Chapter 1: The Chief Public Health Officer's Report on the State of Public Health in Canada 2012 – The state of public health in Canada

Chapter 1: The State of Public Health in Canada

This chapter presents an overview of the demographics of the Canadian population, including their life expectancy and patterns of ill health, disability and mortality. Also discussed are determinants that influence health – income, employment, education, health behaviours and access to health care. Although some health challenges can be related to our genetic make-up, evidence shows that income, education, employment and other social determinants of health can cause or influence the health outcomes of individuals and communities. While it is important to discuss the overall state of public health in Canada, it is equally important to acknowledge that not all populations experience health at the same level. Taking this into account, issues associated with key populations (by age, sex, origin or other combinations), are explored further where possible.

Data presented throughout this chapter often come from surveys. Despite the inherent limitations of self-reported data, such as the subjectivity of individual responses and the exclusion of those living in institutions and on reserves, they can provide valuable information otherwise not available.

Who we are

The Canadian population was 33.5 million in 2011, divided almost equally between males (49%) and females (51%).Footnote 26 Projected proportions for 2011 estimate the Aboriginal population at 1.4 million (62% First Nations, 31% Métis and 4% Inuit), about 4% of the total Canadian population.Footnote 27, Footnote 28 The foreign-born population is projected to account for more than 20% of the total population in 2011.Footnote 29 Based on 2006 data, males make up 49% and 48% of the Aboriginal and foreign-born populations respectively.Footnote 30, Footnote 31

About 84% of Canadians lived in urban areas in 2011.Footnote 32, Footnote 33 Since 2001, nearly 90% of the country’s population growth has been concentrated in Canada’s large census metropolitan areas.Footnote 34 This is due, in part, to an increasing number of younger rural residents having moved to urban areas, leaving senior residents to make up more of the overall rural population.Footnote 35 From 2001 to 2006, nearly 1 in 7 Canadians between 25 and 44 years moved from the downtown areas in Toronto, Vancouver and Montreal to surrounding suburbs.Footnote 36 Those most likely to move to the suburbs included new parents and people with college or trades diplomas and with after-tax income between $70,000 and $99,999.Footnote 36

The population is also aging. The number of Canadians 65 years and older increased between 1976 and 2011 from 9% to 15% of the total population.Footnote 26, Footnote 28 This proportion is projected to grow to nearly one-quarter (24%) by 2036 (see Figure 1.1).Footnote 37 In 2011, children under the age of 12 and youth between 12 and 19 years accounted for less than one-quarter of the population (13% and 10% respectively), whereas young- and middle-aged adults between 20 and 64 years made up 62% of the population.Footnote 26 Although the population is divided almost equally by sex, the proportion of males and females varies somewhat by age group. From birth to 29 years, males slightly outnumber females at 51% of the population. The proportions reverse between 30 and 64 years with females at 51%.Footnote 26 From the age of 65 years onward, the male proportion continues to diminish: 47% males compared with 53% females between 65 and 79 years, and 37% males compared with 63% females among Canadians 80 years and older.Footnote 26

An exception to the aging population trend can be found among Aboriginal peoples who have a much younger population.Footnote 38 In 2006, almost one-third (31%) were between 12 and 29 years (49% males and 51% females) compared with 23% in the non-Aboriginal population.Footnote 39, Footnote 40 Within the Inuit population in the same year, 35% were youth and young adults between 12 and 29 years (50% males and 50% females).Footnote 39, Footnote 40

Figure 1.1 Population distribution by age group, Canada, 1976, 2011 and 2036Footnote 26, Footnote 28, Footnote 37

Figure 1
Text Equivalent - Figure 1.1

Summary: In 1976 the population was concentrated in the younger age groups, with the distribution of Canadians peaking in the 15 to 19 year-old age group. In 2011, the peak shifted toward the middle age groups, specifically in the 45 to 54 year-old age range, followed by a relatively steep decline across the older age groups. It is projected that the population will be distributed more evenly across age groups from 0 to 79 years and only decreasing significantly from age 80 onwards.

Source: Public Health Agency of Canada using data from Census 2011 and Canadian Population Estimates and Projections, Statistics Canada.

Age Group Population in millions in 1976 Population in millions in 2011 Population in millions in 2036
0 to 4 1.8 1.9 2.2
5 to 9 1.9 1.8 2.3
10 to 14 2.3 1.9 2.4
15 to 19 2.4 2.2 2.5
20 to 24 2.3 2.2 2.6
25 to 29 2.1 2.2 2.6
30 to 34 1.7 2.2 2.5
35 to 39 1.4 2.2 2.7
40 to 44 1.3 2.3 2.9
45 to 49 1.3 2.7 2.9
50 to 54 1.2 2.7 2.8
55 to 59 1.0 2.3 2.6
60 to 64 0.9 2.1 2.4
65 to 69 0.7 1.5 2.3
70 to 74 0.5 1.2 2.5
75 to 79 0.4 0.9 2.2
80 to 84 0.2 0.7 1.7
85 to 89 0.1 0.4 1.1
90 and older 0.1 0.2 0.6

Source: Public Health Agency of Canada using data from Census 2011 and Canadian Population Estimates and Projections, Statistics Canada.

The life expectancy of Canadians has increased dramatically over the past century to the point where a male born in Canada today can expect to live about 79 years and a female about 83 years.Footnote 41 Canadian women have historically experienced greater longevity, but between 1992–1994 and 2006–2008, the difference in life expectancy at birth between Canadian men and women decreased from 6.1 years to 4.6 years.Footnote 41 This is not because women are dying at a younger age, but rather because men are living longer.Footnote 41

Life expectancy among the Aboriginal population continues to be lower than among the general Canadian population. In 2001, life expectancy at birth for Métis was the highest among Aboriginal populations (71.9 years for males and 77.7 years for females), followed by First Nations (71.1 years for males and 76.7 years for females) and was lowest among Inuit (62.6 years for males and 71.7 years for females).Footnote 42 As with the general population, life expectancy among Aboriginal females is consistently higher than among males.Footnote 42

Variations in life expectancy are also seen by income. As shown in Figure 1.2, life expectancy in higher income neighbourhoods exceeded those in lower income neighbourhoods in 2005–2007.Footnote 43 Females at every neighbourhood income level have a higher life expectancy than males, with poor males being particularly disadvantaged.Footnote 43 As seen in Figure 1.2, the life expectancy gap between the lowest and highest income groups is 4.7 years for men but just 2.3 years for women, suggesting that income levels may have a greater effect among men.Footnote 43

Figure 1.2 Life expectancy at birth by sex and neighbourhood income quintiles, Canada, 2005–2007Footnote 43

Figure 2
Text Equivalent - Figure 1.2

Summary: Between 2005 and 2007, the life expectancy at birth of Canadians, by neighbourhood income quintile was as follows: in the lowest income quintile, 75.6 years for males and 81.7 years among females; in income quintile two, 77.8 years among males and 83.0 years among females; in the middle income quintile, 78.7 years among males and 83.3 years among females; in income quintile four, 79.1 years among males and 83.3 years among females; and in the highest income quintile, 80.3 years among males and 84.0 years among females.

Source: Greenberg, L. & Normandin, C. (2011). Disparities in life expectancy at birth. Health at a Glance, April 2011(1), 1-13.

Income Quintile Males Females
Q1 - Lowest 75.6 years 81.7 years
Q2 77.8 years 83.0 years
Q3 - Middle 78.7 years 83.3 years
Q4 79.1 years 83.3 years
Q5 - Highest 80.3 years 84.0 years

Source: Greenberg, L. & Normandin, C. (2011). Disparities in life expectancy at birth. Health at a Glance, April 2011(1), 1-13.

Our health

According to the 2010 Canadian Community Health Survey (CCHS), the majority of Canadians 12 years and older reported their health as either excellent (22%) or very good (38%).Footnote 44 Even more reported their mental health as excellent (37%) or very good (37%).Footnote 44 While both proportions decreased with age, a greater decline is seen for physical health than mental health (see Figure 1.3).Footnote 44 A slightly higher proportion of females (61%) reported very good or excellent health, whereas a slightly higher proportion of males (75%) reported very good or excellent mental health than females.Footnote 45

Figure 1.3 Excellent or very good self-perceived health and mental health by age group, Canada, 2010Footnote 44

Figure 3
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Summary: In 2010, the percentage of Canadians with excellent or very good self-perceived health, by age group, was as follows: aged 12 to 19 years, 67%: aged 20 to 29 years, 72%; aged 30 to 54 years, 63%; aged 55 to 64 years, 53%; aged 65 to 79 years, 44% and aged 80 years and older, 34%.

