Appendix A: The Chief Public Health Officer's Report on the State of Public Health in Canada 2014 – The health and well-being of Canadians

Appendix A: The Health and Well-Being of Canadians

Many factors can impact and influence the health of a population. Being able to identify who we are using characteristics such as age and sex, and factors that may influence overall health, such as education, income and personal behaviours, can help to explain some health outcomes.

Who we are

Population

Canada's population has increased by 56% over the past 40 years and exceeded 35 million people in 2013.Footnote 15 As estimated by the 2011 National Household Survey, 1.4 million people in Canada identified as Aboriginal (61% First Nations, 32% Métis and 4% Inuit), while 6.8 million identified as being foreign born.Footnote 9,Footnote 415 The majority of Canadians (61%) lived in large urban population centres in 2011.Footnote 15,Footnote 308

Life expectancy

The life expectancy of Canadians has increased dramatically, by approximately 19 years for males and 22 years for females, over the past three-quarter century.Footnote 17,Footnote 18

Figure A.1 Population by age, Canada, 1973*
and 2013Footnote 15

* Population totals at 90 years in 1973.

Text Equivalent - Figure A.1

Figure highlights how the age distribution of Canada’s population has shifted since the early 1970s when a larger portion of the population was found in the younger age groups compared to today when most of the population falls within the middle and older age groups.

Figure A.2 Population distribution by origin, Canada, 2011Footnote 9,Footnote 15,Footnote 415

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In 2011, 76% of the total population was comprised of Canadian-born non-Aboriginals, 4% was comprised of Aboriginal Peoples (2.5% identified as First Nations, 1.3% identified as Métis, 0.2% identified as Inuit and 0.1% identified as multiple or other Aboriginal identities) and 20% was comprised of immigrants (6.3% moved within the past 10 years and 13.4% moved more than 10 years ago).

Figure A.3 Population distribution by
population density, Canada, 2011Footnote 15,Footnote 308

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In 2011, 12% of the total population lived in small population centres, 9% lived in medium population centres, 61% lived in large urban population centres and 18% lived in rural areas.

Figure A.4 Life expectancy at birth by sex, Canada, 1931 and 2009/2011Footnote 17,Footnote 18

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Life expectancy for males increased from 60.0 years in 1931 to 79.3 years in 2009/2011. Life expectancy for females increased from 62.1 years in 1931 to 83.6 years in 2009/2011.

Factors influencing health

Education, employment and income

Figure A.5 Population* completing high school or post-secondary school by sex, Canada excluding territories, 1990 to 2013Footnote 416

Figure A.5

* Population aged 25 to 44 years.

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Between 1990 and 2013 of those aged 25 to 44 years the percent of: females completing high school increased from 78.2% to 94.0%; males completing high school increased from 76.5% to 91.0%. Between 1990 and 2013 of those aged 25 to 44 years the percent of: females completing post-secondary education increased from 42.7% to 73.8%; males completing post-secondary education increased from 46.5% to 65.4%. Between 1995 and 1997 the percent of females completing a post-secondary education exceeded that of males.

Education

Better education generally leads to better overall health.Footnote 124,Footnote 418,Footnote 419 The number of Canadians who have completed high school has steadily increased over the past 20 years.Footnote 416 The number of people, particularly females, who have completed a post-secondary education has also increased.Footnote 416

Figure A.6 Unemployment and underemployment rate by age group, Canada excluding territories, 2013Footnote 417

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By age group, unemployment was highest among those aged 15 to 24 years (13.7%) and lowest among those aged 65 years and older (4.3%). Unemployment for those aged 25 to 54 years was 5.9% and was 6.4% for those aged 55 to 64 years. Rates of underemployment—people working part-time because they cannot find full-time employment, discouraged employment seekers and those waiting to hear about possible employment—were highest among those aged 15 to 24 years (5.5%) and lowest among those ages 65 years and older (2.0%). Under employment for those aged 25 to 54 years was 2.5% and was 3.1% for those aged 55 to 64 years.

Employment

Unemployment has been associated with poorer health outcomes.Footnote 124,Footnote 171 Unemployed workers are twice as likely as their employed counterparts to experience psychological problems such as depression, anxiety, low self-perceived health and poor self-esteem.Footnote 419,Footnote 420

Like unemployment, underemployment—people working part-time because they cannot find full-time employment, discouraged employment seekers and those waiting to hear about possible employment—is unequally distributed across the population.Footnote 421 Younger workers, females and visible minorities report higher rates of underemployment.Footnote 421

Household income

Overall, the percentage of people living in after-tax low-income households has decreased.Footnote 109 Research has linked living on low income to lower life expectancy, increased rates of suicide and other burdens of disease such as diabetes and cardiovascular disease.Footnote 124,Footnote 419,Footnote 422-424 A household is said to be in low income when they are likely to spend 20% or more of their total post-tax income on necessities (food, clothing and footwear, and shelter), compared to an average family of the same size in the same broad community size.Footnote 425

Figure A.7 Canadians living in low income after tax by age group and select household type, Canada excluding territories, 1978 to 2011Footnote 109,Footnote 426

* Economic family refers to a group of two or more people who live in the same dwelling and are related to each other by blood, marriage, common-law or adoption. A couple may be of opposite or same sex. Foster children are included.

Text Equivalent - Figure A.7

Between 1976 and 2011, the percent of the population aged 18 years and under living in low-income households decreased from 13.4% to 8.5% (those living in two-parent households decreased from 9.3% to 5.9%; those living in female lone-parent households decreased from 58.7% to 23.0%; and those living in all other types of households decreased from 27.4% to 12.0%).

Between 1976 and 2011, the percent of the population aged 18 to 64 years living in low-income households decreased from 10.5% to 9.7% (those living in families decreased from 8.1% to 5.1%; and those living alone increased from 30.8% to 32.3%).

Between 1976 and 2011, the percent of the population aged 65 years and older living in low-income households decreased from 29.0% to 5.2% (those living in families decreased from 15.0% to 1.5%; and those living alone increased from 64.9% to 14.9%).

Environment, housing and community

Ozone concentrations and fine particulate matter

Poor outdoor air quality, including smog, can exacerbate respiratory and cardiovascular diseases, increasing emergency room visits, hospital admissions and premature deaths.Footnote 185,Footnote 186,Footnote 427 The two main components of smog are ozone concentrations and fine particulate matter.Footnote 185

Figure A.8 Annual average ozone concentrations, Canada and select regions, 2000 to 2011Footnote 428-433

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Figure A.8 Annual average ozone concentrations (parts per billion), Canada and select regions, 2000 to 2011 Year Canada Atlantic Canada Southern Quebec Southern Ontario Prairies and northern Ontario British Columbia 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Figure A.9 Annual average fine particulate matter concentrations, Canada and select regions, 2000 to 2011Footnote 434-439

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Figure A.9 Annual average fine particulate matter concentrations (micrograms per cubic metre), Canada and select regions, 2000 to 2011 Year Canada Atlantic Canada Southern Quebec Southern Ontario Prairies and northern Ontario British Columbia 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Housing conditions

Figure A.10 Households in core housing need by origin, Canada, 1996 and 2006Footnote 453-455

* An Aboriginal household is defined as: a non-family household in which at least 50% of household members self-identified as Aboriginal; or a family household that meets at least one of two criteria: at least one spouse, common-law partner, or lone parent self-identified as an Aboriginal; or at least 50% of household members self-identified as Aboriginal. Data excludes farm, band, and reserve households (for which shelter costs are not collected by the Census); households with incomes of zero or less; and households whose shelter costs equal or exceed their incomes. † Recent immigrant households represent those households whose primary maintainer immigrated to Canada in the 5 years prior to the Census. For 2006, the primary maintainer arrived between 2001 and 2005. For 1996, the primary maintainer arrived between 1991 and 1995.

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Between 1996 and 2006, the percent of Canadian households living in core housing need decreased from 15.6% to 12.7%.

Between 1996 and 2006, the percent of households headed by Aboriginal Peoples living in core housing need decreased from 30.3% to 20.4% (core housing need for: status Indian headed households decreased from 34.4% to 24.8%;  non-status Indian households decreased from 29.9% to 20.3%; Métis households decreased from 26.0% to 16.2%; and Inuit households increased from 32.8% to 35.8%).

