Health

Respiratory diseases include asthma, tuberculosis, bronchiolitis, emphysema, cystic fibrosis, influenza, and pneumonia. Although Canada and most of its peer countries have seen a decrease in respiratory diseases over the past few decades, aging populations in developed countries are expected to lead to a surge in these diseases in the future.

Over 3 million Canadians of all ages have a serious respiratory disease such as asthma, chronic obstructive pulmonary disease (COPD), influenza and pneumonia, bronchiolitis, tuberculosis (TB), cystic fibrosis, and respiratory distress syndrome (RDS).¹

Smoking is the main preventable risk factor for respiratory diseases like lung cancer and COPD. As more women became smokers after the First World War, the incidence (number of new cases) and prevalence (total number of cases) of respiratory diseases among women increased.² Fortunately, the proportion of smokers has dropped significantly in the past several decades. About 18 per cent of Canadians aged 15 and older smoke cigarettes every day, which represents a 24 per cent decrease since the early 1960s.

Although the proportion of smokers has dropped, Canada, like many of its peer countries, is facing an increase in chronic respiratory diseases. As a report published by Health Canada explains, "since many of these diseases affect adults over the age of 65, the number of people with respiratory diseases will increase as the population ages. The corresponding increase in demand for services will pose a significant challenge for the health-care system.”³

Canada earned a “B” in 2006, ranking 9th out of 16 peer countries, for an estimated mortality rate of 41 deaths per 100,000 population.⁴ The mortality rate due to respiratory system diseases ranges from Finland’s low of 24 deaths per 100,000 population to Ireland’s high of 79 deaths. The most recent year of published data on mortality due to respiratory disease for Canada is 2004, with 43 deaths per 100,000 population.

Canada has reduced its death rate due to respiratory system diseases over time—from 59 deaths per 100,000 population in 1960 to an estimated 41 deaths in 2006. Germany has made the most progress since 1960, but most other countries have also reduced their mortality rates.

The two exceptions are Denmark (its mortality rate increased from 52 in 1960 to 59 deaths per 100,000 population in 2006) and the U.S. (its mortality rate increased from 58 deaths to 59 deaths). Ireland slightly improved its respiratory system mortality rate, but remains the worst performer on this indicator.

Use the pull-down menu to compare the change in Canada’s mortality rate due to respiratory system diseases with that of its peers.

Relative to its peers, Canada has performed well on this indicator, scoring an “A” during four of the five decades, although it slipped to a “B” in 2006. Other strong performers are Australia, Austria, France, Germany, Italy, Sweden, and Switzerland. Ireland has been a consistently poor performer, with a “D” in all five decades. Because Denmark’s mortality rate increased over time, its grade fell from an “A” in the first three decades, to a “B” in the 1990s and a “C” in the 2000s.

Three of the leading respiratory diseases contributing to the overall Canadian respiratory disease burden are:

• asthma
• chronic obstructive pulmonary disease (COPD)
• acute respiratory tract infections

Asthma is now the most common of all respiratory diseases in Canada, with about 2.7 million cases. Additionally, more than 700,000 Canadians are believed to be living with COPD. Including other chronic respiratory conditions, it is estimated that more than 6 million Canadians, or roughly 1 in 5, are living with lung diseases.

Human influenza—or the flu—is a highly contagious respiratory infection caused by the influenza virus. Although most people recover within a week or so, some people develop more severe complications, such as pneumonia. Depending on the severity of the strain in a particular year, between 4,000 and 8,000 Canadians can die of influenza and its complications annually.⁵ For more information on the symptoms, prevention, and treatment of influenza and on its different strains, see the Public Health Agency of Canada’s website.

A pandemic influenza occurs when a determined strain of flu virus spread rapidly among humans. The World Health Organization’s pandemic levels measure how fast the virus is travelling and affecting people—not the severity of the disease itself.  Phase 6, the highest, indicates community-level outbreaks in at least two WHO regions.

A new strain of influenza A (H1N1), an influenza virus that typically affects pigs, is responsible for the first flu pandemic in 41 years. This virus, which causes a respiratory illness with symptoms similar to those of the regular seasonal influenza, has spread rapidly through the world. In March 2009, the first case of swine flu was reported in Mexico. By the end of April, 11 countries had officially reported 257 cases.⁶ By June 2009, the WHO reported 30,000 confirmed cases in 70 countries over all WHO regions, prompting it to declare a Phase 6 pandemic.  

Although H1N1 has comparable symptoms to regular seasonal influenza, H1N1 has shown higher transmission rates and has resulted in a higher percentage of emergency department visits and use of intensive care than regular seasonal influenza.⁷ Some cases of H1N1 have resulted in rapidly progressive respiratory disease and subsequent respiratory failure and need for intensive care,⁸ which has generated concerns about intensive care resources as the number of confirmed cases rises.  