In 2010, the percentage of Canadians with excellent or very good self-perceived mental health, by age group, was as follows: aged 12 to 19 years, 75%: aged 20 to 29 years, 78%; aged 30 to 54 years, 74%; aged 55 to 64 years, 72%; aged 65 to 79 years, 72%; and aged 80 years and older, 64%.

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Age group Health Mental health
12 to 19 67% 75%
20 to 29 72% 78%
30 to 54 63% 74%
55 to 64 53% 72%
65 to 79 44% 72%
80 and older 34% 64%

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Despite relatively high rates of very good or excellent perceived health and mental health, not all years are spent in good health.Footnote 46 The health-adjusted life expectancy (HALE) from 2004 to 2006 shows that, of their 78.9 years of expected life, males spend the equivalent of 69.6 years in good health. During the same period, females with a life expectancy of 83.6 years had a HALE of 72.1 years.Footnote 46

Table 1.1 Our health status
Our health status Males Females Year
Abbreviations:
human immunodeficiency virus
potential years of life lost.
*Denotes self-reported data.

Note: More detailed information can be found in Appendix D: Definitions and Data Sources for Indicators.

Sources: Statistics Canada, Canadian Cancer Society and Public Health Agency of Canada.

Reported health and life expectancy
Perceived health, very good or excellentTable 1 - Footnote * (percent of population aged 12+ years) 59.7 60.5 2010
Perceived mental health, very good or excellentTable 1 - Footnote * (percent of population aged 12+ years) 74.5 73.3 2010
Life expectancy at birth (years of expected life) 78.5 83.1 2006–2008
Health-adjusted life expectancy at birth (years of expected healthy life) 69.6 72.1 2004–2006
Patterns of ill health
Back problemsTable 1 - Footnote * (percent of the population aged 12+ years) 18.5 19.6 2010
Cancer incidence (new cases age-standardized per 100,000 population per year) 456 369 2011
Diabetes prevalence (percent of the population aged 1+ years) 7.2 6.4 2008–2009
ArthritisTable 1 - Footnote * (percent of population aged 15+ years) 12.8 19.7 2010
AsthmaTable 1 - Footnote * (percent of population aged 12+ years) 7.1 9.8 2010
High blood pressureTable 1 - Footnote * (percent of the population aged 30+ years) 24.2 24.4 2010
Mood disordersTable 1 - Footnote * (percent of the population aged 15+ years) 5.0 8.2 2010
Causes of death and premature death (per 100,000 population per year)
Cancers (deaths) 224.4 199.3 2008
Circulatory diseases (deaths) 211.0 208.9 2008
Respiratory diseases (deaths) 64.2 60.3 2008
Cancers, aged 0 to 74 years (PYLL) 1,543.8 1,516.6 2008
Circulatory diseases, aged 0 to 74 years (PYLL) 1,106.6 444.2 2008
Unintentional injuries, aged 0 to 74 years (PYLL) 862.4 317.6 2008
Suicide and self-inflicted injuries, aged 0 to 74 years (PYLL) 446.7 173.8 2008
Respiratory diseases, aged 0 to 74 years (PYLL) 205.3 162.5 2008
HIV, aged 0 to 74 years (PYLL) 50.3 17.9 2008

A complete list of indicators, definitions and data sources can be found in Appendix C: Indicators of Our Health and Factors Influencing Our Health and Appendix D: Definitions and Data Sources for Indicators.

Patterns of ill health

The proportion of Canadians living with specific diseases and health conditions varies across the population. Although chronic health conditions are most often experienced by – and associated with – older members of the population, more than one-half (55%) of Canadians 12 years and older reported living with at least one of a number of chronic health conditions (see Figure 1.4).Footnote 44

Figure 1.4 Proportion of Canadians reporting one or more chronic health conditionsFigure 1.4 - Footnote * by age group, Canada, 2010Footnote 44

Figure 4
Text Equivalent - Figure 1.4

Summary: More than one-half (55%) of Canadians 12 years and older reported living with at least one of a number of chronic health conditions in 2010. The proportion increases with age, as do the proportions living with two, three and four or more conditions within age groups.

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Age group No chronic conditions One chronic condition Two chronic conditions Three chronic conditions Four or more chronic conditions
12 to 29 68.2% 21.5% 6.8% 2.0% 1.5%
30 to 54 48.2% 26.6% 13.3% 6.0% 5.9%
55 to 64 27.9% 26.9% 20.3% 12.1% 12.8%
65 to 79 15.8% 22.7% 24.1% 17.3% 20.1%
80 and older 10.2% 18.0% 24.9% 19.9% 27.0%

Footnote:

Figure 1.4 - Footnote 1
Conditions include asthma, fibromyalgia, arthritis or rheumatism, back problems, hypertension (high blood pressure), migraines, chronic obstructive pulmonary disease, diabetes, heart disease, cancer, ulcers, effects of a stroke, bowel disorders, Alzheimer’s disease, chronic fatigue syndrome, mood disorders, anxiety disorders, epilepsy, cerebral palsy, spina bifida, hydrocephalus, muscular dystrophy, dystonia, Tourette’s syndrome, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), Huntington’s disease and multiple sclerosis.
*Conditions include asthma, fibromyalgia, arthritis or rheumatism, back problems, hypertension (high blood pressure), migraines, chronic obstructive pulmonary disease, diabetes, heart disease, cancer, ulcers, effects of a stroke, bowel disorders, Alzheimer’s disease, chronic fatigue syndrome, mood disorders, anxiety disorders, epilepsy, cerebral palsy, spina bifida, hydrocephalus, muscular dystrophy, dystonia, Tourette’s syndrome, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), Huntington’s disease and multiple sclerosis.

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

The most commonly reported chronic health conditions in 2010 included back problems (19%), high blood pressure (18%) and arthritis (16%).Footnote 44 The proportion of females who reported back problems or high blood pressure (20% and 18% respectively) was similar to the proportion of males who reported these conditions (19% and 18% respectively).Footnote 44 For arthritis, however, a significantly larger proportion of females reported a diagnosis (19% versus 13%).Footnote 44

While rates of reported back problems are similar for males and females, they do vary by age, as shown in Figure 1.5.Footnote 44 Although back problems are the most commonly reported chronic health condition among Canadians 12 years and older, the data do not identify the specific nature of the problems affecting those individuals. Back problems could include a range of diseases or disorders such as scoliosis, sciatica, or herniated discs as well as injuries to the spinal cord, bones or muscle tissue.Footnote 47 Most of these types of back problems result in some degree of pain, from mild to severe, and in some cases disabling. Among Canadians 12 years and older who reported having back problems in 2010, 50% of the females and 42% of the males also reported experiencing regular pain or discomfort.Footnote 44

Figure 1.5 Self-reported back problemsFigure 1.5 - Footnote * by sex and age group, Canada, 2010Footnote 44, Footnote 48

Figure 5
Text Equivalent - Figure 1.5
*Other than arthritis and fibromyalgia

Source: Public Health Agency of Canada using data from the Canadian Community Health Survey, Statistics Canada.

High blood pressure has been linked to heart attacks, heart failure, kidney failure, dementia and, among males, erectile dysfunction and is a major contributor to some of the top causes of death in Canada.Footnote 49-Footnote 51 In 2010, nearly one-quarter (24%) of Canadians 30 years and older reported having high blood pressure.Footnote 44 This proportion increases with age: 42% of those 55 years and older and 51% of those 65 years and older reported having high blood pressure.Footnote 44 It also varies by ethnicity and sex (see Figure 1.6).Footnote 44 Increasing physical activity, smoking cessation and improving eating habits can all reduce the risk of developing hypertension.Footnote 52, Footnote 53

Figure 1.6 Self-reported high blood pressure by sex, origin and select age groups, Canada, 2010Footnote 44

Figure 6
Text Equivalent - Figure 1.6

Summary: Self-reported rates of high blood pressure vary by age group, sex and ethnicity.

