Canada's Performance 2004

V. The Health of Canadians

Introduction

Health is a state of complete physical, mental, and social well-being, and not merely absence of disease. Many factors can influence health. These include, for example, family history, social, physical and economic environment, individual coping skills and access to health care services.

While Canadians are much healthier than ever before, this progress is not even and major disparities exist. For example, there are clear disparities in health status by gender, age, socioeconomic status and place of residence. Some groups of people in Canada, for example, Aboriginal peoples are also generally in poorer health than the population as a whole (see Chapter IV).

The Government of Canada's Role in Health

The federal, provincial and territorial governments each play key roles in Canada's health care system. The federal government's responsibilities divide into five broad areas:

• Delivery of direct health services to specific groups including veterans, military personnel, inmates of federal penitentiaries, refugee claimants, serving members of the Royal Canadian Mounted Police, as well as First Nations populations living on reserves and the Inuit.
• Protecting the health of Canadians by working with others to set standards and guidelines and to ensure that Canadians have accurate, timely health information on which to base individual decisions. For example, the federal government regulates pharmaceuticals and medical devices; monitors the safety of the Canadian food supply; and monitors the effects on health of changes in the environment.
• Supporting the health care system by setting and administering national principles or standards through the Canada Health Act and assisting in the financing of provincial/territorial health care services through fiscal transfers.
• Promoting strategies to improve the health of the population. These strategies - in areas such as illness prevention and education - work together to mobilize others to educate, inform and encourage individuals to take an active part in enhancing their own health and well-being.
• Representing Canada in international for a on global health initiatives and participating in multinational efforts to eradicate disease, improve health and reduce risk.

This chapter measures progress against two key Government of Canada outcomes related to the Health of Canadians:

1. A Healthy Population; and
2. A Strong Health Care System.

The set of health indicators included in this report does not cover all aspects of health in Canada. Other recent publications cover a wider range of health indicators: Healthy Canadians - A Federal Report on Comparable Health Indicators (Government of Canada, 2003) and Health Care in Canada 2004 (Canadian Institute for Health Information).

Government of Canada outcome: A healthy population

Why Is It Important?

Just as individual health is a cornerstone of a happy, productive and long life, a healthy population is an important mainstay of a thriving country. Canada's public health system exists to safeguard and improve the health of Canadians. Responsibility for public health is spread across federal, provincial/territorial and municipal governments. The practice of public health also requires the collaboration of multiple sectors, such as health, agriculture and environment, as well as the active participation of individuals, community groups, non-governmental organizations, business, and public sector agencies (e.g. schools).

Public health focuses on the social, environmental and economic factors affecting health, as well as on the communities and settings where people live, learn, work and play. There are five key functions of public health (Source: Canadian Institute for Health Research, 2003):

• Health promotion (actions to affect overall health and well-being);
• Prevention (of specific diseases, injuries and social problems);
• Protection (preventive and emergency services);
• Surveillance (keeping track of patterns of disease to enable timely action); and
• Population health assessment (measuring, monitoring and reporting on the status of population health).

To support population health activities and protect the health of Canadians, the Government of Canada employs strategies in each of those domains. The Government's public health efforts cover a wide range of activities, from responding to threats from emerging and re-emerging infectious diseases to immunization, emergency preparedness, safe blood, food and water to nutrition, sanitation, early childhood development, occupational health and safety, and the promotion and development of physical activity and sport.

To ensure that Canada's public health system is prepared to respond to threats from emerging and re-emerging infectious diseases, in 2004 the government established the Public Health Agency of Canada and began setting up the initial Six Collaborating Centres for Public Health to act as a focal point for disease prevention and control as well as emergency response. The resources allocated to the new agency in the 2004 Budget will help to detect outbreaks earlier and mobilize emergency resources faster.

Measures to Track Progress

Health status and health outcome indicators tell us about the health of the overall population. The following four indicators contribute to measuring Canada's progress in a Healthy Population:

• Life expectancy as measured by the number of years a person would be expected to live, on the basis of the mortality statistics for a given observation period;
• Self-rated health as measured by population (aged 12 and over) who rate their own health status as being either excellent, very good, good, fair or poor;
• Infant mortality as measured by the number of deaths of children under one year of age expressed per 1,000 live births;
• Healthy lifestyles as measured by physical activity and body weight.