The H1N1 virus has hit Canada hard. WHO figures indicate that Canada ranks third in terms of the total number of confirmed H1N1 cases in the world, after the U.S. and Mexico. Canadian statistics from the Public Health Agency of Canada reported that there were a total of 1,454 hospitalized cases and 72 deaths as of the end of August 2009.⁹ Given that not every individual demonstrating flu-like symptoms is tested, the actual number of cases is likely under-reported—it could be more than 10 times the number of confirmed H1N1 cases.¹⁰

Canada also ranks fifth in the number of H1N1 deaths per million population after Argentina, Uruguay, Mexico, and Chile. The H1N1 virus appears to have significantly different impacts among various groups. In Canada, the virus seems to be more severely affecting pregnant women, people with underlying medical conditions (e.g., asthma, chronic heart or lung disease, cancer), and Canada’s Aboriginal peoples. Mortality rates are higher among people over 65 years of age, those under 1 year of age, and people with underlying medical conditions.

Influenza vaccination rates have nearly doubled across Canada since 1996–97, according to a Canadian study from the Institute for Clinical Evaluative Sciences (ICES). Yet despite the increase, high-risk groups still fall short of national vaccination targets. The study, published in the October 2007 issue of Health Reports, examined the recent trends in influenza vaccination rates in Canada, identified what makes people more likely to get a flu shot, and looked at the effects of Ontario’s universal influenza immunization program on vaccination rates.¹¹

“Convincing people they need to be vaccinated and getting them vaccinated are the two biggest challenges we face in this country,” says Dr. Jeff Kwong, the study’s lead author and ICES scientist. “Not enough individuals who are considered to be high risk for serious complications, like seniors, those with chronic conditions, and young children, are getting the shot.”¹²

According to ICES, a national consensus conference on influenza in 1993 "set target vaccination coverage rates of 70 per cent for adults aged 65 or older and for all adults with chronic medical conditions. The national target was raised to 80 per cent in 2005 and was reached by seniors aged 75 or older with chronic conditions. Just 56 per cent of individuals aged 50 to 64 with chronic conditions were vaccinated in 2005; the figure was about one-third for those younger than 49 with chronic conditions."¹³ Federal and provincial governments are encouraging the public to be vaccinated, given the H1N1 threat. In preparation for the flu season, the federal government ordered 50.4 million doses of an H1N1 vaccine that was under development.

The severity of the impact of the H1N1 flu is testing the capacity of the health-care system to respond to a surge of activity. As the number of cases increases, demand for beds in intensive-care units may rise, surgeries may be cancelled or delayed, and the need for other medical technology and equipment may grow.¹⁴

This pandemic is also potentially a business and economic continuity crisis. H1N1 is likely to have significant economic impact if forecast levels of absenteeism become real. Appropriate and effective pandemic responses are critical for maintaining the operation of Canada’s private and public sector organizations. 

¹ Canadian Institute for Health Information, Canadian Lung Association, Health Canada, and Statistics Canada, Respiratory Disease in Canada (Ottawa: Authors, 2001), p. vii [online, cited June 22, 2009].

² Canadian Institute for Health Information, Canadian Lung Association, Health Canada, and Statistics Canada, Respiratory Disease in Canada (Ottawa: Authors, 2001), p. vii [online, cited June 22, 2009].

³ Canadian Institute for Health Information, Canadian Lung Association, Health Canada, and Statistics Canada, Respiratory Disease in Canada (Ottawa: Authors, 2001), p. vii [online, cited June 22, 2009].

⁴ Missing data up to 2006 were obtained by projecting the most recent year of data using a 10-year average annual growth rate.

⁵ Public Health Agency of Canada, “Influenza” [online website content, cited]. June 22, 2009].

⁶ World Health Organization, Influenza A (H1N1)—Update 6, April 30, 2009, [online, cited September 13, 2009].

⁷ World Health Organization, Epidemiology and Illness Severity of Pandemic (H1N1) 09 Virus, presentation at SAGE Meeting, July 7, 2009, [online, cited September 13, 2009].

⁸ European Society on Intensive care Medicine, H1N1 Flu Registry on Intensive Care—Scientific Manual, p. 5, [online, cited September 13, 2009].

⁹ Public Health Agency of Canada, FluWatch August 23, 2009 to August 29, 2009 (Week 34), [online, cited September 13, 2009]. 

¹⁰ The Conference Board of Canada, Ready or Not: Effective Pandemic Response (Ottawa: Author, July 2009).

¹¹ Institute for Clinical Evaluative Sciences, Influenza vaccination rates more than doubled in Canada over past decade: ‘Too few people who need them get them,’ October 2007 [online, cited September 23, 2009].

¹² Ibid.

¹³ Ibid.

¹⁴ The Conference Board of Canada, Ready or Not: Effective Pandemic Response (Ottawa: Author, July 2009).

See discussions on other indicators
Life expectancy	Mortality due to diabetes
Self-reported health status	Mortality due to musculoskeletal system diseases
Premature mortality	Mortality due to mental disorders
Mortality due to cancer	Infant mortality
Mortality due to circulatory diseases	Mortality due to medical misadventures
Mortality due to respiratory diseases