Males Females
Age Group Canadian-born non-Aboriginal Canadian-born Aboriginal Foreign-born Canadian-born non-Aboriginal Canadian-born Aboriginal Foreign-born
30 to 54 12% 13% 13% 10% 10% 11%
55 to 64 34% 31% 36% 29% 42% 32%
65 and older 49% 52% 45% 54% 58% 54%

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Over 100 different types of arthritis affect the joints, ligaments, tendons, bones and other components of the musculoskeletal system. These range in severity from mild to crippling.Footnote 54-Footnote 56 Over the long term, arthritis can lead to chronic pain and decreased mobility and function, predisposing people to depression, cardiovascular disease, diabetes and other chronic health conditions.Footnote 54 Key risk factors associated with arthritis include physical inactivity, overweight and obesity, joint injuries, smoking, occupation, and infection – all of which can be modified to reduce risk.Footnote 57

Of the 16% of Canadians over the age of 15 years who reported being diagnosed with arthritis in 2010, 39% were men and 61% were women.Footnote 44 The prevalence of arthritis was slightly lower among foreign-born (15%); however, as with those born in Canada, more foreign-born women (19%) than foreign-born men (12%) reported having it.Footnote 44 Arthritis is also one of the most prevalent chronic health conditions among the Aboriginal population.Footnote 58 According to the 2006 Aboriginal Peoples Survey, 20% of respondents 15 years and older reported being diagnosed with arthritis or rheumatism.Footnote 59 That same year, 21% of First Nations not living on a reserve (16% of men and 25% of women), 21% of Métis (18% of men and 24% of women) and 12% of Inuit (8% of men and 16% of women) reported being diagnosed with arthritis or rheumatism by a physician.Footnote 59

Although not among the most commonly reported chronic health conditions, asthma, diabetes and cancer also affect many people. Asthma, which is characterized by coughing, shortness of breath, chest tightness and wheezing, was reported by 9% of the population aged 12 years and older (7% of males and 10% of females) in 2010.Footnote 45, Footnote 60, Footnote 61 Early onset of asthma has been linked to low birth-weight, exposure to tobacco smoke and family history, whereas later onset has been linked to genetic predisposition, obesity and increased exposure to allergens and environmental factors such as pollution.Footnote 60, Footnote 61

According to the 2008/2009 Canadian Chronic Disease Surveillance System, close to 2.4 million Canadians aged one year and older were living with diagnosed diabetes.Footnote 62 Although both type 1 and type 2 diabetes have been linked to genetic anomalies, type 2 diabetes is also associated with being overweight or obese.Footnote 62-Footnote 64 About 178,000 new cases of cancer were expected to be diagnosed in 2011, 52% in men.Footnote 65 Cancers of the breast, lung, colon/rectum and prostate were expected to account for 54% of all cancers diagnosed in the same year.Footnote 65

While the top three chronic health conditions most commonly reported in 2010 were physical conditions, many Canadians also reported some form of mental illness. Mental illness can affect people of all ages, cultures, education and income levels.Footnote 66 However, those with a family history of mental illness, substance abuse issues, certain chronic health conditions or who have experienced stressful life events are more at risk.Footnote 66 In addition, sexual orientation and sexual behaviour is a significant predictor of mental health issues among vulnerable youth.Footnote 67

The most commonly self-reported mental health condition in 2010 was mood disorders such as depression, bipolar disorder, mania or dysthymia.Footnote 44, Footnote 48 The overall percentage of Canadians 15 years and older who reported having been diagnosed with a mood disorder was 6.9%.Footnote 44 A greater percentage of females (8.2%) than males (5.0%) reported mood disorders, overall and within different age groups (see Figure 1.7).Footnote 44 Older adults between 55 and 64 years old had the highest reported rates (8.3%) in the same year.Footnote 44 The percentage was highest among Aboriginal people not living on a reserve (11.7%), with females having a much larger percentage of self-reported diagnoses at 14.2% compared with 8.9% for males.Footnote 44 Rates of mental illness in Canada may be underestimated as many people remain undiagnosed and those with severe conditions may not be captured at all.Footnote 68

Figure 1.7 Self-reported mood disorder by sex and age group, Canada, 2010Footnote 44

Figure 7
Text Equivalent - Figure 1.7

Summary: In 2010, the percentage of Canadian males reporting mood disorders, by age group, was as follows: aged 12 to 19 years, 2.8%: aged 20 to 29 years, 4.3%; aged 30 to 54 years, 5.8%; aged 55 to 64 years, 6.7%; and aged 65 years and older, 4.2%.

In 2010, the percentage of Canadian females reporting mood disorders, by age group, was as follows: aged 12 to 19 years, 5.3%: aged 20 to 29 years, 6.8%; aged 30 to 54 years, 10.0%; aged 55 to 64 years, 9.9%; and aged 65 years and older, 6.5%.

Source: Public Health Agency of Canada using data from the Canadian Community Health Survey, Statistics Canada.

Age group Males Females
12 to 19 2.8% 5.3%
20 to 29 4.3% 6.8%
30 to 54 5.8% 10.0%
55 to 64 6.7% 9.9%
65 and older 4.2% 6.5%

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Causes of death

In 2008, cancers became the leading overall cause of death in Canada (30%), followed by circulatory diseases (29%) and respiratory diseases (9%) (see Figure 1.8).Footnote 69-Footnote 88 While cancers are the number one cause of death for males (31% of male deaths), females most often died due to circulatory diseases (30% of female deaths).Footnote 69-Footnote 88

Figure 1.8 Number of deaths by select causes and sex, Canada, 2008Footnote 69-Footnote 88

Figure 8
Text Equivalent - Figure 1.8

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Death Database, Statistics Canada.

Cause of death Total Males Females
Total deaths 238,617 50% 50%
Respiratory diseases 20,728 51% 49%
Chronic lower respiratory diseases 10,923 53% 47%
Influenza and pneumonia 5,386 46% 54%
All other respiratory diseases 4,419 54% 46%
Cancers 71,948 53% 47%
Lung and bronchus 18,697 55% 45%
Colon, rectum and anus 7,842 54% 46%
Breast 5,006 1% 99%
Prostate 3,720 100% 0%
All other cancers 36,683 53% 47%
Injuries and Poisonings 15,439 64% 46%
Suicide 3,700 75% 25%
Falls 3,098 48% 52%
Transport 2,848 72% 28%
Assault 565 79% 21%
All other injuries and poisonings 5,228 60% 40%
Circulatory diseases 69,945 50% 50%
Ischaemic heart disease 36,934 56% 44%
Cerebrovascular disease 13,870 41% 59%
Hypertensive diseases 2,337 39% 61%
All other circulatory diseases 16,804 46% 54%
Alzheimer’s disease and other dementias 16,775 32% 68%
All other diseases 43,782 50% 50%

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Death Database, Statistics Canada.

Deaths related to circulatory disease were most often due to ischaemic heart (53%), cerebrovascular (20%) and hypertensive (3%) diseases.Footnote 77 While ischaemic heart disease caused more deaths among males (56%), more females died of cerebrovascular (59%) and hypertensive (61%) diseases (see Figure 1.8).Footnote 77 Other causes of death also affect one sex more than the other. Of deaths related to injuries and poisoning, almost two-thirds (64%) were among males.Footnote 87 Males also accounted for about three times as many deaths due to assaults (79%), suicide (75%) and transport incidents (72%).Footnote 87 On the other hand, the female proportion of all deaths due to Alzheimer’s disease and other dementias (68%) was more double that of men.Footnote 73, Footnote 74

Figure 1.9 Age-standardized mortality rate by sex and select causes of death, Canada, 2008Footnote 28, Footnote 70, Footnote 73, Footnote 74, Footnote 77, Footnote 78, Footnote 87

Figure 9
Text Equivalent - Figure 1.9

Summary: Because the population distributions of males and females by age are not identical, the age-adjusted sex-specific mortality rates due to these causes differ from the distribution of total deaths.

Source: Public Health Agency of Canada using data from Canadian Population Estimates and Projections, and Vital Statistics, Death Database, Statistics Canada.

Cause of death Males Age-standardized rate per 100,000 population Females Age-standardized rate per 100,000 population
Circulatory diseases 188 116
Ischaemic heart disease 110 55
Cerebrovascular disease 31 27
Hypertensive diseases 5 5
Injuries and poisonings 57 24
Suicide 16 5
Transport 13 5
Cancers 201 143
Lung and bronchus 55 36
Respiratory diseases 58 35
Chronic lower respiratory diseases 31 19
Alzheimer’s disease and other dementias 30 33
*per 100,000 population

Source: Public Health Agency of Canada using data from Canadian Population Estimates and Projections, and Vital Statistics, Death Database, Statistics Canada.

