ARCHIVED - Research About – Population Health

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health-care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 13,000 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $ 69,0 million in 2008-09 in population health-related research.

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The Facts

Many factors influence health. Income and social status, education and literacy, employment, working conditions, social support networks, and social and physical environments are all important determinants of health at the population level. Here are some examples:

• Men living in Canada's richest neighbourhoods can expect to live 79 years, five years longer than men living in Canada's poorest neighbourhoods.

• Men living in Ontario and British Columbia can expect to live to 78 years, compared to 67 years in Nunavut.

• Canadians' perceptions of their own health and well-being change depending on the education level. Only 50% of persons with a grade 8 education or less self-rated their physical health as excellent or very good, compared to more than 70% among persons with a bachelor's degree.

• People who earn more are more likely to engage in physical activity in their leisure time than lower-income earners, according to an analysis of data collected in the 2005 Canadian Community Health Survey.

• Worldwide, the number of people with access to safe drinking water rose from 4.1 billion in 1990 to 5.7 billion in 2006.

Sources: Statistics Canada, Chief Public Health Officer's Report on the State of Public Health in Canada 2008; Final Report of the Senate Subcommittee on Population Health

Finding Solutions

Street-involved Aboriginal youth need targeted programs

In a 2006 CIHR-funded health survey of marginalized and street-involved youth in British Columbia communities, more than half of the participants identified themselves as Aboriginal – significantly more than when a similar survey was conducted in 2000. A follow-up study, led by University of British Columbia's Dr. Elizabeth Saewyc, analyzed the experiences of 410 homeless, inadequately housed, street-involved and marginalized Aboriginal youth aged 12 to 18. The findings, released in a report entitled Moving Upstream, suggest that prevention, intervention and other supportive programming for street-involved youth must include approaches specifically aimed at Aboriginal communities and Aboriginal youth. The report is available online.

The picture of mental health and neighbourhoods

In a study published in March in the journal Health & Place, University of Toronto's Dr. Patricia O'Campo and colleagues identified and rated the importance of over 100 neighbourhood characteristics for either good or poor mental well-being. The characteristics ranged from the more predictable (neighbourhood violence, substance abuse, vandalism and discrimination) to the unanticipated (good public transportation, the presence of children in the neighbourhood and communication between neighbours). The results will provide useful information for policy-makers considering ways to improve poor mental health in neighbourhoods and increase existing levels of mental well-being.

Kraft Dinner comfort not always available to the poor

A CIHR-funded study shows that while Kraft Dinner may be considered a simple comfort food, low-income Canadians cannot always afford the basic ingredients like milk and butter needed to make it. Led by Dr. Melanie Rock of the University of Calgary's Faculty of Medicine, the study suggests a need to monitor the problem of food insecurity. The results were published in the international journal Agriculture and Human Values.

Poor reasons for driving while impaired

As in other provinces, Quebec's convicted drunk drivers must participate in intervention programs to get their driving licence back. However, many offenders delay regaining their licence, which may lead to unlicensed driving, untreated alcoholism and drunk-driving risks. Research by McGill University's Dr. Thomas G. Brown, Principal Investigator in a CIHR multidisciplinary team examining the incidence of driving while impaired, suggests that some convicted drunk drivers get behind the wheel without a licence or alcoholism treatment for financial reasons. Recidivists often fall into two groups: the poor, and those with cognitive impairment, possibly from alcoholism, that reduces their ability to make proper cost-benefit analyses about life decisions. The results of the study were published in the journal Traffic Injury Prevention in June 2008.

The Researchers

Dr. Carolyn Dewa – The Bottom Line on Mental Health

While most economists watch stock market turbulence, health economist Dr. Carolyn Dewa tracks another index of financial well-being: the ups-and-downs of employees' mental health. And as companies and governments consider how to cut costs during the current financial slump, she has some dollars-and-cents advice: spend a little now on employee health benefits to save a lot later.

"Companies are often hesitant to strongly support mental health care because they're often not sure the extent to which the mental illness is directly work related," says Dr. Dewa, a CIHR-supported health economist with the Toronto-based Centre for Addiction and Mental Health.

"But the result of trying to cut costs, such as supplemental drug benefits, usually backfires and results in much higher long-term disability costs for companies and governments."

Dr. Dewa says the current economic uncertainty exacerbates what many workers already experience as chronic job stress. This stress contributes to mental health issues such as depression and anxiety, conditions that are frequently responsible for employee disability leaves.

Mental health-related costs have a profound impact on the Canadian economy. In a 2008 study, Dr. Dewa and colleagues found that the total cost of mental health issues to the Canadian economy was $51 billion, based on both the value of lost work and the cost of related health services.

As companies try to reduce these costs, Dr. Dewa says cutting employee health benefits can actually increase the company's mental health-related costs. In a recent study, she found that even minor out-of-pocket costs for medications for those on mental health-related disability leave dissuaded some people from purchasing medications, and thus prolonged their time away from work.

This highlights the dilemma faced by many employers—the desire to control rising costs of prescription drug benefits must be balanced with the fact that it's important not to create barriers to treatment.

So what can companies and governments do to support employees' mental health and control the related costs?

"Companies need to be good consumers of the types of insurance policies they have. They often don't know what's being offered, and the real associated costs and benefits associated with the coverage," Dr. Dewa says.

For example, in a recent pilot study with a large, national financial services company, she assessed the costs and benefits of providing employees with early access to specialty mental health care. The study found that quick action on workplace mental health concerns reduced absenteeism by an average of 15 days.

"The company was very excited with the results," says Dr. Dewa. "For each worker on long-term disability, it costs the company as much as $1 million. We were able to clearly document one way to improve employees' mental health and the company's bottom line."

For More Information

CIHR's Institute of Population and Public Health (CIHR-IPPH) supports research into the complex interactions (biological, social, cultural and environmental) that determine the health of individuals, communities and global populations. Not only does CIHR-IPPH seek to understand the determinants of health, it also supports research into the application of that knowledge to improve the health of populations and individuals. To learn more about these priorities and other CIHR-IPPH activities, please visit their website.

For more information, go to ARCHIVED - Your Health Research Dollars at Work.