Health

What is health? For some, health means the absence of disease and pain; for others, it is a general feeling of wellness. The World Health Organization (WHO) defines health more broadly: “the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”¹

This broad definition aligns with the Conference Board’s overarching goal in benchmarking Canada’s performance—to measure quality of life in Canada and in its peer countries. Most Canadians would agree that without health, quality of life is severely compromised.

To measure health performance, we evaluate Canada and 16 peer countries on the following 11 report card indicators: life expectancy; self-reported health status; premature mortality; mortality due to cancer; mortality due to circulatory disease; mortality due to respiratory disease; mortality due to diabetes; mortality due to diseases of the musculoskeletal system; mortality due to mental disorders; infant mortality; and mortality due to medical misadventures—a new indicator added this year that reflects patient safety and the quality of health-care services.

It is important to note that the Conference Board is not attempting to rate Canada’s health-care system. Although the health-care system has an impact on the health status of a population, our goal is to evaluate the health status of Canadians and of their peers in other countries.

Canada’s middle-of-the-road ranking overall—a solid “B”—would surprise most Canadians who are immensely proud of their health-care system. Canadians have universal access to health-care services, highly skilled and committed health-care professionals, and internationally recognized health-care and research institutions. But the Canadian health-care system also has challenges. These include limited availability of comprehensive health information systems, wait times for some health-care diagnostics and treatments, and management systems that don’t focus enough on the quality of health outcomes. What’s more, health care is just one of several contributors to the health of Canadians; other factors also come into play, such as the age of the population and lifestyle choices including tobacco use, alcohol consumption, physical activity, and eating habits. These factors are, for the most part, independent of the formal health-care system.

Lifestyle choices are integral to determining the degree to which a population may suffer from chronic disease. In 2005, for example, the World Health Organization estimated that Canada would lose US$500 million in national income from premature deaths due to heart disease, stroke, and diabetes.² As more people die each year, these losses accumulate; financial losses due to these premature deaths will skyrocket to an estimated US$1.5 billion by 2015, triple the 2005 numbers. If Canadians adjust their lifestyles to reduce risks, however, these morbidity and mortality rates—and their associated costs—can be reduced.

The radar diagram below provides a snapshot of Canada’s health performance on the 11 indicators relative to the best-performing country for each decade. It has 11 axes—one for each indicator—that radiate out from the centre. A score closer to the centre represents worse performance, while a score closer to the outer circle represents better performance.

On balance, fewer Canadians are dying today from the diseases benchmarked here than they did in the 1960s and 1970s. Clearly, progress is being made in reducing the number of people dying from catastrophic disease.

Relative to its peers, however, Canada dropped to 10th place in the most recent year of data—down from a much more envious 5th place in the 1990s.

Canada has not made progress on all indicators. The mortality rate due to misadventures during medical care is higher now than it was in the early 1980s, and so Canada’s relative ranking on this indicator has dropped from an “A” in the 1990s to a “B” this decade. However, this increase might be due to increased reporting of misadventures resulting from greater awareness of the importance of reporting and the availability of better tracking systems that have been generated by recent patient safety movements.  

Canada’s record on addressing mental illness has steadily deteriorated. This is especially disturbing given that Canada’s mental health services are in need of serious reform. In May 2006, the Standing Senate Committee on Social Affairs, Science, and Technology released its landmark mental health report entitled Out of the Shadows at Last, which documented that an astounding one in five Canadians will experience some sort of mental disorder in their lifetime, and two-thirds of these people will never receive treatment. The Senate mental health report contains over 100 recommendations that sweep across the health system and could have a significant impact on this fragmented part of the health system. The efforts of this committee were instrumental in persuading the federal government to establish the Mental Health Commission in August 2007. This Commission is now the cornerstone of Canada’s strategy to address mental health issues in the country.

More also needs to be done to combat diabetes, which now affects more than 2 million Canadians (or 1 in 11 adults). The Diabetes in Canada Evaluation (DICE) study found that nearly half of diabetes patients do not have their blood sugar levels under control.³

The Health Council of Canada found that half of all family physicians are not well prepared to handle patients with multiple chronic health conditions.⁴ In 2005, the federal government committed $300 million over five years to the Integrated Strategy on Healthy Living and Chronic Disease. Its target is a 20 per cent increase by 2015 in the number of Canadians who are physically active, follow healthy diets, and achieve a healthy body weight. With targets now set, governments and partner organizations need to devise mechanisms for tracking and reporting on progress toward the national targets.

