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C. Implications for Health Each indicator in the list is an effective measure of several influences upon health. Many of the medical incidences already mentioned are related to hygiene, familial care and supervision, poor diet and abuse of alcohol. The six indicators must describe something about these conditions which either lead to or away from poor health. 1. The percentage of the labour force unemployed, 15 to 24, reflects the amount of youth unemployment and generally shows not only how many jobs there are for young people, but also how well their skills are matched to the jobs available. This statistic permits generalization about the ability of the local economy to launch stable careers and shows whether youth have access to the economy (Harp,1996, interview). Idle time for this age group is somewhat problematic; these are very energetic years in which most people find jobs that will carry them through their careers. The lack of a steady income puts anyone at a disadvantage, but if the main wage earner in a young family has inconsistent employment during these years, the stability needed to raise young children and develop strong familial bonds may be absent. It is a loss to society that rates of youth unemployment are double or triple the rate for the whole population (Harp,1996, interview). Several tangible health effects have been noted among young unemployed: for males, greater use of tobacco and alcohol; and for females, greater use of medication, such as pills, vitamins, minerals, ointments, tranquillizers, and pain relievers" (D'Arcy and Siddique, 1987, P. 255). Unemployed singles reported greater consumption of alcohol than those who were married. 2. The second factor, “the percentage unemployed between age 45 and 54”, indicates discontinuity of employment and the inability of the local economy to sustain career-long employment. This influences the general wealth of the family as these are the peak earning years (Gartley, 1994, P.17) in which money is set aside for retirement security. Mid-career lay-off or unemployment is an important blow to a family's economy, and a possible indication of familial stress. Studies suggest that with unemployment comes "deterioration of one's physical and mental health" (D'Arcy and Siddique, 1987,P. 255). Higher income and higher levels of education have been found to be variables which reduced "the negative effects of unemployment" (ibid, P.256). 3. The third factor, the percentage of single parent female households, indicates income level instability in many cases. Statistics reveal that families headed by women average only 38% of the annual income of dual wage families and are often well below the poverty line (Colombo, 1992, P. 85). Single parent families tend to be less able than two parent families to provide supervision for children so as to limit the risk of accidents. Single mothers with less than a grade nine working full-time averaged $17,406 in 1991 in Canada (Gartley, 1994, P. 21). This level of family income translates into limited access to housing, food, clothing and safe transportation. It has been observed that if a lone parent’s incomes must exceed $20,000 before wages compensate them enough to pay for child care and to be able to work outside the home ( Gartley,1994, P. 22). Jobs of this calibre are rare in outlying regions of Manitoba, consequently many low-skilled lone parents rely upon social assistance. 4. The fourth factor, the percentage of the population between the ages of 25 and 34 having completed high school, is an indication of how educated the "core" workforce is. Since high school graduates are more likely to be employed than those without diplomas (Communications Branch, 1996, P.1) and to therefore earn higher salaries (Kirsch, et al, 1993, P. 66), then this factor reveals the likely proportion of successful job-holders in the region. As with the other employment-related factors, high school completion is an indicator of possible income. Adults in this age group are most productive in their work and benefit from a steady income which allows them to establish homes and families. 5. The fifth factor, the percentage of female labour force participation, suggests the availability of jobs and consequent extra income for families. If females are in the workforce, the implication is that there is a "job rich" economy; there may also be a number of two income families suggesting higher household income, better surroundings, housing, health care, foods, transportation, ability to afford child care, etc. 6. The final factor, the average dwelling value is a direct measurement of how much money there is in the home. It implies what kind of neighbourhood or community the home might be in, the facilities it might have, and the likelihood of its being a safe, healthy environment for children. There are other impoverished communities in northern Manitoba besides Shamattawa. They all need to build the fabric of the society before good health will be attained. What investment can be made to ensure a long term solution to the ills in such desperate places? D. Literacy and Health Factors Of the six indicators selected as best explaining diffences in regional health quality, three are directly related to literacy abilities. As literacy skills are clearly important in the acquisition and maintenance of employment, and because the percentage of graduates from high school is a direct indication of (potential) literacy skill, the link between literacy and health is made! If we can accept that two of the other factors, namely dwelling value and female partication in the workforce, are also indicators of income, and that those with higher literacy skills are shown to have higher incomes (Statistics Canada, 1995, P.132), then we can see the literacy connection in five out of the six indicators. E. Health in Low Literacy Regions While other factors including ethnic origins, income, mother tongue, age, and mobility of population were rejected as being less determinant, the six most accurate factors were grouped into a Socio-Economic Risk Index. The researchers at the Manitoba Health Centre for Policy and Evaluation have used the Socio-Economic Risk Index (SERI) to explain components in health across the province and to illustrate "differences in the lifetime burdens of illness" (Frohlich and Mustard,1994, P. 20). After analysis using the SERI, certain facts stand out. Residents of Thompson and Norman regions scored highest on the SERI. There were high rates of unemployment at all ages, a high percentage of single female parented families, low rates of high school completion, low rates of female participation in the workforce and low housing values. (Frohlich and Mustard, 1994, P. 21). Thompson, Norman, and Parklands residents had the highest rates of acute medical care in the province, approximately twice the rate of Winnipeggers (ibid. P. 55). Thompson and Norman residents also had the province's highest rates of persons hospitalized, and days of hospital care. Children were sent to hospital more often from the Parklands, Norman, and Thompson regions; two to three times more frequently than Winnipeg's youngsters ( Frohlich and Mustard, 1994, P. 62). Norman also led the province in the need for surgical procedures, exceeding the provincial average by 45% (ibid, P. 64). The health of people within these northern regions is clearly poorer than that of other Manitobans. The direct impact of low literacy in these areas is seen in several sorts of cases. Since many of the northern hospitalizations are long distance transferrals using air ambulance, face to face contacts between doctor and the patient's care-givers are rare. Patient consent forms must be administered orally, sometimes by telephone. During emergencies, forms are signed by only partially comprehending clients (Jacobs,1991, P. 10). In "long distance medicine" there is an increased reliance upon written or printed instructions in post-hospital recovery (Lerner, 1993, P. 18). Re-admittals are common and costly as the period of recovery is lengthened (Frohlich, et al, 1994, P. 45). Although reserve populations seem to dominate many of the regional statistics, all rural low-literates do not live on reserves. Sixty-nine Manitoba towns and municipalities have rates of grade nine non-completion of between 25 and 50%. Low literacy exacerbates inherent dangers associated with daily work and leisure activities. Safety regulations accompanying fertilizers, pesticides and other farm and home chemicals are violated by those who merely "guess" at what the instructions say, for example. Difficulty comprehending precautions on farm and recreational machinery such as all-terrain vehicles, watersleds, snowmobiles and farm equipment of all sorts, make rural life more dangerous. Hunting, fishing, boating, and driving regulations may be written down, but compliance is often a question of reading skill and comprehension. |