Chapter 2: The Chief Public Health Officer's report on the state of public health in Canada 2008 – A work in progress

Public Health in Canada

A work in progress

Canada has made great strides in implementing public health initiatives to maintain and improve the health of Canadians. Considerable challenges remain however, as recent decades have seen the rise of new diseases as well as the continuation of old problems that still threaten the health of the population.

For example, 2,923 Canadians lost their lives on Canada’s roads in 2005 despite safety improvements over the years.¹¹⁰ Although this number is in decline due to better roads and safer cars, speeding, and dangerous and impaired driving are still serious risks.

Physical environments can also result in adverse health effects. Conditions associated with climate change − such as rising temperatures and extreme weather events – and migrating species/diseases, such as West Nile Virus, can lead to illness and death among vulnerable populations.¹¹¹ Air quality is of great concern as the number of ‘smog days’ is increasing in Canadian cities and the impact on health for children, seniors and those suffering from pre-existing illness such as cardiovascular and respiratory diseases, is significant.¹¹²

The necessity of clean water and reliable infrastructure was reinforced with the E.coli contamination of the community water supply in Walkerton, Ontario in 2000 where the water-borne infection claimed seven lives and left almost half the town’s population ill.¹¹³ The following year, the community water supply in North Battleford, Saskatchewan was contaminated with cryptosporidia which caused between 5,800 and 7,100 people to become ill.¹¹⁴

Sedentary lifestyles and escalating obesity rates are risk factors for preventable conditions, such as Type 2 diabetes, which reduce Canadians’ quality of life and put their lives at risk.^{12, 14} Each year in Canada, about three quarters of all deaths result from circulatory diseases, cancers, diabetes and respiratory illnesses.¹¹⁵ Moreover, 51% of all years lost to premature death were caused by cancer, circulatory diseases and respiratory diseases in 2001.¹¹⁶

Serious health challenges such as stress, mental illnesses and suicide also continue to be major problems. One in five participants in the 2002 Mental Health and Well-being Survey indicated that they had experienced a mental illness (such as anxiety disorders, depression and substance dependence) at some point during their lifetime. Mental illnesses affect people in all occupations, education levels, socio-economic conditions and cultures. And, despite the fact that most Canadians will be affected by mental illness themselves, or through a family member, friend or colleague, reducing the stigma associated with mental illness continues to be the greatest challenge to treatment and care. ^{117, 118}

There is also an unequal distribution of health in Canada. Poverty, which is often linked to low education and employment levels, is also linked to people being less healthy on average. Research has shown repeatedly that persons with low incomes are more likely to experience illness and use the health care system, and those who are ill are often more likely to become economically disadvantaged.^{119, 120, 121}

Studies also show that other factors like education, early childhood development and social support can compound or mitigate these inequalities.^{7, 122} Poverty then is not simply an issue of lack of money, but a cluster of disadvantages of which economic poverty is a key driver. This will be explored further in Chapters 3 and 4.

For all the progress that has been achieved to date, it is clear that considerable work remains to be done. However, these ongoing challenges do not diminish the extraordinary strides in Canada’s public health history. In the past century, life expectancy for women has soared from 50 to 83 years and from 47 to 78 years for men.^{123, 124} Improved sanitation, living conditions, community development measures, and innovations such as immunization have dramatically demonstrated effectiveness in preventing premature death and improving Canadians’ health and quality of life. Continuous improvement in public health action will be required throughout the 21st century to sustain this impressive record.

Chapter 2 - Public Health in Canada

• What is public Health
• Canada's public health history
• A work in progress