Assessing Canada’s performance on the risk factors that lead to heart disease, cancer, diabetes, and respiratory disease is as important as assessing its approach to and success with treatment. Canada is a top performer among comparator countries on two leading risk factors: tobacco and alcohol consumption. The high number of deaths from lung cancer reflects the smoking habits of Canadians in previous decades; since then, a campaign to curtail smoking and anti-smoking bans in public places throughout the country have helped Canada to register the fourth-lowest proportion of smokers among all OECD countries. This augurs well for the risk of lung diseases.

At the time of the 1974 Lalonde Report on health, Canada was looked to as a world leader in the area of public health, including disease prevention and health promotion. Canada’s proud record in turning around tobacco consumption demonstrated the ability to create behavioural change in society. Canada will need to rally the same resources to overcome similar risks, such as obesity.

Although Canadians have not historically been heavy drinkers, alcohol consumption has increased over the last 10 years. Canadians 15 years and over now consume, per person per year on average, 84 litres of beer, 16 litres of wine, and 8 litres of spirits.⁵ The Canadian Community Health Survey reports that 21.8 per cent of Canadians age 12 and older admit to being heavy drinkers (five or more drinks on one occasion, 12 or more times a year).⁶

Physical inactivity and poor eating habits are two other prominent risk factors for heart disease, cancer, and diabetes that Canadians need to do more about.

New estimates suggest that one-third of cancers could be prevented with increased vegetable and fruit consumption, increased physical activity, and maintenance of a healthy body weight. Some of the strongest evidence of the relationship between diet and cancer has found that diets high in vegetables and fruit provide protection against cancer.⁷ Canada’s Food Guide to Healthy Eating provides new recommendations for children, teens, and adults for food consumption based on current evidence. Health Canada believes that following this new food guide will reduce the risk of obesity, type 2 diabetes, heart disease, certain types of cancer, and osteoporosis.

But many Canadians have yet to be persuaded that eating and fitness habits are integral to their quality of life and good health. In September 2000, the First Ministers’ Communiqué on Health directed health ministers to report publicly on health-care systems in Canada. The Performance Indicators Reporting Committee was formed to develop new health indicators. In 2000, Health Canada, Statistics Canada, and the Canadian Institute for Health Information (CIHI) started the Canadian Community Health Survey (CCHS) to collect population-level information on health determinants, health status, and health system utilization. CCHS tracked variables including physical activity and dietary practices. This self-reported data indicate that only 43 per cent of Canadians believe they are moderately active—up from 37 per cent in 1994–95. Similar data for eating habits indicate that only about 40 per cent of the population eats the five or more servings of fruits and vegetables a day recommended in Canada’s Food Guide. While comparable international data are not yet available, the CCHS results should raise serious concerns about Canadians’ physical activity levels and dietary practices, and the potential linkages to chronic diseases.

The radar diagram below provides a snapshot of Canada’s health performance on the 11 indicators relative to the best-performing country and the 17-country average. (For all the mortality rates due to the various diseases, it’s a 16-country average that excludes Belgium because equivalent data were not available. For the mortality rate due to medical misadventures, it's a 15-country average that excludes Belgium and Switzerland because equivalent data were not available.) The diagram has 11 axes—one for each indicator—that radiate out from the centre. A score closer to the centre represents worse performance, while a score closer to the outer ring represents better performance.

Canada performs better than the peer-country average on six indicators: life expectancy, self-reported health status, mortality due to circulatory diseases, mortality due to respiratory diseases, mortality due to mental disorders, and mortality due to medical misadventures. Canada’s performance is noticeably worse than the peer-country average on three indicators: mortality due to cancer, mortality due to diabetes, and infant mortality. On premature mortality and mortality due to diseases of the musculoskeletal system, Canada is close to average.

Use the pull-down menu to compare Canada's performance on each health indicator with that of any of its peers.

