Is it health care or is it health?

In the past 2 years, Maclean's has used a composite scoring system to rank health care services in Canada.1 However, the Maclean's scoring system includes components that are influenced by factors other than health care services. For example, life expectancy,2 low birth weight,3 and avoidable hospitalizations4 are all influenced strongly by socioeconomic factors such as income, employment and education.

We examined the relationship between each of average income, percent unemployment and the percentage of the population with a postsecondary education, and the Maclean's score for the same 50 health regions that the magazine studied. We obtained these socioeconomic data from Statistics Canada.5 For each relationship we calculated the Pearson correlation coefficient and associated p value. We found a significant linear relationship between each of the socioeconomic factors and the Maclean's score (r = 0.49 and p < 0.001 for average income, r = –0.70 and p < 0.001 for percent unemployment (Fig. 1), r = 0.52 and p < 0.001 for the percentage of the population with a postsecondary education).

• Download figure
• Open in new tab
• Download powerpoint

Fig. 1: Correlation between percent unemployment and the Maclean's score for the 50 regions studied by the magazine.

Our findings highlight a need for caution when translating descriptions of health services into an overall assessment of health care. We recommend, along with others,6 that reports of clinical performance be adjusted for socioeconomic factors so that disparities in health care due to these factors can be emphasized and addressed.