Because the population distributions of males and females by age are not identical, the age-adjusted sex-specific mortality rates due to these causes, particularly for deaths in older age groups, may give a better indication of mortality risk (see Figure 1.9). For example, although only 12% more of all ischaemic heart disease deaths occurred among males than females, the age-standardized mortality rate for males was twice that of females — 110 deaths per 100,000 population compared with 55 deaths per 100,000 population.Footnote 28, Footnote 77 Whereas females die more often from cerebrovascular disease than do males, the fact that females live to an older age and suffer those deaths later in life results in males actually having a higher age-standardized mortality rate of 31 deaths per 100,000 population compared with 27 deaths per 100,000 female population.Footnote 28, Footnote 77 For deaths occurring at younger ages when the ratio of females to males is more even, the differences in cause-specific age-standardized mortality rates more closely resemble the magnitude of differences in numbers of deaths as seen in Figure 1.9.

While knowing the number of deaths due to a particular disease or condition is important to understanding the health of the Canadian population, so too is knowing the age at which those deaths occur. Measuring the number of potential years of life lost (PYLL) to premature death provides a better sense of the impact a given disease or condition has on the health of the population. For example, if a Canadian dies of cancer at age 45 years, he or she has potentially lost 30 years of life (conservatively assuming a life expectancy of 75 years at birth, as is commonly done in these calculations).

In 2008, most years of lost life were due to premature deaths associated with cancers (1,530 years per 100,000 population), circulatory diseases (777 years per 100,000 population) and unintentional injuries (591 years per 100,000 population).Footnote 89 While men and women had comparable PYLL rates for cancers and respiratory diseases, PYLL rates for circulatory diseases, unintentional injuries, suicide and self-inflicted injuries as well as human immunodeficiency virus (HIV) infection were more than double for men than for women (see Figure 1.10).Footnote 89

Figure 1.10 Age-standardized potential years of life lost by sex and select causes of death, Canada, 2008Footnote 89

Figure 10
Text Equivalent - Figure 1.10

Summary: In 2008, men and women had comparable rates of potential years of life lost for cancers (1,544 per 100,000 population for males and 1,517 per 100,000 population for females) and respiratory diseases (205 per 100,000 population for males and 163 per 100,000 population for females). Rates were significantly higher among men for circulatory diseases (1,107 per 100,000 population for males and 444 per 100,000 population for females), unintentional injuries (862 per 100,000 population for males and 318 per 100,000 population for females), suicide and self-inflicted injury (447 per 100,000 population for males and 174 per 100,000 population for females) and HIV (50 per 100,000 population for males and 18 per 100,000 population for females).

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Death Database, Statistics Canada.

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Death Database, Statistics Canada.

Factors influencing health

Economic and social factors such as education, employment and income have a direct bearing on health.Footnote 10, Footnote 90 While some health challenges can be related to our genetic make-up, evidence shows that Canadians with adequate shelter, a safe and secure food supply, access to education, employment and sufficient income for basic needs adopt healthier behaviours and have better health.

In general, an improvement in any of these can produce an improvement in both health behaviours and outcomes at the individual, group or population level. These social determinants of health strongly interact to influence overall health, and they show important similarities and differences by sex.

Education

Between the 1990/1991 and 2010/2011 school years, the percentage of Canadians between 20 and 24 years who completed high school increased from 81% to 90%.Footnote 91 Men, however, continue to have consistently higher non-completion rates when compared with women, with 89% versus 92% completing high school in 2011 (see Figure 1.11).Footnote 91 In the 2009/2010 school year, the high school non-completion rate of 6% for the foreign-born population aged 20 to 24 years was lower than the overall Canadian rate.Footnote 92 Conversely, Aboriginal peoples aged 20 to 24 years not living on a reserve had the highest rates of high school non-completion, averaging 26% over the 2007/2008 to 2009/2010 school years – more than double the rate for the non-Aboriginal population.Footnote 92

Figure 1.11 High school non-completion rate by sex, population aged 20 to 24 years, Canada, 1990/1991 to 2010/2011Footnote 91

Figure 11
Text Equivalent - Figure 1.11

Summary: Rates of high school non-completion have decreased between the 1990/1991 and 2010/2011 school years for both males (21.4% to 11.2%) and females (15.7% to 8.3%).

Source: Public Health Agency of Canada using data from Labour Force Survey, Statistics Canada.

Source: Public Health Agency of Canada using data from Labour Force Survey, Statistics Canada.

Between the 1990/1991 and 2010/2011 school years, the percentage of Canadians between 25 and 34 years who had completed a post-secondary education increased from 44% to 68%.Footnote 91 Again, differences can be seen between males and females, with the number of women in this category increasing sharply from 44% in 1990/1991 to 72% in 2010/2011, whereas the number of men increased moderately, from 45% to 64% in the same time.Footnote 91

In 2006, two-thirds (70%) of Canada’s foreign-born population between 25 and 34 years had completed post-secondary studies, with more women (72%) completing studies than men (68%).Footnote 93 About 42% of the Aboriginal population (37% of First Nations, 34% of Inuit and 50% of Métis) between 25 and 34 years were post-secondary graduates (diploma, degree or certificate in apprenticeship or trades, college or CEGEP, or university) in 2006, with a higher rate among women (45%) than men (38%).Footnote 94 In the same year, 9% of Canadians between 25 and 34 years had completed a post-secondary degree above bachelor level, in comparison with only 2% of the Aboriginal population.Footnote 94

Between 1991 and 2009, the number of people who completed a registered apprenticeship training increased by 57%.Footnote 95 Graduation rates increased by 49% for males and by 176% for females.Footnote 95 The greatest increases for men were seen in training to be landscape and horticulture technicians and specialists; heavy equipment operators; plumbers, pipefitters and steamfitters; welders; and hairstylists and aestheticians.Footnote 95 For women, the greatest increases were in training to be plumbers, pipefitters and steamfitters; welders; electricians; carpenters; and electronics and instrumentation technicians.Footnote 95

Employment and working conditions

Unemployment and a stressful or unsafe workplace have been associated with poorer health outcomes.Footnote 10, Footnote 90 People who have more control over their work circumstances and fewer stress-related demands associated with their job tend to be healthier and live longer than those in more stressful or riskier work environments.Footnote 10, Footnote 90

Over the past century, Canada has transitioned from being a primary producer of agricultural produce and raw materials to an industrial nation with a robust service sector economy. In 1911, more than one-third (37%) of the employed population worked in agriculture, forestry and fishing; by 2006 only 3% worked in those same industries.Footnote 96, Footnote 97 Today, wholesale and retail trade (15%); health care and social assistance (10%); and educational services (7%) are the main sectors of the Canadian work force.Footnote 97

In 2011, the unemployment rate for young Canadians between 15 and 24 years was 14.2%, with clear differences between males (15.9%) and females (12.4%) (see Figure 1.12).Footnote 98 While the unemployment rate of 16.6% among recent immigrants in this age group is higher than the national rate, the rate of 7.8% among immigrants who have been in Canada more than 10 years was significantly lower in the same year.Footnote 99 The unemployment rate for Canadians between 25 and 54 years was 6.2%, with little difference between males (6.4%) and females (6.0%) in 2011 (see Figure 1.12).Footnote 98 The unemployment rate among immigrants (8.4%) was higher than the national rate, regardless of length of time since immigration (10.8% among recent immigrants; 7.1% among immigrants who have been in Canada 10 or more years).Footnote 99

Figure 1.12 Unemployment rate by select age groups and sex, Canada, 1990 to 2011Footnote 98

Figure 12
Text Equivalent - Figure 1.12

Summary: While the rate of unemployment for young Canadians between 15 and 24 years was slightly higher in 2011 compared to 1990 (males: 15.9% in 2011 compared to 13.5% in 1990; females: 12.4% in 2011 compared to 11.0% in 1990), young men have consistently had higher rates of unemployment than young women. Among adults between 25 and 54 years rates of unemployment were slightly lower in 2011 compared to 1990 (males: 6.4% in 2011 compared to 7.2% in 1990; females: 6.0% in 2011 compared to 7.6% in 1990), with men and women having similar rates of unemployment throughout that time.

