Health Overview

Canada’s health-care system has fuelled the debate in the U.S. on health-care reform. But how does Canada fare on actual health outcomes relative to its neighbour? Quite well. Overall, Canada scores a “B” grade, ranking in 10th place, while the U.S. is the worst performer, with an overall "D" and four "D" grades in the 11 report cards that measure different aspects of the Health category. Indeed, Canada ranks ahead of the U.S. on all but one of these 11 report cards. On life expectancy, widely regarded as an overall indicator of a country’s health, Canada ranks 6th and scores a “B” grade; the U.S. ranks last. The U.S. also places last in the premature mortality and infant mortality report cards.

The only health report card in which the U.S. ranks above Canada is the one for the mortality rate due to cancer. While both countries score a “B” grade on this indicator, the U.S. mortality rate of 157 deaths per 100,000 population is less than Canada’s mortality rate (166 deaths per 100,000 population), giving it an overall ranking of 8th place. Mortality rates related to colon cancer, breast cancer, and prostate cancer are higher in Canada than in the United States. But mortality rates due to cervical cancer and lung cancer are lower in Canada.

These findings are not surprising. Despite being the biggest spender on health care among the OECD countries (over 15 per cent of GDP³), the United States fails to obtain good outcomes from these investments. The main reason is its inability to deliver the right care, at the right place, at the right time. Over 46.3 million Americans have no health insurance (an increase from 45.7 million in 2007).⁴ These individuals have limited or no access to appropriate primary health-care service, which is the best place for education, prevention, screening, and health promotion. Uninsured Americans are more likely to skip or delay treatment, have their conditions diagnosed at a later stage, be admitted to hospital for avoidable conditions, and suffer significantly greater stress that affects their well-being and that of their families.⁵ Even though the U.S. is an early adopter of state-of-the-art medical procedures and technologies, great inequities in the country affect the health status of its citizens.

Lifestyle factors such as tobacco use, alcohol consumption, physical inactivity, and poor eating habits are responsible for the high prevalence of chronic diseases in developed countries, particularly the U.S. and Canada. Over 67 per cent of Americans and 47 per cent of Canadians are overweight or obese (with a body mass index, or BMI, of 25 or over). Both countries have high mortality rates due to diabetes, and most diabetes cases are type 2—an adult-onset disease that is affected by diet and physical activity.

The only health report card in which Canada and the U.S. score an “A” grade is self-reported health status, where they rank 1st and 2nd, respectively.

Canada’s “B”s over five decades may lead Canadians to think that no real progress is being made in improving health outcomes. In fact, Canada is making progress on many indicators. There has been a steady reduction in the number of lives lost due to most of the diseases benchmarked in this report card. Canada’s peers have also improved, however, so our relative grade has not gone up. In two disease categories—diabetes and mental illness—Canada’s mortality rate has actually increased.

Japan is once again the top-ranking country. Japan turned a “C” in the 1960s to a sustainable “A” by the 1970s. It is joined in the “A” category this year by Switzerland, Italy, and Norway. Finland ranks above Canada this year thanks to its lower mortality rates on six of the nine mortality rate report cards.

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.

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 such as diabetes and cancer. Health-care costs are rising and chronic care is consuming an ever-larger share of total health-care spending. Canadians are not making significant progress in prevention. To do so, they must change their attitudes and behaviours.

Canada has no choice but to adopt a model of health care that focuses on sound primary care practices and population health approaches—particularly preventing and managing chronic diseases—and recognizes and rewards health-care quality outcomes. Targets set by governments in the Integrated Pan-Canadian Healthy Living Strategy are the building blocks of a prevention-oriented strategy. Developing a report card that assesses Canada’s progress on these health-care goals is fundamental to the sustainability of the health-care system.

Innovative health information technologies can make patients safer and improve health care. These systems support disease prevention and management and help to achieve efficiencies and cost savings (about $77 billion in the United States⁶). Electronic patient records, decision support systems, and computerized physician order entry for medications are among the electronic tools that will allow Canada to renew its health-care system and make it among the very 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.

¹ World Health Organization, Constitution of the World Health Organization, [online, cited August 18, 2008].

² Standing Senate Committee on Social Affairs, Science and Technology, A Healthy, Productive Canada: A Determinant of Health Approach, Final Report of the Senate Subcommittee on Population Health (June 2009).

³ Karen Davis et al., “Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?” The Commonwealth Fund (47) January 29, 2007 [online, cited September 12, 2009].

⁴ The Commonwealth Fund, Statement From Karen Davis: New Census Data on Uninsured Americans, September 10, 2009. [online, cited September 12, 2009].

⁵ Jonathon Oberlander, “The US Health Care System: On a Road to Nowhere?”, Canadian Medical Association Journal, July 23, 2002 [online, cited September 22, 2009].

⁶ RAND Corporation, Health Information Technology: Can HIT Lower Costs and Improve Quality? [online, cited September 12, 2009].