Between 1996 and 2006, the percent of households headed by immigrants living in core housing need decreased from 20.0% to 18.2% (core housing need for: recent immigrants decreased from 42.8% to 35.4%; and long-term immigrants decreased from 17.1% to 16.2%).

Housing, a critical component of a person's environment, was identified as a basic requirement for health in the 1986 Ottawa Charter for Health Promotion.Footnote 124,Footnote 440 Living in poor housing conditions (e.g. indoor air pollution caused by moulds, off-gassing from modern materials) has been linked to respiratory conditions, lead poisoning, injuries from falls and decreased mental health.Footnote 419,Footnote 441 Physical design of housing can also affect health. Accessibility features, for example ramps and grab bars, can improve quality of life for those with disabilities or frailties.Footnote 442-452 Those who cannot access affordable housing may experience increased levels for stress and feel more vulnerable and insecure.Footnote 419

A household is considered to be in core housing need if it does not meet one or more of the adequacy, suitability or affordability standards and it would have to spend 30% or more of its before-tax income to pay the median rent (including utility costs) of alternative local market housing that meets all three standards.Footnote 456 Nationally, the percentage of households in core housing need has decreased from 15.6% to 12.7% between 1996 and 2006.Footnote 456

Community belonging

Family, friends and a feeling of belonging to a community gives people the sense of being a part of something larger than themselves.Footnote 457 The extent to which people participate in their community and feel that they belong can positively influence their long-term physical and mental health.Footnote 458

Violent crime

One measure of safety in a community is the crime rate. While many Canadians believe that crime rates in their neighbourhoods have either stayed constant (62%) or increased (26%), in reality they have actually been decreasing.Footnote 459-461

Housing, a critical component of a person's environment, was identified as a basic requirement for health in the 1986 Ottawa Charter for Health Promotion.Footnote 124,Footnote 440 Living in poor housing conditions (e.g. indoor air pollution caused by moulds, off-gassing from modern materials) has been linked to respiratory conditions, lead poisoning, injuries from falls and decreased mental health.Footnote 419,Footnote 441 Physical design of housing can also affect health. Accessibility features, for example ramps and grab bars, can improve quality of life for those with disabilities or frailties.Footnote 442-452 Those who cannot access affordable housing may experience increased levels for stress and feel more vulnerable and insecure.Footnote 419

A household is considered to be in core housing need if it does not meet one or more of the adequacy, suitability or affordability standards and it would have to spend 30% or more of its before-tax income to pay the median rent (including utility costs) of alternative local market housing that meets all three standards.Footnote 456 Nationally, the percentage of households in core housing need has decreased from 15.6% to 12.7% between 1996 and 2006.Footnote 456

Community belonging

Family, friends and a feeling of belonging to a community gives people the sense of being a part of something larger than themselves.Footnote 457 The extent to which people participate in their community and feel that they belong can positively influence their long-term physical and mental health.Footnote 458

Violent crime

One measure of safety in a community is the crime rate. While many Canadians believe that crime rates in their neighbourhoods have either stayed constant (62%) or increased (26%), in reality they have actually been decreasing.Footnote 459-461

Figure A.11 Population reporting somewhat or very strong sense of community belonging by age group and area of residency, Canada, 2012Footnote 38,Footnote 48

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Among young Canadians aged 12 to 19 years, those living in urban settings reported higher rates of sense of community belonging compared to their rural counterparts (76% compared to 75%). Among all other age groups the inverse was true: population aged 20 to 34 years (56% compared to 64%); population aged 35 to 44 years (64% compared to 69%); population aged 45 to 64 years (66% compared to 67%); and population aged 65 years and older (73% compared to 75%).

Figure A.12 Police-reported violent crime rate, Canada, 2000 to 2012Footnote 460,Footnote 461

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Rates of reported violent crime have decreased from 1,494 per 100,000 population in 2000 to 1,190 per 100,000 population in 2012.

Health behaviours

Physical activity

Studies report that physical inactivity can increase the risk for poor health outcomes such as coronary heart disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes, depression, arthritis and osteoporosis.Footnote 462 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; while 60 minutes of moderate-to-vigorous physical activity every day is recommended for children and youth aged between 5 and 17 years.Footnote 463,Footnote 464

Figure A.13 Children and youth attaining suggested levels of physical activity by age group and sex, Canada, March 2007 to February 2009Footnote 41

Text Equivalent - Figure A.13

Among children aged 6 to 10 years, 14% of males and 7% of females attained 60 minutes of moderate-to-vigorous physical activity 6 or more days per week. Among children aged 11 to 14 years, 7% of males and 5% of females attained 60 minutes of moderate-to-vigorous physical activity 6 or more days per week. Among children aged 15 to 19 years, 6% of males and 2% of females attained 60 minutes of moderate-to-vigorous physical activity 6 or more days per week.

Figure A.14 Adults attaining suggested levels of physical activity by age group and sex, Canada, March 2007 to February 2009Footnote 42

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Among adults aged 20 to 39 years, 21% of males and 14% of females attained 150 minutes of moderate-to-vigorous physical per week. Among adults aged 40 to 59 years, 15% of males and 14% of females attained 150 minutes of moderate-to-vigorous physical activity per week. Among adults aged 60 to 79 years, 14% of males and 13% of females attained 150 minutes of moderate-to-vigorous physical activity per week.

Fruit and vegetable consumption

Figure A.15 Population* reporting fruit and vegetable consumption, 5 or more times
per day, by sex, Canada, 2007 and 2012Footnote 468

* Population aged 12 years and older.

Text Equivalent - Figure A.15

The percent of males who consume fruits and vegetables 5 or more times per day has decreased from 37% in 2007 to 34% in 2012. The percent of females who consume fruits and vegetables 5 or more times per day has decreased from 51% in 2007 to 47% in 2012.

Eating habits also play a key role in achieving and maintaining health.Footnote 465,Footnote 466 Eating fresh fruits and vegetables daily can help in preventing a variety of diseases including type 2 diabetes, heart disease, osteoporosis and certain types of cancer.Footnote 465,Footnote 467

Figure A.16 Recommended number of Canada's Food Guide servings per dayFootnote 467

Text Equivalent - Figure A.16

Figure A.16 Recommended number of Food Guide servings per day Children Teens Adults Age in years 2-3 4-8 9-13 14-18 19-50 51+ Sex Girls and Boys Females Males Females Males Females Males Vegetables and Fruit Grain Products Milk and Alternatives Meat and Alternatives

Figure A.17 Household food insecurity by household type, Canada, 2007/2008 and 2011/2012Footnote 469

Figure A.17

Severe food insecurity: Indication of reduced food intake and disrupted eating patterns.
Moderate food insecurity: Indication of compromise in quality and/or quantity of food consumed.

Text Equivalent - Figure A.17

Total households experiencing moderate to severe food insecurity has increased from 7.8% in 2007/2008 (moderate = 5.1%; severe = 2.7%) to 8.3% in 2011/2012 (moderate = 5.8%; severe = 2.5%). Households with children aged less than 18 years experiencing moderate to severe food insecurity has increased from 9.7% in 2007/2008 (moderate = 6.9%; severe = 2.8%) to 10.2% in 2011/2012 (moderate = 7.9%; severe = 2.3%). Households with no children experiencing moderate to severe food insecurity has increased from 6.8% in 2007/2008 (moderate = 4.2%; severe = 2.6%) to 7.5% in 2011/2012 (moderate = 4.9%; severe = 2.6%).

Food security

The number of households in Canada reporting moderate to severe levels of food insecurity has been increasing.Footnote 469 Being able to eat healthily requires being food secure—having "... physical and economic access to sufficient, safe and nutritious food to meet ... dietary needs and food preferences for an active and healthy life" at all times.Footnote 470 Food insecurity among Aboriginal households in Canada can be 3 to 6 times higher than among non-Aboriginal households (depending on the study and Aboriginal sub-population), with populations living in northern and isolated communities being especially at risk.Footnote 234-236,Footnote 471,Footnote 472

Figure A.18 Current smokers† by sex, Canada excluding territories, 1985 to 2012Footnote 473,Footnote 474

Figure A.18

* Data for 1996/1997 from same survey year.
† Population aged 15 years and older.

Text Equivalent - Figure A.18

Smoking rates among males has decreased from 38% in 1985 to 18% in 2012. Smoking rates among females has decreased from 32% in 1985 to 14% in 2012.

