The impact of area residential property values on self-rated health: A cross-sectional comparative study of Seattle and Paris

The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.

Administrative databases in the Canadian health sector do not contain socio-economic information. To facilitate the monitoring of social inequalities for health planning, this study proposes a material and social deprivation index for Canada. After explaining the concept of deprivation, we describe the methodological aspects of the index and apply it to the example of premature mortality (i.e. death before the age of 75). We illustrate variations in deprivation and the links between deprivation and mortality nationwide and in different geographic areas including the census metropolitan areas (CMAs) of Toronto, Montréal and Vancouver; other CMAs; average-size cities, referred to as census agglomerations (CAs); small towns and rural communities; and five regions of Canada, namely Atlantic, Quebec, Ontario, the Prairies and British Columbia. Material and social deprivation and their links to mortality vary considerably by geographic area. We comment on the results as well as the limitations of the index and its advantages for health planning.