Source: Public Health Agency of Canada using data from Labour Force Statistics Survey, Statistics Canada.

Source: Public Health Agency of Canada using data from Labour Force Statistics Survey, Statistics Canada.

In 2006, the unemployment rate among Aboriginal peoples between 15 and 24 years was nearly twice the national rate at 22%, with rates highest among First Nations (27%) and Inuit (26%) populations.Footnote 100 In the same year, unemployment among Aboriginal males and females between 25 and 54 continued to be high, with rates of 14% and 12% respectively.Footnote 100 Inuit populations between 25 and 54 years had the highest overall unemployment rates at 19%, whereas Métis populations had the lowest at 8%.Footnote 100 The unemployment rate was highest among Inuit males, between 25 and 54 years, at 23%.Footnote 100

High levels of work-related stress have been linked to increased risks of physical injury at work, high blood pressure, cardiovascular disease, depression and other mental health conditions.Footnote 101-Footnote 106 Personal behaviours, such as smoking, drinking and drug misuse, may also increase and lead to further health complications.Footnote 101, Footnote 104, Footnote 106, Footnote 107 In 2010, nearly one-third (32%) of the working population between 30 and 54 years self-reported having “quite a bit” or “extreme” work-related stress, with similar rates among men and women (31% and 34% respectively).Footnote 44 Although younger adults also reported relatively high rates of work-related stress, the proportion was higher among young women than young men (28% compared with 24%).Footnote 44 Those between 25 and 54 years who had not completed high school reported the lowest rates of work-related stress (27%), whereas those in the same age group who had completed a post-secondary education reported the highest rates (34%).Footnote 44

According to data collected by the Association of Workers’ Compensation Boards of Canada, about 250,000 accepted time-loss injuries occurred in 2010.Footnote 108 The majority of these (63%) were reported by men, and more than one-third (34%) were among people working in the manufacturing, construction, and transportation and storage industries.Footnote 108 The same year saw more than 1,000 workplace-related fatalities, mainly of men (96%).Footnote 108 More than one-half (57%) of the workplace fatalities were among Canadians 60 years and older and more than one half (56%) were in the manufacturing, construction, and transportation and storage industries, which employed 19% (2,895,900 men compared with 377,200 women) of the estimated 17,041,000-strong workforce in 2010.Footnote 108, Footnote 109

Income

Canadians have seen an overall increase in personal income (adjusted for inflation) over time, but increases have not been consistent for everyone. In fact, the gap between those with the highest and lowest income has widened significantly between 1976 and 2009 (see Figure 1.13).Footnote 110 Gaps are also seen in the median income of Aboriginal and foreign-born populations in Canada compared with the total population. In 2005, the median total income of the Aboriginal population between 25 and 54 years was just over $22,000, of the foreign-born population was just over $27,000, and of the total population in the same age group was over $33,000.Footnote 111, Footnote 112 While their median incomes were lower than that of the total population, Aboriginal and foreign-born men had larger incomes ($25,000 and $34,000 respectively) than Aboriginal and foreign-born women ($20,000 and $23,000 respectively).Footnote 111, Footnote 112

Figure 1.13 Average after-tax income for economic families (two or more persons), 2010 constant dollars, Canada, 1976 to 2009Footnote 110

Figure 13
Text Equivalent - Figure 1.13

Summary: While the average income after-tax has increased for all economic families between 1976 and 2009, those in the highest quintile have seen the greatest increases. The average income in economic families in the lowest quintile increased from $13,000 to $17,200. The average income in economic families in the middle quintile increased from $29,900 to $39,600. The average income in economic families in the highest quintile increased from $61,300 to $86,600.

Source: Public Health Agency of Canada using data from Survey of Labour and Income Dynamics, Statistics Canada.

Source: Public Health Agency of Canada using data from Survey of Labour and Income Dynamics, Statistics Canada.

Although women face living in low income more often than do men, the difference in these rates has disappeared over time. As of 2009 the low-income rates stood at 9.5% for men and women (see Figure 1.14).Footnote 113 The number of children under the age of 18 years living in low-income households has declined from a peak of 18.4% in 1996 to 9.4% in 2009.Footnote 113 The rate living in low-income households was more than double (21.5%) for children under the age of 18 years living in single parent households headed by women.Footnote 113 The 5.1% of Canadian seniors living in low income (3.3% of men and 6.6% of women) in 2009 was also a large decrease from 30.4% in 1977 (25.0% of men, 34.7% of women).Footnote 113 In addition, 18.7% of Aboriginal and 14.4% of foreign-born populations lived in low-income households in 2005.Footnote 111, Footnote 112

Figure 1.14 Population living in low income by sex, Canada, 1976 to 2009Footnote 113

Figure 14
Text Equivalent - Figure 1.14

Summary: Over time, the gap between men and women living in low income households has diminished. In 1976, 11.1% of males and 14.8% of females lived in low income households. In 2009, 9.5% of males and 9.5% of females lived in low income households.

Source: Public Health Agency of Canada using data from Survey of Labour and Income Dynamics, Statistics Canada.

Source: Public Health Agency of Canada using data from Survey of Labour and Income Dynamics, Statistics Canada.

Health behaviours

Individual behaviours, such as being physically active and eating well, can contribute to good health, whereas smoking, heavy drinking, drug misuse and sedentary behaviour can have detrimental health effects. Ultimately, health behaviours are individual choices that people make. However, the physical, social and economic environments where individuals live, work and learn can influence these choices.Footnote 114, Footnote 115

Smoking

The effects of smoking on health and well-being are well documented: smoking has been linked to increased risk of lung cancer, heart disease and stroke.Footnote 116-Footnote 118 It can also interfere with various drug therapies, causing medications, including antidepressants, to be less effective.Footnote 119-Footnote 121 While the overall smoking rate has declined since 1999, 17% of Canadians 15 years and older reported smoking (14% of females and 20% of males) in 2010.Footnote 122-Footnote 133 Men have consistently reported higher rates of smoking compared with women, with young adults between 20 and 29 years reporting the highest smoking rate of all age groups in Canada during the same periods (see Figure 1.15).Footnote 134-Footnote 145 In 2010, 22% of young adults were smokers, with a higher rate among young men (28%) than young women (17%).Footnote 134

Figure 1.15 Current smokers by sex and age group, Canada, 1999 and 2010Footnote 134, Footnote 135

Figure 15
Text Equivalent - Figure 1.15

Summary: While smoking rates for males and females have declined between 1999 and 2010, males in all age groups have consistently reported higher smoking rates than females, with young adults between 20 and 29 years reporting the highest smoking rate of all age groups in Canada during the same periods.

Source: Public Health Agency of Canada using data from Canadian Tobacco Use Monitoring Survey, Health Canada.

Males Females
Age Group 1999 2010 1999 2010
15 to 19 27% 13% 29% 11%
20 to 29 37% 28% 32% 17%
30 to 54 30% 23% 25% 16%
55 to 64 19% 17% 18% 13%
65 and older 13% 8% 11% 8%

Source: Public Health Agency of Canada using data from Canadian Tobacco Use Monitoring Survey, Health Canada.

Smoking rates are higher than average among some sub-populations compared with the Canadian population as a whole. In 2006, 19% of all Canadians were daily or occasional smokers compared with 39% of Métis, 46% of First Nations not living on a reserve and 68% of Inuit.Footnote 59, Footnote 142 Inuit women had the highest smoking rate among the Aboriginal population at 71%.Footnote 59 In 2008/2010, 57% of First Nations living on a reserve reported being daily or occasional smokers.Footnote 146

Variations in smoking rates can also be seen by education level. In 2010, smoking rates for people (ages 25 years and older) who had not completed high school were double the rate seen in those who had completed a post-secondary education (24% compared with 12%).Footnote 134

Alcohol consumption

Alcohol is the psychoactive substance most commonly used by Canadians.Footnote 147 Alcohol intoxication can lead to a variety of risks including harmful effects on physical and mental health, personal relationships, work and education; in extreme cases, it can even cause death.Footnote 147-Footnote 151

In 2010, 77% of Canadians 15 years and older had consumed alcohol in the past year.Footnote 152 Of those, nearly one-half (47%) consumed alcohol at least once per week – 54% of males and 40% of females.Footnote 152 Among drinkers, 9% (10% of males and 6% of females) consumed 5 or more drinks at least once a week in the past year.Footnote 152 Consuming large amounts of alcohol frequently, and especially over a short period of time, can lead to poor judgment, impulsive behaviour and alcohol poisoning.Footnote 153 Rates of frequent heavy drinking – consuming five or more drinks on one occasion, one or more times per week – was highest among males in all age groups, with the highest rates being among young men (see Figure 1.16).Footnote 152 Variations in heavy drinking can also be seen by education level. In 2010, rates of heavy drinking for people (ages 25 years and older) who had not completed high school were more than double the rate seen in those who had completed a post-secondary education (13% compared with 6%).Footnote 152

Figure 1.16 Frequent heavy drinkingFigure 1.16 - Footnote * by sex and age group, Canada, 2010Footnote 152

Figure 16
Text Equivalent - Figure 1.16

Summary: Rates of frequent heavy drinking was highest among males in all age groups, with the highest rates being among young males between 20 and 29 years (43%). Among females the highest rates were seen among those between 15 and 19 years (31%).