Tobacco use

Smoking and exposure to second-hand smoke have been linked to an increased risk of a number of diseases and conditions that affect cardiovascular and respiratory systems.Footnote 475,Footnote 476 Tobacco smoke also includes known cancer-causing substances.Footnote 476 Despite decreases in the prevalence of smoking among all Canadians over the past three decades, Aboriginal people's rates of non-traditional tobacco use continue to be high (31% of Métis, 58% of Inuit, and 57% of First Nations people on reserve).Footnote 473,Footnote 474,Footnote 477-479

Figure A.19 What is a standard drink?Footnote 480

Figure A.19

Note: Some beers have more alcohol content than one standard drink.

Text Equivalent - Figure A.19

Figure A.19 What is a standard drink?DrinkRegular beerWineFortified wineHard liquorSize 341 ml = 12 oz 142 ml = 5 oz 85 ml = 3 oz 43 ml = 1.5 oz % Alcohol 5% 12% 16% - 18% 40%

Alcohol use

Alcohol intoxication can harm physical and mental health, affect personal relationships, people's ability to work and study and in extreme cases can cause death.Footnote 480,Footnote 481 For females, consuming 3 drinks or more on a single occasion exceeds the low-risk guidelines for acute effects, while consuming more than 10 drinks a week with more than 2 drinks most days exceeds the low-risk guidelines for chronic effects.Footnote 482 For males, consuming 4 drinks or more on a single occasion exceeds the low-risk guidelines for acute effects, while consuming more than 15 drinks a week with more than 3 drinks most days exceeds the low-risk guidelines for chronic effects.Footnote 482

Figure A.20 Exceeding low-risk drinking guidelines* for acute effects by age group and sex, Canada excluding territories, 2012Footnote 483

* Alcohol consumption in the past 7 days.

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On average, 13% of males and 7% of females exceeded low-risk drinking guideline for acute effects in 2012. Among males, low-risk drinking guidelines for acute effects were exceeded by: 2% of those aged 15 to 17 years; 22% of those aged 18 to 19 years; 18% of those aged 20 to 34 years; 13% of those aged 35 to 44 years; 13% of those aged 45 to 64 years; and 7% of those aged 65 years and older. Among females, low-risk drinking guidelines for acute effects were exceeded by: 3% of those aged 15 to 17 years; 8% of those aged 18 to 19 years; 10% of those aged 20 to 34 years; 8% of those aged 35 to 44 years; 7% of those aged 45 to 64 years; and 4% of those aged 65 years and older.

Figure A.21 Exceeding low-risk drinking guidelines* for chronic effects by age group and sex, Canada excluding territories, 2012Footnote 483

* Alcohol consumption in the past 7 days.

Text Equivalent - Figure A.21

On average, 17% of males and 12% of females exceeded low-risk drinking guideline for chronic effects in 2012. Among males, low-risk drinking guidelines for chronic effects were exceeded by: 3% of those aged 15 to 17 years; 33% of those aged 18 to 19 years; 24% of those aged 20 to 34 years; 18% of those aged 35 to 44 years; 17% of those aged 45 to 64 years; and 10% of those aged 65 years and older. Among females, low-risk drinking guidelines for chronic effects were exceeded by: 4% of those aged 15 to 17 years; 12% of those aged 18 to 19 years; 15% of those aged 20 to 34 years; 12% of those aged 35 to 44 years; 13% of those aged 45 to 64 years; and 7% of those aged 65 years and older.

Illicit drug use

The use of illicit drugs (i.e. abuse, misuse or dependence) can affect performance at school and at work and, in extreme cases, cause death.Footnote 485-488 Illicit drug use has been linked to various health and social problems including panic attacks, hallucinations, psychosis, paranoia and risky or violent behaviour.Footnote 485-488 In Canada, the most commonly used illicit drug is cannabis.Footnote 482 Pharmaceutical drugs prescribed for therapeutic purposes, including opioid pain relievers, stimulants, tranquillizers and sedatives, may also be abused due to their psychoactive properties.Footnote 482 In 2012, of those who used psychoactive pharmaceutical drugs, 6.3% reported abusing them.Footnote 482

Figure A.22 Cannabis use in the past 12 months by age group, Canada excluding territories, 2012Footnote 483,Footnote 484

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In 2012, 10% of Canadians used cannabis in the past 12 months. Those aged 20 to 34 reported the highest rate to usage (20%), followed by those aged 15 to 19 years (19%), 35 to 44 years (9%), 45 to 64 years (7%) and 65 years and older (1%).

Figure A.23 Illicit drug* use in the past 12 months excluding cannabis by age group, Canada excluding territories, 2012Footnote 483,Footnote 484

* Includes cocaine, speed, ectasy, heroin and hallucinogens including salvia).

Text Equivalent - Figure A.23

In 2012, 2% of Canadians used an illicit drug (cocaine, speed, ectasy, heroin and hallucinogens including salvia) other than cannabis in the past 12 months. Those aged 15 to 19 reported the highest rate to usage (5.5%), followed by those aged 20 to 34 years (5.0%), 35 to 44 years (1.0%), 45 to 64 years (0.7%) and 65 years and older (0.2%).

Contact with medical doctor

Access to healthcare is fundamental to health.Footnote 489,Footnote 490 In 2012, the majority (85%) of Canadians reported having a regular medical doctor.Footnote 468 Of those who reported not having a regular medical doctor, nearly one-half (46%) indicated they had not tried to contact one.Footnote 38,Footnote 48 Barriers such as language, sociocultural differences, physical inaccessibility and transportation can also limit access.Footnote 419,Footnote 491-493

Contact with dental professional

Good oral health is a key component to a healthy life. Poor oral health can result in a range of negative health outcomes including gum disease, lung infections, diabetes and heart disease.Footnote 494,Footnote 495 Despite the importance of oral health, many Canadians do not visit a dental health professional every year.Footnote 38,Footnote 48 Overall, the promotion of good oral health habits such as making healthy food choices, brushing teeth twice daily with fluoridated toothpaste, regular flossing and visits to a dental care provider can all help to prevent decay and maintain a healthy mouth for a lifetime.Footnote 496

 

Figure A.24 Having a regular medical doctor and contact with a medical doctor by age group, Canada, 2012Footnote 468

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The majority of Canadians reported having a regular medical doctor in 2012: 85% of those aged 12 to 19 years; 73% of those aged 20 to 34 years; 83% of those aged 35 to 44 years; 90% of those aged 45 to 64 years; and 95% of those aged 65 years and older.

In 2012, many Canadians reported not having seen a medical doctor within the past 12 months: 68% of those aged 12 to 19 years; 71% of those aged 20 to 34 years; 78% of those aged 35 to 44 years; 83% of those aged 45 to 64 years; and 90% of those aged 65 years and older.

Figure A.25 Last time visited dentist by select age groups, Canada, 2012Footnote 38,Footnote 48

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Figure A.25 Last time visited dentist by select age groups, Canada, 2012 Age group Less than 1 year 1 to less than 3 years 3 to less than 5 years 5 years or more Never 12 to 19 years 20 to 34 years 35 to 44 years 45 to 64 years 65 years and older

Health status

Perceived health and health-adjusted life expectancy

Overall, the majority of Canadians feel that their health is either very good or excellent.Footnote 468 Between 2003 and 2012, very good or excellent self-perceived health increased through most age groups.Footnote 468 While life expectancy and perceived health have increased, not all years are spent in good health.Footnote 468,Footnote 497,Footnote 498

Figure A.26 Very good or excellent self-perceived health by age group, Canada, 2003 and 2012Footnote 468

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Between 2003 and 2012 self-perceived health increased among those aged 12 to 19 years (67% compared to 70%), 35 to 44 years (64% compared to 65%), 45 to 64 years (53% compared to 56%) and 65 years and older (37% compared to 44%). Self-perceived health among those aged 20 to 34 (69% compared to 68%) decreased during the same period.

Figure A.27 Life expectancy and health-adjusted life expectancy at birth by sex, Canada excluding territories, 2000/2002 and 2005/2007Footnote 497

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Between 2000/2002 and 2005/2007, health-adjusted life expectancy increased for both males (67.5 years to 68.9 years) and females (69.9 years to 71.2 years). Overall life expectancy also increased for both males (77.0 years to 78.3 years) and females (82.0 years to 83.0 years) during the same period.

Figure A.28 Teen* birth rate, Canada, 1930 to 2011Footnote 499-501

Figure A.28

* Females aged 15 to 19 years.

