1. 1 PUBLIC HEALTH PHYSICIANS, SOCIAL INEQUALITIES IN HEALTH AND INFECTIOUS DISEASE CONTROL T ERRY -N AN T ANNENBAUM P UBLIC H EALTH D EPARTMENT A GENCE DE LA SANTÉ ET DES SERVICES SOCIAUX DE M ONTRÉAL PHPC CPD S ESSION, 9 J UNE 2013

2. 2 B ACKGROUND Infectious disease control – Basic public health function – Protection: case investigations, outbreak control – Prevention/promotion: vaccination, disease prevention activities Staff not always aware of importance of social inequalities in effectiveness of public health measures

3. 3 O BJECTIVE OF PRESENTATION How can staff use equity lens when planning and carrying out prevention/promotion activities Share Montreal experience and learn what others are doing

4. 4 M ONTREAL EXPERIENCE Knowledge of social inequalities in health (SIH) in infectious disease control (IDC) low Little data on importance of social determinants in disease occurrence Little knowledge and capacity to design programs to reduce SIH “Gut feeling”: most important factors are cultural community, literacy level, recent immigration, presence of factors such as homelessness

5. 5 F IRST EFFORTS Needed data to understand importance of social factors in disease occurrence Chose one area of IDC to develop interventions: vaccination coverage

6. 6 I NCOME

7. 7 E DUCATION

8. 8 E COLOGIC ANALYSIS OF THE DETERMINANTS OF 9 R EPORTABLE D ISEASE S Source: Allard R, Steet MC, LeGuerrier P, Jochem K. Analyse écologique des déterminants des MADO, DSP, Agence de Montréal, 2013

9. 9 I NDICATORS OF SOCIAL INEQUALITY ASSOCIATED WITH CERTAIN REPORTABLE DISEASES Households of 6 persons or more Educational level Occupational status Income Population measures observed at level of RTA, but not necessarily at individual level Source: Allard R, Steet MC, LeGuerrier P, Jochem K., Analyse écologique des déterminants des MADO, DSP, Agence de Montréal, 2013

10. 10 I NCIDENCE OF SHIGELLA BY FSA, M ONTREAL 2004-2008 Associated with higher proportion of households with 6 persons or more, certain cultural groups

11. 11 I NCIDENCE OF INFECTIOUS SYPHILIS BY FSA M ONTRÉAL, 2004-2008 Associated with income level, larger households certain cultural groups and lower employment activity

12. 12 No vaccine registry, data on coverage by territory incomplete School vaccination only available indicator – Vaccination coverage of HPV (4 th grade) – Measles vaccination campaign in 2010 V ACCINATION RATES

13. 13 M EASLES COVERAGE BY CSSS T ERRITORY Source: Kaiser D. Couverture vaccinale contre la rougeole en milieu scolaire, DSP Agence de Montréal, 2013

14. 14 M EASLES COVERAGE BY TYPE OF SCHOOL Source: Kaiser D. Couverture vaccinale contre la rougeole en milieu scolaire, DSP Agence de Montréal, 2013

15. 15 HPV C OVERAGE RATES BY SCHOOL, M ONTREAL, 2010 - 2011

16. 16 P ROPOSED INDICATORS FOR INFECTIOUS DISEASE MONITORING Rates of HIV, Chlamydia, TB, Influenza and pneumococcal vaccination – recommended Rates of gonorrhea, syphilis, basic immunisation coverage, invasive pneumoccal disease – possible indicators Source: Massé R, Raynault MF. Indicateurs de surveillance pour les ISS en maladies infectieuses. Décembre 2011

17. 17 W HERE WE ARE : P UBLIC H EALTH D EPARTMENT Small central unit to coordinate projects and support teams Other teams each chose one area to examine: – Occupational health: do programs reach vulnerable populations (agency workers) – Preventive practices: do programs account for literacy issues – Maternal and child health: how to address equity in program to reduce time spent in front of screens

18. 18 W HERE WE ARE : H EALTH P ROTECTION T EAM Use of indicators – Available data inadequate to guide or evaluate interventions – Data that is available doesn’t necessarily coincide with gut feeling – Need to develop indicators that are available and robust to help develop programs Other possible actions – Apply health equity lens to health promotion/health prevention activities – Examples: prevention of enteric diseases, vaccination promotion

19. 19 A CKNOWLEDGEMENTS Health protection sector, Public Health Department, Agence de la santé et des services sociaux de Montréal Marie-France Raynault, Public Health Department, Agence de la santé et des services sociaux de Montréal