As described below, each provides a snapshot of the overall health of Canadians.

Life expectancy

Current Level and Trend

Although life expectancy is a measure of longevity and not quality of life, it is widely used as an indicator of the health status of the population.

Life expectancy for Canadians reached 79.7 years in 2002 compared with 77.8 years in 1991. A woman born in 2002 can expect to live 82.1 years, while a man can expect to live 77.2 years (life expectancy for women remained unchanged while life expectancy for men increased 0.2 years since 2001). (Source: Statistics Canada, The Daily, September 27, 2004)

International Comparison

The remarkable gains in life expectancy in the G-7 countries over the past four decades are due largely to rising standards of living, public health interventions and progress in medical care. According to the OECD, Japan had the highest life expectancy among G-7 countries in 2001 (81.5 years) followed by Italy (79.8 years) and Canada (79.7 years). The US ranked lowest among G-7 countries at 77.1 years. (Source: OECD, Health Data 2004)

Self-Rated Health

Current Level and Trends

Self-rated health is a widely accepted indicator of potential health problems, or the existence of more objectively measured health problems.

Over the last decade the proportion of Canadians describing their health as excellent or very good declined among both men and women in every age group. In 2003, 59.6 per cent of Canadians aged 12 and older reported that they were in excellent or very good health, down from 62.5 per cent in 2000-01 and 63.3 per cent in 1994-95. However, the percentage of Canadians who rated their own health as good increased from 26.5 per cent in 1994-95 to 29.7 per cent in 2003.

The percentage of Canadians who rated their health as fair or poor increased slightly from 10.2 per cent in 1994-95 to 10.6 per cent in 2003. In general, the proportion of Canadians who reported fair or poor health increased with age and lower educational attainment and income levels. In addition, a greater proportion of Canadians who smoked, were obese and had infrequent exercise also reported fair or poor health. (Source: Statistics Canada, "Regional Socio-Economic Context and Health," Health Reports, 2002)

International Comparison

Internationally, Canada ranks second after the United States in the percentage of the population reporting their health status as either good or better. (Source: OECD, Health Data, 2004)

According to the Joint Canada/United States Survey of Health, the vast majority in both countries - 88 per cent of Canadians and 85 per cent of Americans - reported that they were in good, very good or excellent health in 2003.

Americans were slightly more likely to report excellent health than Canadians. This was mainly the result of the 15 per cent of Americans aged 65 and older who reported excellent health, almost twice the proportion of only 8 per cent of Canadians in the same age group. (Source: Statistics Canada, Joint Canada/United States Survey of Health, 2004)

Infant Mortality

Current Level and Trends

The infant mortality rate is one of the most widely used measures of societal health. It is influenced by a number of factors in the population, including income, maternal education, and health services.

The Canadian infant mortality rate has decreased from 6.4 deaths per 1,000 live births in 1991 to 5.2 per 1,000 in 2001, a continuation of the trend of past decades (Source: Statistics Canada, 2003).

International Comparison

Canada ranked fifth among G-7 countries in 2001, with 5.2 infant deaths per 1,000 live births. (Source: OECD, Health Data, 2004)

Healthy Lifestyles

Healthy lifestyles are ways of living, including control over personal health practices and choices, that individuals make and that influence their state of health. Some important components of health lifestyle are physical activity, body weight and non-smoking. Healthy Lifestyles have been shown to be clearly associated with reducing the risk of health problems.

