Social and economic factors that contribute to health are known as the social determinants of health. Key determinants of health include among others: education, employment, income, housing, and food security.1 Health equity is influenced by the interplay between the systematic and unfair socio-economic disadvantages that impact individuals’, groups’ and communities’ health including: lack of education, lack of employment opportunities, poverty, limited access to stable housing and healthy food.2 The social determinants of health can impact health both in the short and long-term and there is a growing understanding that early exposures can affect health throughout the life course.3
Overall, socio-economic conditions are similar in Middlesex-London and Ontario and overall improvements in the population’s education levels and unemployment rates are encouraging. Of greater concern are specific sub-groups within the population which may be disadvantaged in one or more of the socio-economic factors that underpin health. Also there is some indication that the distribution of income became more unequal in Middlesex-London over the past decade. In 2015, the top half of households took home 79.1% of earnings and the bottom half of households took home 20.9% of earnings. Middlesex-London ranked as the third most unequal health unit in Ontario in terms of income share behind Toronto and Halton in 2015.
Post-secondary completion rates for Middlesex-London (65.4%) are similar to Ontario (65.1%), and approximately one-third of Middlesex-London residents aged 25 to 64 (34.6%) did not have any post-secondary education. The completion of post-secondary education is not the same between genders, particular amongst a younger cohort. A lower percentage of younger males aged 24 to 34 have completed post-secondary education (63.6%) in comparison to their same aged female counterparts (76.0%).
Unemployment rates have steadily declined from the high seen in the 2008-09 recession (9.2%) and have dipped below Ontario’s rate. In 2017, the unemployment rate of those aged 15 and older in Middlesex-London was 5.8%. However, youth unemployment remains higher than the general labour force at 10.5% in 2017.
As of 2015 in Middlesex-London, 15.0% of the population was considered to be living in poverty, as measured by the Market Basket Measure, Canada’s new poverty line. Poverty was higher in children aged zero to four (21%) and young adults aged 20 to 24 (27.2%). Those without post-secondary education were more likely (29.6%) than those with postsecondary education (10.8%) to be living in poverty.
Affordable housing should cost less than 30% of a household’s total before-tax income according to the Canada Mortgage and Housing Corporation. A quarter of all Middlesex-London households (25.9%) spent more than 30% of their total before-tax household income on shelter costs in 2015. A much higher percent of households that rent (45.7%) than owner households (14.3%) spent 30% or more on shelter costs in Middlesex-London.
Food insecurity was experienced by approximately 13.9% of households in Middlesex-London in 2013/14. When data years are combined to look at sub-populations within Middlesex-London, food insecurity in female headed households with children under 25 years old was significantly higher (29.9%) than households in general (12.0%) between 2009-2014.
1. Ontario Ministry of Health and Long-Term Care. Health equity guideline [Internet]. Toronto (ON): Queen’s Printer for Ontario; 2018 [cited 2019 Feb 9]. 20 p. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards
2. Ontario Ministry of Health and Long-Term Care. Improving the odds: championing health equity in Ontario – 2016 annual report of the Chief Medical Officer of Health of Ontario to the legislative assembly of Ontario [Internet]. Toronto (ON): Queen’s Printer for Ontario; 2018 Feb [ cited 2019 Feb 20]. 27 p. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/cmoh_18
3. Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep [Internet]. 2014 Jan-Feb [cited 2019 Feb 20] ;129(Suppl 2):19-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863696
Last modified on: March 18, 2019