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Résumé (français)

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Résumé (anglais)

Between 2000 and 2005, the portion of Canadians reporting excellent health declined by 14%. This decline in self-reported health is documented as far back as 1994, and is observed across all age groups and gender. Over the same period, Canadian market structure shifted dramatically, experiencing a rise in large corporations and “super-sized” outlets. The percent of total operating revenue attributed to small business fell nearly 30%. Big business is hierarchical in nature and is reported to engender income inequality and social isolation, all identified as correlates of poor health. Thus changes in market structure may be negatively associated with health and may be behind part of the recent decrease in self-reported health. Exploiting variation in market composition across time and community, this study explores the relationship between market structure and health. Using the Survey of Labour and Income Dynamics (SLID), we investigate whether individuals who live in communities with proportionately more small business report being healthier than those who do not. We also consider individual employment characteristics associated with ‘big business’ such as firm size, insurance coverage, and managerial status. Results indicate that both employment characteristics and market structure are significantly correlated with better reported health, even after controlling for income inequality, income and other socio-economic determinants of health. These strong and significant associations suggest a role for policies in improving the proportion of small businesses, as well as promoting socially cohesive activities in community and work environments.