Intra-metropolitan health disparities in Canada: Studying how and why globalization matters, and what to do about it

Intra-metropolitan health disparities in Canada: Studying how and why globalization matters, and what to do about it Ted Schrecker 1 (tschreck@uottawa.ca; http://www.globalhealthequity.ca/about/schrecker.shtml) Institute of Population Health, University of Ottawa, Canada Prepared for conference on Mapping Global Inequality, University of California – Santa Cruz, December 13-14, 2007 This paper describes work in progress. Comments are welcomed, but please do not quote or cite without first contacting the author 1. Introduction This paper describes the background and offers a provisional conceptual framework for an innovative transdisciplinary research initiative designed to identify and anticipate the effects of globalization on health and the social determinants of health (SDH) in Canada’s three largest metropolitan areas: Toronto, Montreal and Vancouver. 2 These areas account for one third of Canada’s population, and are growing much more rapidly than the country as a whole, partly because they receive ~ 80 percent of the country’s recent immigrants (Good, 2005). Our research program is distinctive in several ways. First, it focuses on social determinants of health (SDH) in the context of urban/metropolitan systems and health, which provide “mosaics of risk Although this paper has only one identified author (because of time pressures surrounding its preparation), it reflects an valuable ongoing collaboration with a large number of leading Canadian researchers in the Globalization and the Health of Canadians project (principal investigator: Ronald Labonte). They are not identified here because they have not had a chance to comment on this text, and to shield them from blame for the errors and omissions that it no doubt contains. Comments on an earlier draft by Kirsten Stoebenau were extremely helpful. For updates on our work, go to http://www.globalhealthequity. ca/projects/proj_health_cnds/index.shtml. Census Metropolitan Areas (CMAs) are units used by the national statistical agency, Statistics Canada, for aggregating data from large numbers of smaller units known as census tracts, which are the basic units for organizing census data for urban and rural areas alike. CMAs include numerous municipalities as well as substantial rural areas of very low population density; some of these municipalities are mid-sized cities in their own right. The city of Mississauga (west of downtown Toronto and with the largest of several suburban downtowns that have developed within the Toronto CMA), for example, had a population of 668,000 in 2006, making it Ontario’s third largest city, behind only Toronto itself and Ottawa. Conversely, the Toronto CMA does not include some cities that arguably should be considered part of the Toronto metropolitan system – for example, Burlington and Oshawa -- because substantial numbers of people commute from them to jobs in the Toronto CMA and because they are part of a single metropolitan land and housing market. A larger planning region with a total population of 5.5 million, the Greater Toronto Area (or GTA), consists of the City of Toronto (formerly Metropolitan Toronto) and the surrounding regional municipalities of Peel, York, Halton and Durham; these include the previously mentioned cities and a number of others.