Source: Public Health Agency of Canada using data from Canadian Alcohol and Drug Use Monitoring Survey, Health Canada.

Age group Males Females
15 to 19 33% 31%
20 to 29 43% 19%
30 to 54 17% 7%
55 to 64 12% 9%
65 and older 6% 5%

Footnote:

1Consuming five or more alcoholic beverages on one occasion at least once a week
*Consuming five or more alcoholic beverages on one occasion at least once a week.

Source: Public Health Agency of Canada using data from Canadian Alcohol and Drug Use Monitoring Survey, Health Canada.

In 2006, 78% of the Aboriginal population 15 years and older had consumed alcohol in the past year.Footnote 59 Of those, 39% (48% of males compared with 32% of females) consumed alcohol at least once per week.Footnote 59 Among drinkers, 10% (15% of males compared with 6% of females) consumed 5 or more drinks at least once a week in the past year.Footnote 59 According to the 2002/2003 First Nations Regional Health Survey (RHS), 66% of First Nations 18 years and older living on a reserve had consumed alcohol in the past year.Footnote 154 Of those, 18% (23% of males compared with 12% of females) consumed alcohol at least once per week.Footnote 154 Overall, 9% of First Nations living on a reserve reported having consumed five or more drinks on one occasion more than once a week (11% of males and 5% of females).Footnote 154

Alcohol-related acute-care hospitalizations totalled 1.2 million days in 2002, of which two-thirds were among males. That same year, there were 4,258 deaths attributed to alcohol (82% of males), including 1,246 due to cirrhosis of the liver (882 males and 364 females), 909 due to motor vehicle crashes (746 males and 163 females) and 603 due to suicides (493 males and 109 females).Footnote 155

Drug use

Short- and long-term effects of illicit drugs vary. Short-term effects of cannabis, for example, can include an increase in heart rate and a decrease in blood pressure.Footnote 156-Footnote 158 It can interfere with concentration, depth perception and reaction time, affecting driving, among other things.Footnote 156-Footnote 158 Long-term use of cannabis can lead to respiratory distress and increased risk of cancer and may cause impaired memory and information processing.Footnote 156-Footnote 158 Other illicit drugs – cocaine, hallucinogens and ecstasy – have been linked to various health and social problems including panic attacks, paranoia, and risky or violent behaviour and to physical effects such as convulsions and increased blood pressure.Footnote 159-Footnote 162 Over the long term, and depending on the substance, harmful effects can include psychosis, impaired brain function affecting memory and lung and nasal tissue damage.Footnote 159-Footnote 162 The use of illicit drugs (e.g. abuse, misuse, or dependence) can affect performance at school and work, and in extreme cases even cause death.Footnote 159-Footnote 162

The drug most commonly used by Canadians in 2010 was cannabis.Footnote 163 One-in-ten Canadians over the age of 15 years (15% of males and 7% of females) reported having used cannabis in the past year.Footnote 163 While youth and young adults between 15 and 29 years have the highest reported rates of cannabis use in Canada, males, regardless of age, have the highest reported rates overall (see Figure 1.17).Footnote 152 Variations in cannabis use can also be seen by education level. Other than cannabis, the illegal drugs most commonly used were hallucinogens (1.1%), ecstasy (0.7%) and crack/cocaine (0.7%).Footnote 163

Figure 1.17 Cannabis use in the past 12 months by sex and age group, Canada, 2010Footnote 152

Figure 17
Text Equivalent - Figure 1.17

Summary: Males across all age groups report higher rates of cannabis use than females. Males between 20 and 29 years had the highest rates of cannabis use (29.8%), while among females the highest rates were seen among those between 15 and 19 years (21.3%).

Source: Public Health Agency of Canada using data from Canadian Alcohol and Drug Use Monitoring Survey, Health Canada.

Age group Males Females
15 to 19 26.0% 21.3%
20 to 29 29.8% 16.0%
30 to 54 13.9% 5.7%
55 to 64 8.4% 3.7%
65 and older 1.8% 0.1%

Source: Public Health Agency of Canada using data from Canadian Alcohol and Drug Use Monitoring Survey, Health Canada.

Pharmaceutical drugs prescribed for therapeutic purposes, including opioid pain relievers, stimulants, tranquillizers and sedatives, may also be abused due to their psychoactive properties.Footnote 147 In 2010, 1% of those who used psychoactive drugs did so for non-therapeutic reasons.Footnote 147

Sexual health

There have been significant changes in the age-specific fertility rates in Canada over the past 50 years (see Figure 1.18).Footnote 164-Footnote 166 The number of births has remained fairly stable over the past 50 years at more than 370,000 births each year.Footnote 165-Footnote 167 The current total fertility rate of 1.7 children per female aged 15 to 49 years has also changed relatively little since the mid-1970s but is less than one-half of what it was in 1960.Footnote 164, Footnote 165 Although Aboriginal women in Canada are also experiencing a decrease in fertility rates, the rate of 2.6 children per woman aged 15 to 49 years (3.4 children per Inuk woman; 2.9 children per First Nations woman; and 2.2 children per Métis woman) between 1996 and 2001, is still well above the Canadian average.Footnote 164,Footnote 168

Figure 1.18 Age-specific fertility rate by select age groups, Canada, 1960 to 2009Footnote 164-Footnote 166

Figure 18
Text Equivalent - Figure 1.18

Summary: Across all age groups, age-specific fertility rates among women have declined from 1960 to 2009. The highest rate was among 20 to 24 year-old women in 1960 and in the older 30 to 34 year-old age group in 2009.

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Birth Database, Statistics Canada.

Age group 1960 Rate per 1,000 women 2009 Rate per 1,000 women
15 to 19 59.8 14.2
20 to 24 233.5 51.2
25 to 29 224.4 100.6
30 to 34 146.2 107
35 to 39 84.2 50.6
40 to 44 28.5 8.2
45 to 49 2.4 0.4

Note: Data for Newfoundland excluded for 1960; No data available for 1998 and 1999.

Note: Data for Newfoundland excluded for 1960; no data available for 1998 and 1999.

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Birth Database, Statistics Canada.

In 2010, 29% of 15- to 17-year olds reported being sexually active (28% young boys and 30% of young girls).Footnote 44 While rates were considerably lower among the foreign-born population (13%), rates among Aboriginal peoples not living on a reserve in 2010 and First Nations living on a reserve in 2008/2010 were considerably higher (43% and 47% respectively).Footnote 44, Footnote 146 Among adults between 18 and 49 years, 94% reported being sexually active, with similar rates among the foreign-born population (91%), Aboriginal peoples not living on a reserve (96%) and First Nations aged 18 years and older living on a reserve (72%) in 2008/2010.Footnote 44, Footnote 146

Rates of sexually transmitted infections (STIs) officially reported to the Canadian Notifiable Disease Surveillance System increased among the overall Canadian population over the past 15 years.Footnote 169-Footnote 171 Untreated STIs, whether symptomatic or not, can have long-lasting effects on health. STIs have been linked to pelvic inflammatory disease, infertility, ectopic pregnancies, miscarriages and low birth-weight babies as well as genital warts and various types of cancers including cervical, anal and penile.Footnote 172, Footnote 173

The Canadian Notifiable Disease Surveillance System allows for the monitoring of reportable sexually transmitted infections (STIs). The number of reported cases of STIs and the resulting calculated population rates do not account for all infections in the population. In many cases, an infected individual does not show symptoms and as a result may not be tested.Footnote 174

Figure 1.19 Sexually transmitted infection rates by sex and select age groups, Canada, 2009Footnote 169-Footnote 171

Figure 19
Text Equivalent - Figure 1.19

Summary: Females under 40 years of age consistently reported higher rates of chlamydia than males, with the highest rate (1,871.4 per 100,000 population) seen in young women between 20 and 24 years. Among males, the highest rate (900.7 per 100,000 population) was also seen in young men between 20 and 24 years. The highest rates of gonorrhea were reported among young men (141.2 per 100,000 population) and young women (149.0 per 100,000 population) between 20 and 24 years. Males in all age groups consistently reported higher rates of infectious syphilis than females, with the highest rate (17.6 per 100,000 population) seen in young men between 25 and 29 years. Among females the highest rate (3.4 per 100,000 population) was seen in young women between 20 to 29 years.

