The State of Health in Canada: A Look at Strengths, Challenges, and the Future

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Introduction to Health in Canada

The purpose of this paper is to provide a broad set of indicators that measure important aspects of health in Canada. The paper describes positive and negative developments shaping the health of Canadians. It also provides contextual information that helps to frame the best ways to ensure good health for the future. However, it is more than a simple list of indicators. It is also a call for a renewed approach to addressing these and other health challenges. In preparing this report, the Public Health Agency of Canada has benefited greatly from the work and analysis of many researchers, experts, and partner organizations working in the field of public health and the whole of government. From the outset, we strove to ensure that our analysis would be grounded in data, good practices, and appropriate methodologies. We also sought to present a comprehensive picture of health in Canada by including measures of the social determinants of health that have the most direct impact on Canadians’ well-being. This work is accompanied by in-depth analysis in a series of thematic papers. Given the vast complexity of health, this report may not address in-depth some areas of concern for readers. However, in the longer term, we aim to foster further discussions and analyses, using the foundations built here. Indeed, this report is as much a work in progress as Canada’s journey to better health.

In Canada, health is a fundamental right for all residents and a key component of a fair society. Good policies and social conditions are essential to maintain and improve a population’s health. Over the past 50 years, the life expectancy of Canadians has increased significantly. The health of Canadians is among the best in the world when you consider measures such as disease burden, disability, and life expectancy. Although this is a significant and laudable achievement, challenges remain that warrant attention. These include the cost of the healthcare system, which has placed significant financial pressure on provincial and territorial governments, particularly in the last decade; our aging population; the gap between our richest and poorest citizens; the relative health disadvantage experienced by Aboriginal populations and Canadians at both ends of the socioeconomic spectrum; and the continued presence of chronic conditions despite progress in medical science.

Historical Overview of Health Policies and Systems

The period following Confederation was marked by rapid population increases due to immigration. Canada’s policy was quite promoting settlement into western Canada and was open and encouraging immigration, especially through land opportunities. Assisted immigration was replaced with delayed-recruiting Atlantic Canada immigrants looking for jobs in the United States, and the demand in forest Quebec City and Halifax. Settlement of returned soldiers, the depression, and fallout from the First World War led to substantial changes in the policy and practice of assisted immigration. The retention of favored immigrants was the province of the federal government until after the War of 181 Eventually, the concerted efforts of all parts of Canada led to the formal international education and the beginning of a professional Canadian public service of inspecting, filtering, and selecting immigrants, as well as inspecting quarters and keeping records. Local vested interests ensured the work was adopted by eligible medical colleges to qualify specialists in public health and as immigration officers. Provinces took over the inspection and regulation of water, sewage, and garbage, food and restaurants, and schools and policing public health matters. This involved distinctive provincial tests, legitimizing public health workers as health professionals, and health inspectors often wore quasi-military uniforms. There was an expectation that any public health work was sui generis, and health staff dealt with it as is, but still under supervision by medical officers of health.

Current Health Indicators and Trends

Disability-free life expectancy follows the pattern of life expectancy for both men and women, continuing to increase at a fairly steady rate. In recent years, progress towards the ultimate goal of death without disability has appeared slow, as increases in life expectancy have been accompanied by waning progress in contributing to a later onset of disability. There is also the concern that as people live longer there will be a need for an increased level of chronic care. Given the demographic dynamics of a rapidly aging population, this has economic and financial implications.

The existing state of health of a population is of crucial importance when all health services strive to attain and maintain the highest possible levels of health status, which both a population and its individual citizens seek. One of the most important and commonly used measures of the health of a population is life expectancy. Over the past 150 years or so, life expectancy has been increasing in industrialized countries at a fairly constant rate. Currently, life expectancy in Canada for both men and women is well over 75 years of age and continues to increase. Life expectancy is often used as a summary measure of health because it combines in a single index the various risks that people have of dying at different points during the aging process.