Healthy Lifestyles:Physical activity

Current Level and Trends

The prevalence of physical activity among Canadians has significantly increased over the past decade. In 2003, 50.4 per cent of Canadians aged 12 and over were at least moderately physically active during their leisure time, up 7.8 percentage points from the 2000-01 survey and 11 percentage points from the 1994-95 survey. (Source: Statistics Canada, Canadian Community Health Survey, 2004)

Healthy Lifestyles: Body Weight

Current Level and Trends

In terms of body weight, the proportion of Canadians with a BMI of 30.0 or higher has increased over the last decade. BMI or Body Mass Index is a measure to classify body weight and height to indicate health risks. According to World Health Organization (WHO) and Health Canada guidelines, a BMI greater than or equal to 30.0 is considered obese.⁽⁵⁾

From 1994-95 to 2003 the proportion of Canadian adults considered obese grew from 13.2 per cent to 14.9 per cent, reaching 2.8 million people. About 15.9 per cent of adult men and 13.9 per cent of adult women were considered obese. Rates of obesity were highest in the age group 45 to 64.

The proportion of Canadians considered overweight (BMI 25.0-29.9) also increased slightly during the past three years. In 2003, 33.3 per cent of the adult population aged 18 and over was considered overweight, compared to 32.4 per cent in 2000-01.

International Comparison

The number of overweight and obese people has increased in all OECD countries over the past two decades. According to the OECD Health Data 2004, the United States has the highest proportion of adults considered overweight or obese, followed by Mexico, the United Kingdom and Australia.

According to the Joint Canada-US Survey of Health released in 2004 obesity rates are higher in the United States than in Canada (21 per cent versus 15 per cent), primarily due to the proportion of American and Canadian women considered obese. One in five American women was obese compared with approximately one in eight Canadian women (21 per cent versus 13 per cent). There were no significant differences in the BMI distribution among men in the two countries.

Supplemental Information

By clicking on the link in the electronic version of the report, the reader can access information on an additional indicator that measures Canada's progress in the area of A Healthy Population: Non-Smoking.

The Government of Canada's Performance

Several departments and agencies contribute to the pursuit of A Healthy Population through their respective departmental strategic outcomes. In the electronic version of the report, clicking on the links in the table below will lead the reader to planning, performance and resource information, which is contained in the organizations' Departmental Performance Reports and Reports on Plans and Priorities. The Database, which can be found at http://www.tbs-sct.gc.ca/rma/krc/cp-rc_e.asp, also leads to relevant audits and evaluations.

Government of Canada outcome: A strong health care system

Why Is It Important?

Canada's universal publicly funded health care system gives concrete expression to the principles of fairness and equity that define our identity as Canadians. Canadians continue to take pride in our publicly funded system of health care, while at the same time expressing concerns for its future, including such matters as sustainability, waiting times, unmet health care needs and the availability of health care personnel.

The Government of Canada's commitment to health care rests on one fundamental tenet: that every Canadian has timely access to quality care. On September 16, 2004, First Ministers agreed on a Ten-year Plan to Strengthen Health Care, an action plan that commits to a 10-year track of substantial, predictable funding and sets out a clear commitment, shared by all provinces and territories, to achieve tangible results for Canadians.

The agreement responds directly to Canadians' number one priority - reducing wait times and improving access. First Ministers committed to achieve meaningful reductions in wait times in priority areas (such as cancer, heart disease and joint replacements) by March 31, 2007. First Ministers also agreed to establish comparable indicators of access to health care professionals, diagnostic and treatment procedures with a report to their citizens to be developed by all jurisdictions by December 31, 2005.

The Government announced $18 billion over the next six years (and totalling $41 billion over 10 years) of new federal funding in support of the action plan on health. The new funding will be used to strengthen ongoing federal health support provided through the Canada Health Transfer (CHT), as well as to address wait times to ensure Canadians have timely access to essential health care services. As part of the government's commitment to provide growing, long-term health care funding, cash transfers to the provinces and territories for health are expected to reach $22.5 billion in 2007-08 representing an average annual growth rate of 15.6 per cent per year, starting from 2003-04.

Rise in Health Care Spending in Canada

The Canadian Institute for Health Information estimates that in 2003 Canada spent $121.4 billion on health care, or an average of $3,839 per person. This brought health care's share of the total economy - the gross domestic product (GDP) - back to its historic high of 10 per cent, first reached in 1992. (Source: Canadian Institute for Health Information, Health Care in Canada 2004)

Public sector spending currently accounts for seven out of every ten dollars spent on health care. In 2003, governments and social security programs spent just over $84.8 billion. Public expenditures on health in 2003 were 40 per cent higher than in 1993.