Source: Public Health Agency of Canada using data from STI (Sexually Transmitted Infections) Surveillance and Epidemiology.

  Chlamydia Rate per 100,000 population Gonorrhea Rate per 100,000 population Infectious syphilis Rate per 100,000 population
Age group Males Females Males Females Males Females
15 to 19 394.4 1,720.3 61.1 145.6 3.4 1.2
20 to 24 900.7 1,871.4 141.2 149.0 13.0 3.4
25 to 29 556.7 788.4 103.4 70.8 17.6 3.4
30 to 39 209.7 262.1 55.8 26.4 17.2 1.9
40 to 59 47.2 40.0 22.5 4.4 12.9 0.9
60 and older 4.9 2.2 3.2 0.4 1.8 0.1

Source: Public Health Agency of Canada using data from STI (Sexually Transmitted Infections) Surveillance and Epidemiology.

In 2009, young women between 20 and 24 years had the highest reported rate of chlamydia infection, more than seven times the overall national rate and more than five times the overall female rate (see Figure 1.19).Footnote 169 Young men of the same age had the highest reported chlamydia infection rate, although their rate was one-half that of their female peers.Footnote 169

The highest rates of reported gonococcal infections in 2009 were among young men and women between 20 and 24 years (see Figure 1.19).Footnote 171 Among youth between 15 and 19 years, the rate was more than twice as high in adolescent girls as in adolescent boys; among adults 25 years and older, men had a higher gonorrhea rate than did women.Footnote 171

Unlike chlamydia and gonorrhea, reported rates of infectious syphilis in 2009 were higher in males than in females in all age groups (see Figure 1.19).Footnote 170 Young men between 25 and 29 years had the highest reported rate with 17.6 cases per 100,000 population.Footnote 170 The reported rates of infectious syphilis for females were much lower, with the highest rate that year being 3.4 cases per 100,000 population for both 20- to 24-year-old and 25- to 29-year-old young women.Footnote 170

An estimated 65,000 people were living with HIV infection at the end of 2008.Footnote 175, Footnote 176 Nearly three-quarters (74%) of all new HIV infections reported in 2008 were among men, with the highest rates of all new cases being among men between 40 and 49 years (32%).Footnote 176 Men who have sex with men (MSM) accounted for the largest proportion of new positive cases (45%).Footnote 175, Footnote 176 Women represent an increasing proportion of those with positive HIV test reports in Canada, and represented 26% of all new cases reported in 2008.Footnote 175, Footnote 176 Women between 30 and 39 years account for 35% of reported HIV infections among all females.Footnote 176 The two main risk factors for HIV infection among women were heterosexual contact and injection drug use.Footnote 175, Footnote 176

Aboriginal people are also disproportionately affected by HIV in Canada, and more specifically Aboriginal women. Aboriginal people accounted for 13% of all new HIV infections in 2008, a rate estimated to be about 3.6 times higher than among the non-Aboriginal population.Footnote 175 Between 1998 and 2008, women accounted for nearly 50% of all HIV infections reported among Aboriginal people compared with 21% among the non-Aboriginal population.Footnote 175

While STIs are generally viewed as affecting younger people, older Canadians are also at risk. The proportion of new infections reported among those 40 years and older has been increasing.Footnote 169-Footnote 171, Footnote 175-Footnote 177 Several factors may contribute to an increased risk such as limited knowledge associated with transmission, increasing divorce rates, access to drugs for the treatment of erectile dysfunction, and misconceptions about sexuality among middle-aged and older adults by those in the health care and policy fields.Footnote 175, Footnote 178-Footnote 183

While human papillomavirus (HPV) is not a notifiable STI in Canada, the majority (estimated at more than 70%) of sexually active Canadians will contract an HPV infection at some point in their lives.Footnote 173 Although most cases will be asymptomatic and require no treatment, persistent infections of certain types of HPV contribute to anal and genital warts and, anal, cervical and penile cancers.Footnote 173

Physical activity and healthy eating

While many factors can affect a person’s health, research studies report that people who are the most physically active are at a lower risk for poor health.Footnote 184, Footnote 185 Physical inactivity is a modifiable risk factor for a wide range of chronic health conditions including coronary heart disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes and osteoporosis.Footnote 184, Footnote 186, Footnote 187

In order to maximize the health benefits associated with being physically active, World Health Organization (WHO) and Canadian guidelines suggest that adults should accumulate at least 150 minutes of moderate-to-vigorous physical activity per week.Footnote 187-Footnote 189 According to the 2007–2009 Canadian Health Measures Survey (CHMS), only 17% of males and 14% of females achieved this level of physical activity, and most Canadian adults between 20 and 79 years spend the majority of their waking hours – 68% for men and 69% for women – being sedentary.Footnote 187

Levels of physical activity among children between 6 and 19 years were also measured in the 2007–2009 CHMS. As with adults, the majority of their waking hours – 60% for boys and 63% for girls – were sedentary.Footnote 190 WHO and Canadian guidelines suggest that children and youth should accumulate at least 60 minutes of moderate-to-vigorous physical activity every day.Footnote 188-Footnote 190 While only 7% of children (9% of boys and 4% of girls) attained the suggested level of activity, 44% (53% of boys and 35% of girls) were engaged in at least 60 minutes of moderate-to-vigorous physical activity at least three days a week.Footnote 190

The types, quantity and quality of food eaten can also affect health.Footnote 191, Footnote 192 But eating nutritious foods is also dependent on accessibility and availability.Footnote 191-Footnote 194 Healthy eating requires having “food security,” that is, having physical and economic access to sufficient, safe and nutritious foods to meet the dietary needs and food preferences for a healthy and active life.Footnote 195, Footnote 196

In 2010, 8% of Canadian households (excluding those in Prince Edward Island and New Brunswick) reported experiencing moderate to severe food insecurity at some point in the previous year.Footnote 44 Among the provinces, an income gradient was associated with food insecurity, as 23% of households in the lowest household income quintile reported some form of food insecurity compared with 1% of households in the highest household income quintile.Footnote 44 Also, the prevalence of food insecurity was higher in households with the lowest household education attainment level (less than completed high school) (14%) than in those with the highest household education attainment level (completed post-secondary education) (6%).Footnote 44, Footnote 196 Further challenges to healthy eating exist in northern and remote communities due to the availability of quick, less expensive and less healthy foods.Footnote 197-Footnote 199 These communities do not have as many food choices and healthy foods are often more expensive than in more populated regions of the country.Footnote 197-Footnote 199 In the 2007–2008 Inuit Health Survey, approximately 70% of Nunavut households reported experiencing moderate to severe food insecurity over the past year.Footnote 197, Footnote 200

Less healthy eating, including over-consumption, combined with inadequate physical activity can lead to increased body weight.Footnote 191, Footnote 201 Obesity is a risk factor for many chronic diseases including high blood pressure, type 2 diabetes, gallbladder disease, coronary artery disease, osteoarthritis and certain types of cancer. Obesity presents a considerable health challenge in Canada.Footnote 191 Body mass index (BMI) is a common measure based on height and weight that is used to determine healthy and unhealthy weights (see Appendix B: Body mass index cut-points for detailed BMI breakdown). While BMI has been seen as an adequate measure for a portion of the population, standard BMI categories may not accurately reflect the rate of overweight and obesity in all populations.Footnote 202-Footnote 206 Regardless, BMI is still the most commonly used measure to classify overweight and obesity.Footnote 207