Text Equivalent - Figure A.28

Between 1930 and 1959 the teen (those aged 15 to 19 years) birth rate increased from 29.0 per 1,000 live births to 60.4 per 1,000 live births. From 1960 to 2011 the rate decreased from 59.8 per 1,000 live births to 12.6 per 1,000 live births.

Teen birth rate

Rates of teen births have been declining since the late 1950s.Footnote 499-501 The decline in teen births can be attributed to several factors including an increase in the availability and use of contraceptives, legalized abortion, changing social values and an increased awareness of risks associated with unprotected sex.Footnote 502-504

Chronic conditions

Although chronic health conditions are most often experienced by—and associated with—older members of the population, in 2012 more than one—half (55%) of Canadians aged 12 years and older reported living with at least one chronic health condition.Footnote 38,Footnote 48

Cancer incidence

An estimated 187,600 new cases of cancer were expected to be diagnosed in 2013.Footnote 505 Cancers of the lung, breast, colon/rectum and prostate were expected to account for more than one-half (52%) of all cancers diagnosed in the same year.Footnote 505 Although mortality rates for both males and females declined, the age-standardized incidence rate for all cancers increased between 1984 and 2013 for females, but remain fairly stable for males.Footnote 505

Teen birth rate

Rates of teen births have been declining since the late 1950s.Footnote 499-501 The decline in teen births can be attributed to several factors including an increase in the availability and use of contraceptives, legalized abortion, changing social values and an increased awareness of risks associated with unprotected sex.Footnote 502-504

Chronic conditions

Although chronic health conditions are most often experienced by—and associated with—older members of the population, in 2012 more than one—half (55%) of Canadians aged 12 years and older reported living with at least one chronic health condition.Footnote 38,Footnote 48

Cancer incidence

An estimated 187,600 new cases of cancer were expected to be diagnosed in 2013.Footnote 505 Cancers of the lung, breast, colon/rectum and prostate were expected to account for more than one-half (52%) of all cancers diagnosed in the same year.Footnote 505 Although mortality rates for both males and females declined, the age-standardized incidence rate for all cancers increased between 1984 and 2013 for females, but remain fairly stable for males.Footnote 505

Figure A.29 Canadians reporting one or more chronic health condition* by age group, Canada, 2012Footnote 38,Footnote 48

* Conditions include asthma, arthritis, back problems, high blood pressure, migraines, chronic bronchitis, diabetes, heart disease, cancer, ulcers, effects from stroke, urinary incontinence, bowel disorders, Alzheimer's disease, mood disorders and anxiety disorders.

Text Equivalent - Figure A.29
Figure A.29 Canadians reporting one or more chronic health condition by age group, Canada, 2012

Age group One Two Three Four or more 15 to 19 years 20 to 34 years 35 to 44 years 45 to 64 years 65 years and older

Figure A.30 Age-standardized incidence rates (ASIR)† and age-standardized mortality rates (ASMR)* for all cancers by sex, Canada, 1984 to 2013Footnote 505

* ASMR for 2010 through 2013 are estimated based on all provinces and territories. Actual data were available to 2009. These estimates are based on long-term trends and may not reflect recent changes in trends.
† ASIR for 2011 through 2013 are estimated based on all provinces and territories. Actual data were available to 2010 except for Quebec (2007). These estimates are based on long-term trends and may not reflect recent changes in trends.

Text Equivalent - Figure A.30

Between 1984 and 2013 the age-standardized incidence rate for all cancers among males has stayed relative constant (452.3 per 100,000 population compared to 437.0 per 100,000 population). During the same period, the age-standardized incidence rate for all cancers among females increased slightly (329.9 per 100,000 population compared to 370.6 population).

Between 1984 and 2013 the age-standardized mortality rate for all cancers among males has declined (248.1 per 100,000 population compared to 178.2 per 100,000 population). During the same period, the age-standardized incidence rate for all cancers also decreased among females (151.8 per 100,000 population compared to 131.7 population).

Figure A.31 Diagnosed diabetes by age group, Canada, 2004/2005 and 2008/2009Footnote 39,Footnote 506

Figure A.31
Text Equivalent - Figure A.31 Figure A.31 Diagnosed diabetes by age group, Canada, 2004/2005 and 2008/2009 Age group 2004/2005 2008/2009 1 to 19 years 0.3% 0.3% 20 to 24 years 0.6% 0.7% 25 to 29 years 0.9% 1.0% 30 to 34 years 1.4% 1.6% 35 to 39 years 2.1% 2.6% 40 to 44 years 3.0% 4.0% 45 to 49 years 4.6% 5.6% 50 to 54 years 7.1% 8.4% 55 to 59 years 10.3% 12.3% 60 to 64 years 14.1% 16.6% 65 to 69 years 17.6% 20.7% 70 to 74 years 19.9% 24.1% 75 to 79 years 21.3% 25.5% 80 to 84 years 20.7% 25.2% 85 years and older 17.3% 21.0%
Diabetes prevalence

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 39 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 39,Footnote 507 People living with diabetes have an increased risk of developing cardiovascular problems, kidney disease, blindness and diabetic foot ulcers.Footnote 508

Obesity

Obesity is a complex issue that involves a range of biological, behavioural and societal factors.Footnote 33,Footnote 509 Physical activity, sedentary behaviours, screen time, diet and socioeconomic status can all contribute to increased body weight.Footnote 509 Links have been made between obesity and chronic health conditions (type 2 diabetes, asthma, gallbladder disease, osteoarthritis, chronic back pain), cancers and cardiovascular diseases.Footnote 509-511 Body mass index (BMI) is a common measure based on height and weight that is used to determine healthy and unhealthy weights. While BMI is considered an adequate measure for portions of the population, standard BMI categories may not accurately reflect the rate of overweight and obesity in all populations including Inuit and seniors.Footnote 512-514

Diabetes prevalence

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 39 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 39,Footnote 507 People living with diabetes have an increased risk of developing cardiovascular problems, kidney disease, blindness and diabetic foot ulcers.Footnote 508

Obesity

Obesity is a complex issue that involves a range of biological, behavioural and societal factors.Footnote 33,Footnote 509 Physical activity, sedentary behaviours, screen time, diet and socioeconomic status can all contribute to increased body weight.Footnote 509 Links have been made between obesity and chronic health conditions (type 2 diabetes, asthma, gallbladder disease, osteoarthritis, chronic back pain), cancers and cardiovascular diseases.Footnote 509-511 Body mass index (BMI) is a common measure based on height and weight that is used to determine healthy and unhealthy weights. While BMI is considered an adequate measure for portions of the population, standard BMI categories may not accurately reflect the rate of overweight and obesity in all populations including Inuit and seniors.Footnote 512-514

Figure A.32 Measured rates of childhood and adolescent* overweight and obesity by sex, Canada excluding territories, 1978/1979 and 2009/2011Footnote 40,Footnote 515

* Children and youth aged 5 to 17 years.

Text Equivalent - Figure A.32

Rates of overweight and obesity have increased among children and adolescents aged 5 to 17 years between 1978/1979 (overweight = 12.0%; obese = 3.1%) and 2009/2011 (overweight = 16.4%; obese = 8.4%). Among boys, rates of overweight have decreased from 12.4% in 1978/1978 to 15.9% in 2009/2011, while rates of obesity have increased from 3.0% to 9.5% during the same period. Among girls, rates of overweight have increased from 11.5% in 1978/1978 to 17.0% in 2009/2011, while rates of obesity have increased from 3.2% to 7.1% during the same period.

Figure A.33 Measured rates of adult* overweight and obesity by sex, Canada excluding territories, 1978/1979 and 2009/2011Footnote 40,Footnote 515

* Adults aged 18 to 64 years.

Text Equivalent - Figure A.33

Rates of overweight and obesity have increased among adults aged 18 to 64 years between 1978/1979 (overweight = 31.5%; obese = 11.8%) and 2009/2011 (overweight = 33.6%; obese = 24.8%). Among males, rates of overweight have remained stable at 39.0% in 1978/1978 and 39.5% in 2009/2011, while rates of obesity have increased from 11.1% to 26.1% during the same period. Among females, rates of overweight have increased from 24.2% in 1978/1978 to 27.8% in 2009/2011, while rates of obesity have increased from 12.5% to 23.6% during the same period.

