Steven G. Prus

Comparing social determinants of self-rated health across the United States and Canada

A large body of research shows that social determinants of health have significant impact on the health of Canadians and Americans. Yet, very few studies have directly compared the extent to which social factors are associated with health in the two countries, in large part due to the historical lack of comparable cross-national data. This study examines differences in the effect of a wide-range of social determinants on self-rated health across the two populations using data explicitly designed to facilitate comparative health research-Joint Canada/United States Survey of Health. The results show that: 1) sociodemographic and socioeconomic factors have substantial effects on health in each country, though the size of the effects tends to differ-gender, nativity, and race are stronger predictors of health among Americans while the effects of age and marital status on health are much larger in Canada; the income gradient in health is steeper in Canada whereas the education gradient is steeper in the U.S.; 2) Socioeconomic status (SES) mediates or links sociodemographic variables with health in both countries-the observed associations between gender, race, age, and marital status and health are considerably weakened after adjusting for SES; 3) psychosocial, behavioural risk and health care access factors are very strong determinants of health in each country, however being severely/morbidly obese, a smoker, or having low life satisfaction has a stronger negative effect on the health of Americans, while being physically inactive or having unmet health care needs has a stronger effect among Canadians; and 4) risk and health care access factors together play a relatively minor role in linking social structural factors to health. Overall, the findings demonstrate the importance of social determinants of health in both countries, and that some determinants matter more in one country relative to the other.

Ethnic differences in self-rated and functional health: does immigrant status matter?

The current study examines self-rated health status and functional health differences between first-generation immigrant and Canadian-born (CB) persons who share the same ethnocultural origin, and the extent to which such differences reflect social structural and health-related behavioural contexts. Multivariate analyses of data from the 2000/2001 Canadian Community Health Survey indicate that first-generation immigrants of Black and French ethnicity tend to have better health than their CB counterparts, while the opposite is true for those of South Asian and Chinese origins, providing evidence that for these groups, immigrant status matters. West Asians and Arabs and other Asian groups are advantaged in health regardless of country of birth. Health differences between ethnic foreign-born and CB persons generally converge after controlling for sociodemographic, socioeconomic status (SES), and lifestyle factors. Analysis of the data does however reveal extensive ethnocultural disparities in self-rated and functional health within both the immigrant and CB populations. Implications for health care policy and programme development are discussed.

Examining the gender, ethnicity, and age dimensions of the healthy immigrant effect: Factors in the development of equitable health policy

This study expands on previous research on the healthy immigrant effect (HIE) in Canada by considering the effects of both immigrant and visible minority status on self-rated health for males and females in mid-(45-64) and later life (65+). The findings reveal a strong HIE among new immigrant middle-aged men, particularly non-Whites. For older men of color the reality is strikingly different: they are disadvantaged in health compared to their Canadian-born counterparts, even when a number of demographic, economic, and lifestyle factors are controlled. Health outcomes for immigrant women are in contrast to that of immigrant men. Among middle-aged women, immigrants, regardless of their ethnicity or number of years since immigration, are much more likely to report poor health compared to the Canadian-born. And, for older women, recent non-white immigrants are more likely to report better health compared to Canadian-born women, although this finding is explained by differences in demographic, economic, and lifestyle factors. Overall, the findings demonstrate the importance of considering the intersections of age, gender, and ethnicity for policymakers in assessing the health of immigrants.

Income Inequality over the Later-Life Course: a Comparative Analysis of Seven OECD Countries

ABSTRACT This paper examines income inequality over stages of the later-life course (age 45 and older) and systems which can be used to mitigate this inequality. Two hypotheses are tested: (1) levels of income inequality decline during old age because public benefits are more equally distributed than work income; and (2) because of the progressive nature of government benefits, countries with stronger public income security programmes are better able to reduce income inequalities during old age. The analysis is performed by comparing age groups within seven OECD countries (Canada, Germany, the Netherlands, Norway, Sweden, the United Kingdom, and the United States of America) using Luxembourg Income Study data from around 2000. Both hypotheses are supported. Several conclusions are drawn from the findings.

Comparing Racial and Immigrant Health Status and Health Care Access in Later Life in Canada and the United States

Il y a peu de recherche comparative en existence sur les expériences de la santé et les conditions de groupes minoritaires au Canada et aux États-Unis, malgré le fait que les deux pays ont des populations racialement diverses avec une proportion significative des immigrants. Cet article explore les disparités raciales et immigrantes en santé et soins d’accès entre les deux pays. L’étude portait sur l’âge mûr et la vieillesse, compte tenu du changement et de la diversité croissante dans la politique de santé et les soins de santé, tel que Medicare. L’analyse de régression logistique des données de l’Enquête de la santé Canada/États-Unis 2002–2003 montre que l’effet conjoint de la race et de la nativité de santé – différences en santé entre indigènes blancs et étrangers blancs et non-blancs est en grande partie négligeable au Canada, mais considérable aux États-Unis. Americains indigènes non-blancs et américains nés à l’étranger au sein des groupes d’âge 45-à-64 et 65-et-plus expériencent une désavantage significative dans l’état de santé et aussi de l’accès aux soins, indépendamment de la couverture d’assurance-maladie et des facteurs démographiques, socio-économiques et de la mode de vie.

Social Transfers And Income Inequality In Old Age

Abstract This paper examines variation in old-age income inequality between industrialized nations with modern welfare systems. The analysis of income inequality across countries with different retirement income systems provides a perspective on public pension policy choices and designs and their distributional implications. Because of the progressive nature of public pension programs, we hypothesize that there is an inverse relationship between the quality of public pension benefits and old-age income inequality—that is, countries with comprehensive, universal, and generous public pension systems will exhibit more equal distributions of income in old age. Luxembourg Income Study data indeed show that cross-national variation in old-age income inequality is partly explained by differences in the percentage of seniors’ total income derived from public pension transfers. Sweden, for example, has the highest level of government transfers and the lowest level of old-age income inequality, while Israel and the United States have the lowest levels of dependency on government transfers and the highest levels of income inequality. A notable exception is Canada, where public transfers represent only a moderate portion of elderly income, yet old-age income inequality is relatively low. These findings suggest that quality of public pension benefits does indeed play a role in explaining differences in old-age income inequality between industrialized nations, yet these variations are also likely influenced by other factors.