Key Strengths in the Canadian Health System

The total financial commitment to health has remained at around the present levels, that is 5% of gross domestic product (GDP) from public sources and 5% from private sources, for decades. It’s health care respecting the values of equity and access. These values are enshrined in the five core principles in the Canada Health Act: respect for people’s sense of fairness and innate value of human beings, conviction that access to the full range of health services is a matter of rights and a proper role of government, the idea of all for one and one for all, and the pursuit of equal opportunity so that all people are able to get good services.

Publicly funded, as well as the health professional workforce, high-quality, cost-efficient, and accessible primary and hospital care systems. The health status of the population is amongst the best, as well as data and data sources. High level of public acceptance and satisfaction with both the system and characteristic. A vibrant, high-quality not-for-profit sector which plays a leading role in health research and health care delivery, and the basis for a strong research environment due to the ongoing public commitment to health research. These strengths provide the foundation for going forward. Typically, the public and politicians find fault with particular aspects of the system yet remain committed to it. There is a foundation of satisfaction and ability to adjust where the Canadian people view health as a right profoundly shapes Canadian health care. Canadian health care is characterized by rapid and consistent activity in almost every aspect of health on many dimensions. This is an unlimited exploration.

Challenges and Disparities in Access to Healthcare

Inequitable results in terms of health status are evident in Canada across age, gender, ethnicity, and wealth gradients. According to the O’Brien Institute for Public Health at the University of Calgary, low-income Canadians are more likely to report poor overall health, shoulder heavier disease burdens, be physically inactive, smoke, and report mental health concerns than high-income Canadians. Cardiovascular disease, respiratory conditions, and discomfort with physical activity are disproportionately high amongst the economically marginalized. The underlying reason for challenging healthcare problems may be the more complex health needs and barriers to care for those living in poverty. For example, low-income families have a harder time getting to the doctor, paying for the doctor or purchasing medication, and may have more difficulty accessing secondary and tertiary healthcare services than high-income families. The health condition of low-income Canadians may be connected to health conditions experienced during their childhood. Preventing health issues in their youth and addressing social determinants in their youth may provide a way to break the intergenerational cycle of poverty, poor health, and poor healthcare.

Access to healthcare is a key determinant in the health of a population. Canadians are proud of their universal tax-financed health insurance that guarantees access to a medical profession widely recognized for high-quality healthcare. Our healthcare system has many strengths: it has been an important contributor to the ongoing expansion of life expectancy; it is ranked highly in terms of healthcare quality by the World Health Organization; and it is efficient in its use of resources. However, access to the healthcare system is uneven. Uninsured Canadians have more difficulty accessing care or face special restrictions on obtaining care, including access to dental care, prescription drugs, and mental health services. Although the insured in Canada face no formal financial barriers to access, they may still face long waits for some services.

Innovations and Future Directions in Canadian Health Policy

What have we learned? There is a rich body of literature, much of it from other countries, which highlights the many difficulties involved in the task of reforming health care. One key lesson is that it is far easier to identify what needs fixing in the health care system than it is to prescribe effective reforms. Each cure creates its own set of problems and what seems to work well in one system appears to be much less effective in another. Not only are there difficulties in transferring knowledge between countries, there are also serious barriers in transferring knowledge between health sector settings: reforming primary health care, mental health, long-term care, etc., each pose a different set of dilemmas that are quite specific to the nature of the service provided. Moreover, where reforms are enabling changes in practices or attitudes, such as in nursing, or attempts to modify the relationship between individuals and their health, the process of change involves different adjustments and expectations.

Introduction Health policy development is, without question, a complex and ongoing process that involves not only delivering and organizing services, as was envisioned in earlier periods of health policy formulation, but also creating environments and cultures that promote health. Health policy reform is very much about setting a course and establishing a philosophy that guides both the actions of health care providers in their interactions with their patients and the behaviors of health care consumers themselves. This paper will first briefly review what we have learned from past experiences in health policy, review the current state of health of Canadians, and some of the critical determinants of health. We then identify some of the major problems that are facing both the health policy agenda and set out the critical forces that we believe are shaping health policy directions in the future. Finally, we will outline some of the boundaries that will define the range of potential solutions to health problems by sitting within broad conditional limits.

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