Figure A.34 Arthritis by age group and sex, Canada, 2012Footnote 468

Figure A.34
Text Equivalent - Figure A.34

Among males, 2% of those aged 20 to 34 years, 4% of those aged 35 to 44 years, 16% of those aged 45 to 64 years and 32% of those aged 65 years and older reported having been diagnosed with arthritis by a physician. Among females, 3% of those aged 20 to 34 years, 8% of those aged 35 to 44 years, 24% of those aged 45 to 64 years and 47% of those aged 65 years and older reported having been diagnosed with arthritis by a physician.

Arthritis

The term "arthritis" describes more than 100 conditions that affect joints, the tissue surrounding joints and other connective tissue.Footnote 516,Footnote 517 Osteoarthritis and rheumatoid arthritis are two of the most common types.Footnote 516,Footnote 518,Footnote 519 In 2012, 15% (4.4 million) of Canadians aged 15 years and older reported that they had been diagnosed with arthritis.Footnote 468 Disability associated with all forms of arthritis results from problems in body function or structure (reduced mobility of joints, pain and body stiffness), limitations or restrictions in carrying out activities of daily living including self-care (showering, toileting and dressing) or mobility (transferring from beds to chairs and walking around the house) and problems a person may experience in their involvement in life situations (working or participating in social activities).Footnote 516,Footnote 520,Footnote 521

Respiratory conditions

Chronic respiratory diseases include asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, sleep apnea and occupational lung disease.Footnote 522,Footnote 523 Two important respiratory diseases are asthma and COPD. Asthma is characterized by coughing, shortness of breath, chest tightness and wheezing.Footnote 523,Footnote 524 Early onset of asthma has been linked to low birth-weight and exposure to tobacco smoke including second-hand smoke and parental smoking, whereas later onset has been linked to obesity and increased exposure to allergens and environmental factors such as pollution.Footnote 476,Footnote 523-525 COPD is an umbrella term for a number of chronic lung diseases characterized by shortness of breath, cough and sputum production.Footnote 523,Footnote 526 In 2012, 8% of the population aged 12 years and older reported having asthma and 4% of the population aged 35 years and older reported having COPD.Footnote 468

Figure A.35 Asthma by age group and sex, Canada, 2012Footnote 468

Text Equivalent - Figure A.35

Among males, 11% of those aged 12 to 19 years, 9% of those aged 20 to 34 years, 6% of those aged 35 to 44 years, 5% of those aged 45 to 64 years and 6% of those aged 65 years and older reported having been diagnosed with asthma by a physician. Among females, 10% of those aged 12 to 19 years, 11% of those aged 20 to 34 years, 8% of those aged 35 to 44 years, 9% of those aged 45 to 64 years and 9% of those aged 65 years and older reported having been diagnosed with asthma by a physician.

Figure A.36 Chronic obstructive pulmonary disease (COPD) by age group and sex, Canada, 2012Footnote 468

Text Equivalent - Figure A.36

Among males, 1.2% of those aged 35 to 44 years, 3.0% of those aged 45 to 64 years and 8.3% of those aged 65 years and older reported having been diagnosed with chronic obstructive pulmonary disease by a physician. Among females, 2.2% of those aged 35 to 44 years, 4.1% of those aged 45 to 64 years and 7.5% of those aged 65 years and older reported having been diagnosed with chronic obstructive pulmonary disease by a physician.

Heart disease

Heart disease is a broad term for a group of conditions affecting the structure and functions of the heart.Footnote 527,Footnote 528 The conditions include ischemic heart disease, heart failure, rheumatic heart disease and congenital heart disease.Footnote 528 In 2012, 5% of Canadians aged 12 years and older reported having heart disease.Footnote 38,Footnote 48 Reported rates of heart disease increase with age, with seniors aged 65 to 79 years and 80 years and older reporting the highest rates of heart disease (15% and 24%, respectively).Footnote 38,Footnote 48

High blood pressure

High blood pressure, also known as hypertension, increases the risk of stroke, heart attack or failure, dementia, kidney disease, eye problems and erectile dysfunction.Footnote 529 In 2012, 18% (5.4 million) of Canadians aged 12 years and older reported having high blood pressure.Footnote 38,Footnote 48

Figure A.37 Heart disease by age group and sex, Canada, 2012Footnote 38,Footnote 48

Text Equivalent - Figure A.37

Among males, 0.5% of those aged 20 to 34 years, 1.2% of those aged 35 to 44 years, 6.7% of those aged 45 to 64 years and 20.9% of those aged 65 years and older reported having been diagnosed with heart disease by a physician. Among females, 0.4% of those aged 20 to 34 years, 1.8% of those aged 35 to 44 years, 3.4% of those aged 45 to 64 years and 14.0% of those aged 65 years and older reported having been diagnosed with heart disease by a physician.

Figure A.38 High blood pressure by age group and sex, Canada, 2012Footnote 38,Footnote 48

Text Equivalent - Figure A.38

Among males, 2.3% of those aged 20 to 34 years, 9.4% of those aged 35 to 44 years, 25.1% of those aged 45 to 64 years and 50.1% of those aged 65 years and older reported having been diagnosed with high blood pressure by a physician. Among females, 1.8% of those aged 20 to 34 years, 6.5% of those aged 35 to 44 years, 23.7% of those aged 45 to 64 years and 52.3% of those aged 65 years and older reported having been diagnosed with high blood pressure by a physician.

Infectious diseases

Despite progress in preventing and controlling infectious diseases, they continue to be a major health issue and public health concern.Footnote 2,Footnote 329 While most infections are minor and go unreported, some can be serious; many cases are preventable.Footnote 329,Footnote 530

Sexually transmitted infections

Rates of sexually transmitted infections (STIs) officially reported to the Canadian Notifiable Disease Surveillance System (CNDSS) have increased in the overall Canadian population over the past 15 years.Footnote 531 Untreated STIs, whether symptomatic or not, can have long-lasting effects making early detection and treatment important. STIs have been linked to pelvic inflammatory disease, infertility, ectopic pregnancies and low birth-weight babies as well as various types of cancers including cervical, anal and penile and increased risk of acquiring human immunodeficiency virus (HIV).Footnote 531-539 These trends must be interpreted with caution, since both laboratory testing methods and clinical screening practices have changed over time.Footnote 531

Figure A.39 Reported rates of chlamydia by sex, Canada, 1995 to 2011Footnote 531,Footnote 540

Figure A.39
Text Equivalent - Figure A.39 Figure A.39 Reported rates of chlamydia by sex per 100,000 population, Canada, 1995 to 2011 Year Total Male Female 1995 128.2 62.6 192.2 1996 115.9 56.6 174.0 1997 113.9 58.7 167.8 1998 129.0 73.7 183.1 1999 138.2 81.4 193.6 2000 150.9 88.9 211.6 2001 161.4 99.2 221.9 2002 179.5 112.3 245.1 2003 189.6 121.3 256.5 2004 200.5 131.8 267.7 2005 206.2 140.2 270.8 2006 212.7 145.8 278.1 2007 221.0 151.7 285.5 2008 244.2 165.5 321.2 2009 255.4 173.0 336.0 2010 273.7 186.9 358.8 2011 290.4 200.1 378.7
Chlamydia

Chlamydia, an infection caused by the bacterium Chlamydia trachomatis, is the most commonly reported bacterial STI in Canada.Footnote 531 Chlamydial infections are frequently asymptomatic.Footnote 535 In the absence of screening, a lack of symptoms can increase the risk of unknowingly spreading the disease as well as the risk of longer-term health implications for infected individuals. Nationally reported chlamydia rates have increased each year since 1997, resulting in a relative increase of 62% between 2002 and 2011.Footnote 531 The infection disproportionately affects younger people, particularly females, although it is common in both sexes.Footnote 531

Figure A.40 Reported rates of gonorrhea by sex, Canada, 1995 to 2011Footnote 531,Footnote 540

Figure A.40
Text Equivalent - Figure A.40 Figure A.40 Reported rates of gonorrhea by sex, Canada, 1995 to 2011 per 100,000 population Year Total Male Female 1995 19.5 22.9 16.1 1996 16.9 19.4 14.5 1997 14.9 17.8 12.0 1998 16.1 19.5 12.7 1999 17.6 22.0 13.3 2000 20.1 25.1 15.1 2001 21.8 27.2 16.4 2002 23.5 29.5 17.5 2003 26.0 32.1 20.1 2004 29.2 37.2 21.2 2005 28.5 36.0 21.2 2006 34.7 42.3 27.2 2007 35.7 41.9 29.5 2008 36.9 41.4 32.4 2009 31.6 35.0 28.2 2010 31.5 35.9 27.1 2011 33.1 38.4 27.8
Gonorrhea