Measures to Track Progress

There are limitations in the administrative and survey data on quality of service, such as accessibility (the service is readily available and received within a reasonable waiting period) and acceptability (the service provided meets the clients' needs). Using administrative records to systematically collect quality-of-service indicators such as waiting times is relatively new in Canada. Jurisdictions are working toward comparable and consistent methodologies, in particular, approaches that measure waiting times by severity of illness.

The following two indicators contribute to measuring Canada's progress in achieving a Strong Health Care System:

• Waiting times, as measured by the self-reported median waiting times for specialized services, by type of service and population aged 15 and over.
• Patient satisfaction, as measured by population aged 15 and over receiving health services in the past 12 months who rate their level of satisfaction with those services as either very satisfied or somewhat satisfied. Perceived rating of the quality of services received (rated as excellent or good) is another component of this indicator.⁽⁶⁾

Waiting Times

Current Level and Trends

Nationally, the self-reported median wait to consult a specialist (i.e. visits to a specialist for a new illness or condition) was four weeks. This means that half of the people waited longer and half waited less. The median wait for non-emergency surgery was 4.3 weeks and for diagnostic tests three weeks. About 20 per cent of the individuals who waited for specialized services reported that they were affected by waiting for care, i.e. as a result of worry, stress, anxiety, and pain. (Source: Statistics Canada, Access to Health Care Services in Canada, 2003).

Overall, the majority of Canadians who accessed any of the three specialized services (visit to a specialist, non-emergency surgery and diagnostic tests) waited three months or less. Individuals who waited to visit a specialist or get a diagnostic test were more likely to get care within one month than those waiting for non-emergency surgery. The comparable self-reported waiting time data at the provincial level indicate that there was some variation in waiting times across provinces.

The majority (57.5 per cent) of individuals who waited for selected diagnostic tests did so for less than one month. Approximately 12 per cent reported that they had waited longer than three months. Despite some provincial variations in the proportion that waited more than three months, none of the provincial rates was statistically different from the national rate.

Among those who visited a medical specialist, 47.9 per cent waited less than one month. The results varied from a low of 40 per cent in Newfoundland and Labrador to a high of 54 per cent in Québec. At the other end of the spectrum, 11.4 per cent of people reported that they waited longer than three months to visit a specialist. This ranged from a low of 8 per cent in Prince Edward Island to a high of 21 per cent in Newfoundland and Labrador.

In the case of non-emergency surgery, 40.5 per cent of individuals who waited did so for less than one month. Provincially, the results ranged from 34 per cent in Québec to a high of 50 per cent in Newfoundland and Labrador. However, about 17 per cent of people reported that they waited longer than three months for non-emergency surgery. The rate was significantly lower in Newfoundland and Labrador at 10 per cent, and significantly higher in Saskatchewan at 29 per cent.

Between 2001 and 2003 the waiting times for specialized services showed a similar pattern. There was no statistically significant difference in the national median waiting time for all three specialized services, specialist visits (4 weeks in 2003 vs. 4.3 in 2001); selected diagnostic tests (3 weeks for both years); and non-emergency surgery (4.3 weeks for both years).⁽⁷⁾

Patient Satisfaction

Current Level and Trends

Between 2000-01 and 2003 the percentage of Canadians who rated the quality of overall health services as being either excellent or good increased from 84.4 per cent to 86.6 per cent. During the same time period, the percentage of Canadians who reported that they were very satisfied or somewhat satisfied with those services also increased, from 84.6 to 85.3 per cent. (Source: Statistics Canada, CCHS 2000/01 and 2003)

The Government of Canada's Performance

Several departments and agencies contribute to A Strong Health Care System through their respective departmental strategic outcomes. In the electronic version of the report, clicking on the links in the tables will lead the reader to planning, performance and resource information, which is contained in the organizations' Departmental Performance Reports and Reports on Plans and Priorities. The Database, which can be found at http://www.tbs-sct.gc.ca/rma/krc/cp-rc_e.asp, also leads to relevant audits and evaluations.