Testing relationships among determinants of health, health policy, and self-assessed health status in Quebec

By removing financial barriers, the Canada Health Act (1984) equalized acce ss to health care services in Canada. Yet class, educational, and geographi cal disparities in individual and population health status persist. Recent health reform policies in Quebec assert that health and well-being are a fu nction of income, educational level, housing conditions, employment, and ot her socioeconomic factors. They suggest that health policy should encompass social policies that influence individual and community socioeconomic fact ors which in turn affect health. Against the backdrop of these reforms, thi s study tests the importance of socioeconomic factors as a determinant of h ealth-while controlling for other known determinants through a logistic reg ression model-with data from the Sante Quebec health surveys 1987 and 1992- 93. The results confirm the importance of economic security as a determinan t of individual health. This effect appears to operate through an individua l income variable and through the community-level variable of regional unem ployment. The importance of the income effect declined between 1987 and 199 2-93. This may indicate that an increased focus on the socioeconomic determ inants of health has reduced inequalities in health. It may also mean that health inequalities appear inevitable until health care policy merges compl etely with broader health acid social policies. But such integration may we ll conflict with economic (and political) imperatives of the post-Fordist c apitalist system.