Gonorrhea, an infection caused by the bacterium Neisseria gonorrhoeae, is the second most commonly reported bacterial STI in Canada.Footnote 531 Over the last 30 years, multiple strains of gonorrhea have become less susceptible to certain first-line antibiotics such as penicillin, tetracycline and, more recently, quinolones and third-generation oral and injectable cephalosporins.Footnote 531,Footnote 541-544 Reported rates of gonorrhea have steadily increased over time, with an overall increase of 41% from 2002 to 2011.Footnote 531

Figure A.41 Reported rates of infectious syphilis by sex, Canada, 1995 to 2011Footnote 531,Footnote 540

Figure A.41
Text Equivalent - Figure A.41 Figure A.41 Reported rates of syphilis by sex per 100,000 population, Canada, 1995 to 2011 Year Total Male Female 1995 0.5 0.7 0.4 1996 0.4 0.5 0.3 1997 0.4 0.4 0.3 1998 0.6 0.7 0.4 1999 0.6 0.7 0.5 2000 0.6 0.7 0.4 2001 0.9 1.2 0.7 2002 1.5 2.5 0.6 2003 2.9 4.8 0.9 2004 3.5 6.1 0.8 2005 3.4 5.8 1.0 2006 4.1 7.2 1.1 2007 3.8 6.7 1.0 2008 4.2 7.3 1.1 2009 4.7 8.5 0.9 2010 5.0 9.1 0.9 2011 5.1 9.6 0.7
Syphilis

Syphilis is an infection caused by the bacterium Treponema pallidum.Footnote 531 From 1993 to 2000, reported rates of infectious syphilis were relatively stable, but the rates began to sharply increase in 2001.Footnote 531 Between 2002 and 2011, reported syphilis rates increased 232%.Footnote 531 The dramatic increase in cases of syphilis has been most notable among men who have sex with men.Footnote 531,Footnote 539,Footnote 545 Syphilis infection can increase susceptibility to HIV infection.Footnote 531,Footnote 537-539 Co-infection of syphilis among people living with HIV and AIDS is increasing.Footnote 531,Footnote 537-539

Figure A.42 Estimated number of new HIV infections* for selected years, CanadaFootnote 546

Figure A.42

* Bars indicate range of uncertainty.

Text Equivalent - Figure A.42 Figure A.42 Estimated number of new HIV infections for selected years, Canada Year Middle Estimate Range of Uncertainty 1975 26 16 1976 47 28 1977 114 68 1978 270 162 1979 578 347 1980 1,104 662 1981 1,872 1,123 1982 2,821 1,693 1983 3,889 2,333 1984 4,510 2,706 1985 4,649 2,789 1986 4,588 2,753 1987 4,588 2,753 1988 4,334 2,600 1989 4,060 2,436 1990 3,822 2,293 1991     1992     1993 2,968 1,781 1994     1995     1996 2,276 1,366 1997     1998     1999 2,276 1,366 2000     2001     2002 3,026 1,816 2003     2004     2005 3,200 1,920 2006     2007     2008 3,335 1,930 2009     2010     2011 3,175 1,850
HIV

HIV attacks the immune system and can develop into a chronic progressive illness that can make an individual vulnerable to other infections and to chronic diseases.Footnote 547 HIV is transmitted from one person to another through exposure to infected blood or body fluids during unprotected sexual intercourse or by sharing or using contaminated needles.Footnote 547 An HIV-positive mother can also transmit the virus to her infant during pregnancy, delivery or breastfeeding if she is not taking antiretroviral medication.Footnote 547,Footnote 548 Having an STI such as chlamydia or syphilis can increase the risk of HIV transmission and becoming infected with HIV.Footnote 531,Footnote 537-539Approximately 3,175 new HIV infections occurred in 2011, similar to the estimated number of new infections in preceding years.Footnote 546 However, as many as 25% of Canadians infected with HIV, or 17,980 people, may be unaware of their infection and thus may be unknowingly infecting others.Footnote 546

In Canada, HIV infection is not evenly distributed but rather is concentrated in certain at-risk populations, such as men who have sex with men (47% of all new infections) and people who inject drugs (17%).Footnote 546 The rate of new HIV infection among people originating from HIV-endemic countries is about 9 times higher than that in the Canadian-born population whereas Aboriginal people experience an HIV infection rate 3.5 times higher than the non-Aboriginal population.Footnote 546 The number of Canadians living with HIV is increasing because new infections continue to occur but fewer people are dying prematurely as a result of the disease due to the availability of effective antiretroviral treatments.Footnote 546

Tuberculosis

Tuberculosis (TB) is an infectious bacterium that is spread from person to person primarily through the air.Footnote 549-551 TB bacteria of the lungs or airways enter the air when a person with active TB disease exhales by coughing, sneezing or even just talking.Footnote 549,Footnote 551 The bacteria can remain air-borne for several hours and then be inhaled by other people who may, in turn, become infected.Footnote 549,Footnote 551 Over time, an infected person may develop active TB disease.Footnote 549,Footnote 552 Known risk factors for developing either latent TB infection or active TB disease include having a weakened immune system or underlying illness such as HIV or diabetes; coming into close contact with people with known or suspected TB (e.g. sharing living space or living in communities with high rates of TB disease); having a personal history of active TB; having received inappropriate or inadequate treatment for TB disease in the past; living in a low-income household, in crowded and inadequately ventilated housing or being homeless; being malnourished; having a history of smoking or substance abuse; being a resident in an institutional setting such as a long-term care or correctional facility; and working with people at risk of developing TB.Footnote 552,Footnote 553 Despite the overall low incidence of TB disease in Canada, the burden of TB is higher in Canadian Aboriginal populations and in foreign-born Canadians compared to other Canadians.Footnote 554-559

Figure A.43 Reported new active and re-treatment tuberculosis cases by origin, Canada, 2002 to 2012Footnote 555-559

Text Equivalent - Figure A.43
Figure A.43 Reported new active and re-treatment tuberculosis cases by origin per 100,000 population, Canada, 2002 to 2012 Year Canadian-born
non-Aboriginal Canadian-born
Aboriginal Foreign-born 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Figure A.44 Reported new active and re-treatment tuberculosis cases by Aboriginal status, Canada, 2012Footnote 555

Text Equivalent - Figure A.44

In 2012, rates of new active and re-treatment tuberculosis was: 23.3 per 100,000 population among registered First Nations with status living on a reserve, 17.3 per 100,000 population among First Nations with status not living on a reserve; 3.1 per 100,000 population among Métis; and 262.2 per 100,000 population among Inuit.

Mental health and mental illness

Mental health is an important aspect of the overall health and well-being of all Canadians.Footnote 74 It can affect people of all ages, cultures, education and income levels, 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 560,Footnote 561 A considerable body of research supports the concept that mental health and mental illness are not on opposite ends of a single continuum.Footnote 560 Rather mental health and mental illness exist on two separate but related continua, therefore, mental health is more than the absence of mental illness.Footnote 562

Figure A.45 Very good or excellent self-perceived mental health by age group, Canada, 2003 and 2012Footnote 38,Footnote 48,Footnote 563,Footnote 564

Figure A.45
Text Equivalent - Figure A.45

Between 2003 and 2012 very good or excellent self-perceived mental health increased among those aged 15 to 19 years (75.5% compared to 76.9%) and 65 years and older (68.5% compared to 69.2%). Very good or excellent self-perceived mental health decreased among those aged 20 to 34 (76.6% compared to 73.7%), 35 to 44 years (74.1% compared to 70.8%) and 45 to 64 years (72.5% compared to 70.4%) during the same period.

