December 20, 2007
Poorer, Less Educated People in the United States in Worse Health Than Their Counterparts in Canada
(PORTLAND, Ore.) – Analysis of the largest survey directly comparing health in the
United States and Canada reveals significant disparities between some citizens of
the two countries. Although overall population health is similar in both countries,
the survey shows important health disparities associated with age, gender, education,
income, marital status, and country of residence. The most dramatic differences
are associated with income and education – people in the U.S. at the lowest income
level and at lower levels of education are significantly less healthy than those
in Canada with the same income and education. These findings appear in the December
issue of Population Health Metrics.
“Income and education are well-known predictors of health status,” says health economist
David Feeny, PhD, senior investigator at Kaiser Permanente’s Center for Health Research and co-author of the study. “What was surprising, however, was the statistically
significant health gap between people in the U.S. and Canada at the lowest levels
of income and education. The question is, what explains this gap? A reasonable proposition
is that differences in social and economic inequality between the two countries
may account for the health disparities. Compared to the U.S., Canada’s wider social
safety net and its universal healthcare insurance system appear to lead to better
health for its citizens with less income and education. One would hope these survey
findings might inform the American healthcare debate during the coming elections.”
These findings are from the Joint Canada/United States Survey of Health (JCUSH),
a telephone survey on the health of community-dwelling residents in Canada and the
U.S. conducted between November 2002 and March 2003. The same questions were asked
in both countries, and the same methodologies were used to score answers and
analyze results. A total of 8,688 people responded to the survey (3,505 in Canada and 5,183
in the U.S.). Respondents were asked to rate their overall health (poor, fair, good,
very good, excellent) and to rate eight attributes of their current health status
– vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain.
Responses were analyzed using the Health Utilities Index Mark 3 (HUI3), a preference-based
measure of health-related quality of life that translates people’s assessment of
their health into a simple score on a scale ranging from 0.00 (“dead”) to 1.00 (“perfect
health”). Differences of 0.03 or more in overall health status are considered to
be clinically important. For example, scores for people at the highest income level
were the same in the U.S. and Canada (HUI3 score of 0.93), as were scores for those
with a university degree (0.92). However, scores for people in Canada at the lowest
income level were 0.81, compared to 0.77 in the U.S., and 0.81 compared to 0.74
for people with less than a high school diploma. These differences in overall health
of 0.04 (income) and 0.07 (education) are clinically important for comparing the
health of both populations.
“Race is also a factor in health status,” says Ken Eng, MA, co-author of the study
and a former member of the Institute of Health Economics, Edmonton, Canada. “Because
the United States has a much higher percentage of minorities than Canada, we wondered
how much race might be contributing to the striking health disparities we found.
So we also analyzed the data for white survey respondents only and found the same
pattern of health status – similar levels of excellent health among white Canadians
and Americans at the highest levels of income and education but striking health
disparities between white Canadians and Americans at the lowest levels of income
and education.”
Funding for this study of the Joint Canada/United States Survey of Health was provided
by grants from the Alberta Heritage Foundation for Medical Research and the Institute
of Health Economics.
Kaiser Permanente’s Center for Health Research, founded in 1964, is a non-profit
research institution whose mission is advancing knowledge to improve health. It has research facilities in Portland, OR; Honolulu, HI; and Atlanta, GA.
For more infomation contact:
Terry Fitzpatrick, (503) 335-6602, Terry.Fitzpatrick@kpchr.org or
Mary Sawyers,
(503) 813-3967, Mary.A.Sawyers@kp.org