer distinctly poorer
cancer-related health outcomes; and whilst there are a
variety of reasons for this, healthcare access
(utilization) is an important determinant of outcomes
and must be contextualised as such.
INCOME INEQUALITY AND ACCESS TO HEALTHCARE

86. Remember
• Income inequality is
NOT inevitable, it
occurs as result of
social and political
choices.
• This means that we
can make better
choices moving
forward.
CALL TO ACTION

87. What can we do?
• Recognise the forces that create income inequality;
• Understand how income inequality runs through the whole
of society impacting everyone not just the most deprived;
• Improve communication between different sectors
regarding the implications of income inequality;
• Use the media to educate Canadians about the consequences
of income inequality;
• Lobby governments to maintain community, health and
social services that positively affect health and well-being;
• Resist cut in public health and social spending;
• Advocate for a health-in-all policies approach.
Source: Raphael, D. (2000). Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health, 10(2), 193–216.
LETS WORK TOGETHER

88. Thank you
• Q/A
• Email: asayani1@yorku.ca
TOGETHER WE CAN MAKE TOMORROW BETTER

89. Canadian Cancer Survivor Network
Contact Info
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca
Pinterest: http://pinterest.com/survivornetwork/

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