Perceived mental health

It is difficult to determine the state of the population's mental health and rates of mental illness because data are limited. Nevertheless, the data available through surveys, studies and databases help to illustrate the mental health of Canadians. According to the 2012 Canadian Community Health Survey, the majority of Canadians 15 years and older reported their mental health as very good or excellent (72%).Footnote 38,Footnote 48

Mood disorders and major depression

Mood disorders—such as depression, bipolar disorder, mania or dysthymia—are the most commonly self-reported mental health conditions.Footnote 38,Footnote 48 Mood disorders can create feelings of distress or impairment in social, work and school settings as well as other areas of everyday life.Footnote 560 Major depressive disorder, one type of mood disorder, is typically a recurrent illness with relapses where the more severe and long-lasting the initial symptoms are the less likely a person is to fully recover.Footnote 560,Footnote 565

Figure A.46 Mood disorders and major depressive episodes by age group and sex, Canada, 2012Footnote 44

Text Equivalent - Figure A.46

Among males, 6.7% of those aged 15 to 24 years, 5.3% of those aged 25 to 44 years, 3.7% of those aged 45 to 64 years and 1.5% of those aged 65 years and older reported having any type of mood disorder as diagnosed by a physician. Among females, 9.7% of those aged 15 to 24 years, 7.6% of those aged 25 to 44 years, 6.3% of those aged 45 to 64 years and 1.9% of those aged 65 years and older reported having any type of mood disorder as diagnosed by a physician.

Among males, 5.3% of those aged 15 to 24 years, 4.1% of those aged 25 to 44 years, 3.4% of those aged 45 to 64 years and 1.4% of those aged 65 years and older reported having a major depressive episode as diagnosed by a physician. Among females, 9.0% of those aged 15 to 24 years, 6.8% of those aged 25 to 44 years, 5.6% of those aged 45 to 64 years and 1.8% of those aged 65 years and older reported having a major depressive episode as diagnosed by a physician.

Figure A.47 Generalized anxiety disorder by age group and sex, Canada, 2012Footnote 44

Text Equivalent - Figure A.47

Among males, 1.1% of those aged 15 to 24 years, 2.6% of those aged 25 to 44 years, 2.2% of those aged 45 to 64 years and 1.0% of those aged 65 years and older reported having generalized anxiety disorder as diagnosed by a physician. Among females, 3.8% of those aged 15 to 24 years, 3.3% of those aged 25 to 44 years, 3.8% of those aged 45 to 64 years and 1.3% of those aged 65 years and older reported having generalized anxiety disorder as diagnosed by a physician.

Anxiety

Most people have experienced moments of anxiousness at some point in their lives, but for those living with an anxiety disorder, these feelings are amplified and can interfere with relationships, school and work performance and social and recreational activities.Footnote 560 People living with an anxiety disorder may avoid situations that intensify their anxiety or develop compulsive rituals that lessen the anxiety.Footnote 560 Symptoms of anxiety disorders often manifest earlier in life.Footnote 560

Schizophrenia

Schizophrenia has a profound effect on person's ability to function effectively in all aspects of life—self—care, family relationships, income, school, employment, housing, community and social life.Footnote 560,Footnote 566 Early in the disease process, people with schizophrenia may lose their ability to relax, concentrate or sleep and may withdraw from friends and not even recognize that they are ill.Footnote 560,Footnote 566 With effective early treatment to control symptoms, people can prevent further symptoms and increasing symptom severity and can optimize their chance of leading full, productive lives.Footnote 560,Footnote 566 While rates of schizophrenia are roughly equal in males and females, males tend to develop the illness earlier in life whereas females develop it later.Footnote 560,Footnote 566

Figure A.48 Hospitalizations for schizophrenia* in acute care hospitals, by age group and sex, Canada, 2010Footnote 15,Footnote 567

* Using most responsible diagnosis.

Text Equivalent - Figure A.48
Figure A.48 Hospitalizations for schizophrenia in acute care hospitals, by age group and sex per 100,000 population, Canada, 2010 Age group Male Female 10 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years 85 years and older

Figure A.49 Projected prevalence of Alzheimer's disease or other dementia by age group, Canada, 2011 and 2031Footnote 81

Text Equivalent - Figure A.49
Figure A.49 Projected prevalence rates of Alzheimer's disease or other dementia by age group, Canada, 2011 and 2031 Age group 2011 2031 40 to 45 years 45 to 50 years 50 to 55 years 55 to 60 years 60 to 65 years 65 to 70 years 70 to 75 years 75 to 80 years 80 to 85 years 85 years and older
Alzheimer's disease

Alzheimer's disease and other dementias are progressive degenerative neurological conditions that are more common among seniors.Footnote 76,Footnote 80 Alzheimer's disease progresses from mild to severe.Footnote 568 Mild forms of Alzheimer's can cause problems such as getting lost, having difficulty handling money or paying bills, taking longer to complete routine tasks, repeating sentences, poor judgment and small changes in mood or personality.Footnote 568 Moderate Alzheimer's disease causes damage to parts of the brain that control language, reasoning, sensory perception and conscious thought resulting in increased memory loss and confusion.Footnote 568 Those with severe Alzheimer's disease experience significant shrinkage of brain tissue that results in an inability to communicate, as well as complete dependence on others for care.Footnote 568 In 2011, an estimated 340,200 of Canadians ages over 40 years were living with a diagnosis of Alzheimer's disease or other dementias and this number will probably more than double within 20 years.Footnote 76

Causes of death

Figure A.50 Infant mortality rate, Canada, 1921 to 2011Footnote 569-571

Figure A.50
Text Equivalent - Figure A.50

Between 1921 and 2011 the infant mortality rate decreased from 102 per 1,000 births to 4.8 per 1,000 births.

Infant mortality

During the last century, infant mortality has dropped from a rate of more than 100 deaths per 1,000 live births in the early 1920s to 4.8 per 1,000 live births in 2011.Footnote 569,Footnote 570,Footnote 572 The significant decline in infant death rates has been attributed to improved sanitation, nutrition, standard of living, level of education and family planning.Footnote 504,Footnote 573 The main causes of death in infancy are related to congenital malformations (e.g. Down syndrome and malformations of the heart), as well as disorders due to premature birth or low birth-weight.Footnote 574,Footnote 575

Figure A.51 Change in age-standardized mortality rate by select causes of death, Canada, 2000 and 2011Footnote 15,Footnote 577,Footnote 580,Footnote 581,Footnote 584,Footnote 585,Footnote 592

Figure A.51

*per 100,000 population.

Text Equivalent - Figure A.51 Figure A.51 Change in age-standardized mortality rate per 100,000 population by select causes of death, Canada, 2000 and 2011 Year 2000 2011 Cancers 181.8 155.5    Lung and bronchus cancer 47.3 41.9    Breast cancer 14.0 10.7    Prostate cancer 10.5 7.4 Circulatory diseases 213.9 129.1    Ischaemic heart disease 119.4 66.2    Cerebrovascular disease 43.1 25.5    Hypertensive diseases 4.7 4.8 Respiratory diseases 49.6 43.5    Chronic lower respiratory disease 27.6 22.5    Influenza and pneumonia 13.6 10.8 Injuries and poisonings 40.9 38.5    Suicide 11.4 10.1    Transport 10.1 6.6    Falls 4.4 8.0 Alzheimer’s and other dementias 26.4 34.2 All other causes 114.4 97.7
Leading causes of mortality

In 2011, cancers were the leading overall cause of death in Canada (31%), followed by circulatory diseases (27%) and respiratory diseases (9%).Footnote 574-593 Since population distributions are not identical, age-standardized mortality rates (ASMR) provide a better indication of mortality risk within a population. Between 2000 and 2011, the ASMR have decreased among cancers, circulatory diseases, respiratory diseases and injuries and poisonings.Footnote 15,Footnote 577,Footnote 584,Footnote 585,Footnote 592 During the same period, deaths from Alzheimer's and other dementias increased.Footnote 15,Footnote 580

Figure A.52 Age-standardized rate of potential years of life lost (PYLL) by select causes, Canada, 2000/2002 and 2005/2007Footnote 594

Figure A.52

*per 100,000 population.

Text Equivalent - Figure A.52 Figure A.52 Age-standardized rate of potential years of life lost per 100,000 population by select causes, Canada, 2000/2002 and 2005/2007 Cause 2000/2002 2005/2007 Malignant cancers 1,405.9 1,255.3 Circulatory diseases 766.5 649 Unintentional injuries 646.6 620.2 Suicide and self-inflicted injuries 389.6 345.8 Respiratory diseases 153.7 154.4 HIV 43.7 37.6
Potential years of life lost

While knowing the number of deaths due to a particular disease or condition is important for 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 aged 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).Footnote 594 In 2009, most years of lost life were due to premature deaths associated with cancers, circulatory diseases and unintentional injuries.Footnote 595

Summary

Although the health of Canadians is considered to be very good by international standards, a closer inspection of differing rates of death, disease and disability among various groups shows that some of us experience worse health and a lower quality of life than others. Many factors influence these outcomes, including the aging of the population, increasing survival rates for potentially fatal conditions and changes in behaviours related to eating, physical activity and the use of substances such as drugs, tobacco and alcohol. These are not the only factors at play; evidence shows that income, education, employment and working conditions can also affect individual health behaviours and outcomes.