In 2007–2009, 24% of Canadian adults were obese and 37% were overweight based on their measured height and weight.Footnote 208 This is a substantial increase from the 12% reported as obese and 32% reported as overweight in 1978–1979.Footnote 209 Obesity is not only a problem for adult Canadians, however, measured heights and weights of Canadian children in the same period showed that 10% of 6- to 17-year-olds were obese and 18% were overweight.Footnote 208 As with adults, this is a significant increase from the 4% reported as obese and 14% reported as overweight in 1978–1979.Footnote 209 For both adults and children, a larger percentage of males than females were either overweight or obese (see Figure 1.20).Footnote 208 Differences in income have been linked to differences in adult obesity rates, yet men and women seem to be affected differently. While females tend to show an inverse association between income and obesity (i.e. as income increases, rates of obesity decrease), there is no clear pattern for males.Footnote 191

Figure 1.20 Body mass index by sex and age group, Canada, 2007–2009Footnote 208

Figure 20
Text Equivalent - Figure 1.20

Summary: For both adults and children, a larger percentage of males than females were either overweight or obese. Among male children, 18.3% were overweight and 10.7% were obese compared to female children, where 17.5% were overweight and 8.6% were obese. Among male adults, 44.1% were overweight and 24.2% were obese compared to female adults, where 29.5% were overweight and 23.6% were obese.

Source: Public Health Agency of Canada using data from Canadian Health Measures Survey, Statistics Canada.

Body mass index classification Males 6 to 17 years Females 6 to 17 years Males 18 years and older Females 18 years and older
Underweight 5.4% 7.8% 0.8% 2.2%
Normal 65.6% 66.1% 30.9% 44.7%
Overweight 18.3% 17.5% 44.1% 29.5%
Obese 10.7% 8.6% 24.2% 23.6%

Source: Public Health Agency of Canada using data from Canadian Health Measures Survey, Statistics Canada.

Self-reported data from the 2010 CCHS suggest that recent immigrants to Canada have much lower rates of overweight and obesity (39%) compared with the national rate (53%).Footnote 44 However, rates among immigrants who have lived in Canada for 10 or more years equal the national rate.Footnote 44 Among Aboriginal peoples not living on a reserve, 66% of adults 20 years and older and 40% of children and youth are either overweight or obese, based on self-reported height and weight.Footnote 44 For First Nations living on a reserve or in northern communities, 62% of children (3 to 11 years), 43% of youth (12 to 17 years) and 75% of adults (18 years and older) were considered overweight or obese based on self-reported height and weight measurements according to preliminary results from the 2008/2010 RHS.Footnote 146

Accessing primary care

Access to primary care is fundamental to health. In 2010, about 85% of Canadians (89% of females and 81% of males) reported having a regular family doctor.Footnote 45 While the majority of Canadians may have a regular family doctor, not everyone consults a physician annually. Recent immigrants reported the lowest rates of consulting either a family doctor or general practitioner (76% of women and 59% of men) whereas immigrants who had been in Canada for 10 or more years had the highest reported rates (86% of women and 80% of men).Footnote 44 Regardless of whether or not they had a family physician, more women (83%) reported consulting a physician compared with men (72%) (see Figure 1.21).Footnote 44

Figure 1.21 Consulting a doctor by origin and sex, Canada, 2010Footnote 44

Figure 21
Text Equivalent - Figure 1.21

Summary: While women consistently reported consulting a doctor more than men, place of origin also impacted consultations. Recent immigrants reported the lowest rates of consulting either a family doctor or general practitioner (76% of women and 59% of men) whereas immigrants who had been in Canada for 10 or more years had the highest reported rates (86% of women and 80 of men%).

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Origin Males Females

Note:

1Recent foreign-born has been living in Canada for 10 years or less.
2Long-term foreign-born has been living in Canada for more than 10 years.
Canadian-born non-Aboriginal 72% 83%
Canadian-born Aboriginal 66% 78%
Recent foreign-bornFigure 1.21 - Footnote 1 59% 76%
Long-term foreign-bornFigure 1.21 - Footnote 2 80% 86%

Note:

Figure 1.21 - Footnote *
Recent foreign-born has been living in Canada for 10 years or less.
Figure 1.21 - Footnote
Long-term foreign-born has been living in Canada for more than 10 years.

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Not only do people seek treatment through Canada’s publicly funded health care system, they also benefit from a number of disease prevention and health promotion services such as immunization. Currently, all of Canada's provinces/territories have developed publicly funded immunization strategies.Footnote 210 Rates of vaccine-preventable infectious diseases are low in Canada since the majority of Canadian children have been immunized against a range of potentially serious illnesses. In 2009, about 92% of two-year-olds had been immunized against measles, mumps and rubella, 77% against diphtheria, pertussis and tetanus and 83% against polio.Footnote 211

Nevertheless, immunization coverage is below target for several vaccine-preventable diseases. Reduced coverage rates may be the result of barriers to awareness and access, leading to delays in receiving timely immunization; varying provincial/territorial immunization programs for some vaccines across the country; or because of differing cultural norms and personal beliefs.Footnote 210, Footnote 212 In Canada, immunization is a shared responsibility among the federal, provincial and territorial governments.Footnote 213 The federal government is responsible for approving and regulating vaccines, monitoring vaccine safety and providing evidence-based recommendations on the use of vaccines in Canada.Footnote 213,Footnote 214 The provinces and territories are responsible for funding, program planning and delivering immunization programs in their respective jurisdictions.Footnote 213 As there is no timely-mechanism or national immunization registry system to collect immunization records consistently, the Public Health Agency of Canada has collaborated with provinces and territories to establish standards for reporting immunization coverage and surveys to estimate national immunization coverage.Footnote 210, Footnote 215

In 2010, 72% of the population reported having received the influenza vaccination in the previous two years.Footnote 44 Vaccine coverage for seasonal influenza varies among different age groups, with the highest vaccination rates (91%) being reported by seniors.Footnote 44 Among people with chronic health conditions, 81% were vaccinated in the previous two years.Footnote 44 During the same period, 67% of Aboriginal and 74% of foreign-born populations also received the seasonal influenza vaccine.Footnote 44

Accessing non-insured health services, such as dental and eye care, is equally important. In 2010, 82% of Canadians reported they had seen a dentist in the previous two years, though this percentage decreased with age (see Figure 1.22).Footnote 44 That same year, 64% of Canadians reported having seen an eye doctor in the previous two years.Footnote 44 Unlike dental visits, the percentage of people seeing an eye doctor in the previous two years increased with age (see Figure 1.22).Footnote 44 More women reported visiting a dentist (83%) or eye doctor (68%) than did men (81% and 59% respectively).Footnote 44

Figure 1.22 Dental and eye doctor visits in the past 24 months by sex and age group, Canada, 2010Footnote 44

Figure 22
Text Equivalent - Figure 1.22

Summary: The percentage of Canadians who have seen a dentist in the past two years decreased with age for both males (93% between 12 and 19 years and 72% for those aged 65 years and older) and females (94% between 12 and 19 years and 71% for those aged 65 years and older). Unlike dental visits, the percentage of Canadians who have seen an eye doctor in the past two years increases with age for both males (65% between 12 and 19 years and 83% for those aged 65 years and older) and females (72% between 12 and 19 years and 88% for those aged 65 years and older).

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

  Visited a dentist in the past 24 months Visited an eye doctor in the past 24 months
Age group Males Females Males Females
12 to 19 93% 94% 65% 72%
20 to 29 73% 81% 44% 52%
30 to 54 83% 85% 53% 62%
55 to 64 80% 83% 67% 76%
65 and older 72% 71% 83% 88%

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, Statistics Canada.

Summary

Although the health of Canada’s population is considered very good, a closer inspection of differing rates of death, disease and disability among various groups shows that some Canadians experience worse health and a lower quality of life than do others. Many factors influence these outcomes including the aging of the population, increasing survival rates for potentially fatal conditions, and changes in personal choices about eating, physical activity and the use of substances such as tobacco and alcohol. These are not the only factors at play; evidence shows that income, education, employment and working conditions can affect individual health behaviours and outcomes. The following chapter will introduce the concepts of sex and gender and how they are linked to health behaviours and outcomes, both directly and through their connection to the determinants of health. It also briefly explores sex- and gender-based analysis as a tool for analyzing how both sex and gender influence health.

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