Japan—a “C” performer in the 1960s—has made great strides in the overall health of its population and has been a consistent “A” performer since the 1970s. It is the only “A” performer in the current decade. Nine countries receive “B”s in the current decade.

There is no easy, single answer to the question of why other countries are doing better than Canada. Most top-performing countries have achieved better health outcomes through actions on the broader determinants of health such as environmental stewardship and health-promotion programs focusing on changes in lifestyle, including smoking cessation, increased activity, healthier diets, and safer driving habits. Leading countries also focus on other determinants of health—such as education, early childhood development, income, and social status—to improve health outcomes.

Funding for health promotion and disease prevention invariably competes with the financial demands of the health-care system. It is often politically difficult to deny urgent needs in the present to invest in the future.

Yet the demographic profile of Canadian society is changing as the population ages, affecting the incidence of chronic disease. By 2030, the proportion of Canadians over 65 will be double what it was in 1990. The country is already facing a growing burden from chronic diseases. Health-care costs continue to rise, with chronic care consuming an ever-larger share of total health-care spending. Canada is not making significant progress in prevention and health promotion.

Countries with considerably older populations than Canada’s—like Sweden, Spain, and France—do not have more expensive health systems. Sweden, a country with one of the oldest populations in the world, has prioritized an integrated approach, tailoring home care, health care, and fitness activities to the needs of older Swedes.

It is becoming more apparent that individuals must be held more accountable for their own health and must understand the impact of their actions on the health system, especially in terms of rising rates of chronic diseases such as diabetes, cancer, and cardiovascular disease. Recent emphasis on evidence-based and interprofessional care being provided across the continuum of health services will help.

Canada has no choice but to adopt a model that focuses on sound primary care practices and population health approaches—particularly preventing and managing chronic diseases—and recognizes and rewards high-quality health-care services. Targets set by governments in the Public Health Agency of Canada’s Integrated Pan-Canadian Healthy Living Strategy are the building blocks of a prevention-oriented strategy. British Columbia’s internationally lauded ActNow program, which encourages citizens to exercise more and eat healthier food, is a particularly promising model of intra-governmental collaboration to develop health policy. Developing a report card that assesses Canada’s progress on its health-care goals would be an important component of a new business model for health care.

Canada’s middle-of-the-pack performance on mortality rates due to medical misadventures also points to the need to focus on patient safety and the quality of health care. Reporting near misses, rather than morbidity and mortality data, offers the greatest potential to gain insight into how to strengthen patient safety. As Canada builds up its patient-safety culture and improves its health-care information management, it will be possible to better detect safety issues. It will also be possible to react to safety issues in a more timely manner, and to disseminate what’s learned more effectively.

Population health strategies must target funding for improved information technology, electronic patient records, training and development, and innovation that will allow Canada to renew its health-care system and make it among the best. Greater receptivity to innovative technologies and delivery systems—together with supportive environments and policies to speed up their adoption—is essential in order to generate and evaluate new approaches to wellness and disease prevention and management.

Interested in learning more about technological innovation in Canada’s health system?

Exploring Technological Innovation in Health Systems, Ottawa: The Conference Board of Canada, 2007.

¹ World Health Organization, Constitution of the World Health Organization, [online, cited September 13, 2009].

² World Health Organization, Preventing Chronic Diseases: A Vital Investment (Geneva: Author, 2005), p. 78.

³ Canadian Diabetes Association, DICE Study Backgrounder (Toronto: Author, 2005), p. 3.

⁴ Health Council of Canada, Why Health Care Renewal Matters: Lessons from Diabetes (Toronto: Author, March 2007), p. 13, [online, cited September 13, 2009].

⁵ Statistics Canada, Food Statistics 2008, Catalogue no. 21-020-X (Ottawa: Author, May 27, 2009), [online, cited September 13, 2009].

⁶ Statistics Canada, Cansim database, Table 105-0501, Canadian Community Health Survey (CCHS) Indicator Profile by Age and Sex.

⁷ Cancer Care Ontario, Insight on Cancer: News and Information on Nutrition and Cancer Prevention, Volume Two, Supplement One: Vegetable and Fruit Intake (Toronto: Author, 2005), p. 6.