Week 8: Diversity and Inequality in Healthy Aging Flashcards
Health Inequity definition
Unjust or unfair differences in health between persons, often rooted in social, economic, environmental, or systemic conditions that disadvantage certain groups.
In aging: Often stem from lifelong disadvantages, such as poverty, racism, or limited access to healthcare, which effect older adults later in life.
Health Inequality
Observable or measurable health differences in health status or outcomes among different population groups.
In aging: Measurable differences in health outcomes among older
adults in various groups, such as varying levels of mobility, cognitive health, or life expectancy
Health inequities research
-Health outcomes are linked to physical and mental inequities
-Socio-economic factors (i.e., education, income, housing) are strongly linked to health outcomes
-Influence of poverty and disadvantage on health inequities is consistent over time
-Substantial evidence-based research to show that:
-Older adults living in disadvantaged areas have less access to health care
-Disadvantaged groups have higher mortality and lower chances of survival
-Inequities and Inequalities related to survival from various health conditions (i.e., cardiovascular event) are closely linked to age, sex, ethnicity
Examples of Health Inequities for Older Adults in Canada
-Poverty/lack of resources
-Age and gender
-Ethnicity
-Sexual and gender identity
-Geography
-Health and disabilities
-Life transitions
-Knowledge and awareness
-Social relationships
Case Example: Risk Factors
-This figure is from a project called “Who’s at risk and what can be done about it”, looking at various groups of vulnerable and disadvantaged older adults and how they are affected by social isolation.
-Risk factors related to health inequality and health inequity both influence older adults’ risk for social isolation.
-It should also be noted that, in some cases, the opposite of a risk factor is a protective factor. For example, not having access to affordable housing is a risk factor; having access to affordable housing can protect against the risk of social isolation
Indigenous Peoples living in Canada
Indigenous Peoples in Canada
-Were in good health prior to colonization
-Included nutritious diets, rich and diverse healing systems, and active lifestyles
Contact with European settlers greatly affected health outcomes and continues to affect their health today
-Have poorer health outcomes
-Suffer from more chronic illnesses and disabilities, including heart disease and diabetes
Embedded racism and loss of support system has been a direct cause of poor health outcomes
-For example, studies have demonstrated that type-II diabetes continues to be two to five times more common amongst Indigenous people
-Decades of systemic discrimination in the form of the Residential School System
-Effects of colonialism continues to effect the health and healthy aging of Indigenous Peoples living in Canada today
Dementia
-Certain ethno-racial groups (i..e, Black, Hispanic/Latino, Native Hawaiian/Pacific Islander) have higher risks of developing Dementia
-These differences persist despite similar rates of cognitive decline across groups.
-Risk and expression of Dementia are influenced by social determinants, discrimination, and access to care
-There are disparities in access, diagnosis, and outcomes in dementia care
-Influential factors: socioeconomic status, cultural diversity, and geographical location.
Prescription Drug Access
-Canada’s public health insurance covers hospital and physician visits but generally does not cover prescription medications
-No comprehensive national policy exists for drug coverage or pricing, resulting in inconsistent access to medications across the country
-This leads to health inequities and social injustice amongst some Canadians, disproportionately affecting those without private or provincial coverage options
-People with private insurance or provincial drug benefit plans (e.g., older adults, people with disabilities) may have better access to medication coverage
-Yet, many vulnerable Canadians (e.g., older adults, Indigenous people, immigrants) struggle to afford medications, leading to poor adherence & health outcomes
Oral Health
-Oral health inequities affect older adults in Canada, with coverage often based on income and private benefits and typically not included in provincial health plans
-Due to lack of coverage, many older adults avoid dental care because of high costs
-Poor oral health can significantly impact overall health for older adults:
-Issues like lost or broken teeth negatively affect nutritional status = additional health complications
-Stigma around poor oral appearance can affect mental health, potentially leading to social isolation
Older Adults who are Caregivers
-In 2018, almost one-quarter of seniors aged 65 and older (about 1.5 million people) provided care or help to family members or friends with a long-term condition, a physical or mental disability, or problems related to aging
-Increased burden, depression, stress, financial problems, poor health, loneliness & social isolation
-Spousal caregivers at greater risk of experiencing loneliness and decreased social support
Caregiver Interventions (7)
1.Physical and financial support through informal assistance
2. Respite services
3. Home care or related services
4. Income and tax relief programs
5. Education and skills training
6. Psychological Support
7. Interactive online activities and groups
Immigrant Older Adults in Canada
-Older adults represented a relatively smaller proportion of immigrants at 3.3% in Canada
-Considerable diversity among the immigrant population of older adults
-On average, older immigrants are significantly lonelier than Canadian-born older adults
-In a 2022 study, it was found that immigrant older adults had a lower prevalence of successful aging than their Canadian-born peers
-Other research has found a “healthy immigrant effect” within Canada – meaning immigrants are generally healthier than domestic-born Canadians when they first arrive
Inclusive Healthy Aging Interventions for Immigrant Older Adults in Canada
-Additional data collection and research on immigrant older adults in Canada
-Culturally and linguistically appropriate programs and services (e.g., acculturation
programs, financial aids, language programs, information and referral services)
-Case Study: A report titled “Learning from the lived experiences of aging immigrants” recommended making public transportation, health, and support systems more accessible, completing outreach sessions and education with older immigrants, and creating user and aging-friendly communities specific to the needs of older adult immigrants.
Older Adults in Rural/Remote Areas
-Approximately 23% of all seniors in Canada live in rural areas
-Increase risk of social isolation, smaller support networks, greater loneliness, and lower utilization rates of health & social services
-Rural populations are considered a health disparity group in part because these populations have higher rates of mental health concerns, chronic diseases, & worse general health
-Rural older adults also face increased risk of morbidity, obesity, diabetes, coronary heart disease, cancer, COVID-19, and excess mortality
Strategies for Improving Healthy Aging in Rural/Remote Areas (6)
- Reducing- Reducing health inequalities by providing older people with better access to health and social care services in rural/remote areas.
- Joining- Joining up transport, housing, health and social care services to improve cost-effective service provision and access to services
- Developing- Developing cost-effective transport solutions to afford accessibility to services and better social integration
- Improving housing and local environment conditions to allow older people to ‘age in place’
- Developing volunteering and community-based initiatives to improve social integration of older adults in rural/remote areas
- Stimulating bottom-up social enterprises and collaborative ventures to improve the economic diversity and attractiveness of rural areas to encourage further economic development.