Table A.1 Who we are
Who we are (million people) Year
Population (as of July 1, 2013) 35.2 2013
Aboriginal peoples 1.40 2011
First Nations (single identity) 0.85 2011
Inuit (single identity) 0.06 2011
Métis (single identity) 0.45 2011
Multiple Aboriginal identity 0.01 2011
Other Aboriginal identities 0.03 2011
Immigrant 6.78 2011
By birthplace
Africa 0.49 2011
Asia 3.04 2011
Caribbean and Bermuda 0.35 2011
Central America 0.15 2011
Europe 2.13 2011
Oceania and otherTable B.1 - Footnote * 0.07 2011
South America 0.29 2011
United States 0.26 2011
By years since immigration
Recent (≤ 10 years) 2.15 2011
Long-term (> 10 years) 4.62 2011
Population centre residents 28.1 2011
Life expectancy at birth (years of expected life, females) 83.6 2009-2011
Life expectancy at birth (years of expected life, males) 89.3 2009-2011
Footnote *
*"Other" includes countries such as Saint Pierre and Miquelon, Bonaire, Saint Eustatius and Saba; Falkland Islands (Malvinas); Greenland; Saint Barthélemy; Saint Martin (French part); and South Georgia and the South Sandwich Islands, the category "Other country," as well as immigrants born in Canada.

Note: Definitions and data sources can be found in Appendix B.

Source: Statistics Canada.

Table A.2 Factors influencing health
Factors influencing our health 95% CI Year
Education, employment and income
High school graduates (%)Table 2 - Footnote * 84.4 2013
Some post-secondary education (%)Table 2 - Footnote * 64.6 2013
Post-secondary graduates (%)Table 2 - Footnote * 59.6 2013
Unemployment rate (%)Table 2 - Footnote 7.1 2013
Persons living in low income, after tax (% of the population, based on 1992 low income cutoff ) 8.8 2011
Environment, housing and community
Ozone concentrations (parts per billion) 33.0 2011
Fine particulate matter concentrations (micrograms per cubic metre) 6.6 2011
Core housing need (% of households in need) 12.7 2006
Urban core housing need (% of urban households in need) 13.2 2010
Sense of community belonging, somewhat or very strong (%)Table 2 - Footnote , Table 2 - Footnote § 66.1 (65.3-66.8) 2012
Violent crime incidents (per 100,000 population per year) 1,190.1 2012
Health behaviours
Physical activity during leisure-time, moderately active or active (%)Table 2 - Footnote , Table 2 - Footnote § 53.9 (53.1-54.6) 2012
Fruit and vegetable consumption, 5+ times per day (%)Table 2 - Footnote , Table 2 - Footnote § 40.6 (39.8-41.3) 2012
Households reporting moderate to severe food insecurity (%)Table 2 - Footnote , Table 2 - Footnote § 8.3 (8.0-8.7) 2011/2012
Current smoker (%)Table 2 - Footnote 16.1 (15.0-17.3) 2012
Exceeds low-risk drinking guidelines for acute effects (%)Table 2 - Footnote , Table 2 - Footnote 9.9 (8.8-11.0) 2012
Exceeds low-risk drinking guidelines for chronic effects (%)Table 2 - Footnote , Table 2 - Footnote 14.4 (13.1-15.7) 2012
Illicit drug use in the past year (%)Table 2 - Footnote , Table 2 - Footnote 10.6 (9.4-11.8) 2012
Contact with medical doctor (%)Table 2 - Footnote , Table 2 - Footnote § 78.7 (78.1-79.4) 2012
Contact with dental professional (%)Table 2 - Footnote , Table 2 - Footnote § 65.5 (64.6-66.4) 2012
Footnote 1
*Population aged 25+ years.
Footnote 2
Population aged 15+ years.
Footnote 3
Self-reported data.
Footnote 4
§Population aged 12+ years.

Note: Definitions and data sources can be found in Appendix B.
Sources: Statistics Canada, Environment Canada, Canada Mortgage and Housing Corporation and Health Canada.

Table A.3 Health status
Our health status 95% CI Year
Health-adjusted life expectancy and perceived health
Perceived health, very good or excellent (%)Table 3 - Footnote *, Table 3 - Footnote 59.9 (59.2-60.6) 2012
Health-adjusted life expectancy at birth (years of expected health life, females) 71.2 (71.0-71.4) 2005/2007
Health-adjusted life expectancy at birth (years of expected health life, males) 68.9 (68.7-69.0) 2005/2007
Teen birth rate (live births per 1,000 female population aged 15 to 19 years per year) 12.6 2011
Chronic conditions
Cancer incidence (new cases age-standardized per 100,000 population per year) 398.6 2013
Diabetes prevalence (%)Table 3 - Footnote 6.8 (6.83-6.85) 2008/2009
Obesity (%)Table 3 - Footnote § 26.2 (25.3-27.1) 2009/2011
Arthritis (%)Table 3 - Footnote *, Table 3 - Footnote || 15.4 (15.0-15.9) 2012
Asthma (%)Table 3 - Footnote *, Table 3 - Footnote 8.1 (7.7-8.5) 2012
Chronic obstructive pulmonary disease (%)Table 3 - Footnote *, Table 3 - Footnote 4.2 (3.9-4.5) 2012
Heart diseases (%)Table 3 - Footnote *, Table 3 - Footnote 4.9 (4.5-5.3) 2012
High blood pressure (%)Table 3 - Footnote *, Table 3 - Footnote 18.4 (17.6-19.2) 2012
Infectious diseases
Chlamydia (new cases per 100,000 population annually) 290.4 2011
Gonorrhea (new cases per 100,000 population annually) 33.1 2011
Infectious syphilis (new cases per 100,000 population annually) 5.1 2011
New HIV diagnoses (number of new positive HIV tests) 2,062 2012
Tuberculosis (new active and re-treatment cases per 100,000 population annually) 4.8 2011
Mental health and mental illness
Perceived mental health, very good or excellent (%)Table 3 - Footnote *, Table 3 - Footnote 71.7 (71.0-72.4) 2012
Major depressive episode (%, previous 12 months)Table 3 - Footnote *, Table 3 - Footnote || 4.7 (4.3-5.1) 2012
Alcohol use or dependence (%, previous 12 months)Table 3 - Footnote *, Table 3 - Footnote || 3.2 (2.8-3.5) 2012
Anxiety disorders, generalized (%, previous 12 months)Table 3 - Footnote *, Table 3 - Footnote || 2.6 (2.3-2.8) 2012
Schizophrenia or psychosis (ever diagnosed)Table 3 - Footnote *, Table 3 - Footnote || 1.3 (1.1-1.5) 2012
Alzheimer's disease and other dementias (per 1,000 population)Table 3 - Footnote *, Table 3 - Footnote # 3.6 2011
Causes of death
Infant mortality rate (deaths under one year per 1,000 live births) 4.8 2011
Leading causes of mortality (deaths per 100,000 population per year)
Cancers 211.0 2011
Circulatory diseases 192.7 2011
Respiratory diseases 64.3 2011
Causes of premature mortality, aged 0 to 74 years (potential years of life lost per 100,000 population per year)
Cancers 1,504.0 2009
Circulatory diseases 755.4 2009
Unintentional injuries 546.3 2009
Suicide and self-inflicted injuries 322.2 2009
Respiratory diseases 208.0 2009
HIV 28.3 2009
Footnote 1
*Self-reported data.
Footnote 2
Population aged 12+ years.
Footnote 3
Population aged 1+ years.
Footnote 4
§Population aged 18+ years.
Footnote 5
Population aged 35+ years.
Footnote 6
||Population aged 15+ years.
Footnote 7
#Population aged 40+ years.

Note: Definitions and data sources can be found in Appendix B.
Sources: Statistics Canada, Canadian Cancer Society, Public Health Agency of Canada and Alzheimer Society of Canada.

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