Chapter 3: The Chief Public Health Officer's report on the state of public health in Canada 2008 – Our health

Our Population, Our Health and the Distribution of Our Health

Our health

Given the diversity of the Canadian population, how is it possible to determine the state of Canadians’ health or the factors that influence it? The answers lie in the use of statistics, known as health indicators, that measure and monitor trends in the health of Canadians. The indicators shown in Table 3.1 highlight how long people can expect to live on average, what percentage of the population experiences particular health challenges, or how frequently Canadians acquire and live with specific diseases and disabilities. These indicators are widely accepted as a meaningful gauge of overall population health and can be used to provide an indication of how healthy Canadians are over time and in comparison to other countries.137, 138

Two types of health indicators are presented in Table 3.1; those that originate from official information and data sources such as the census, death records, hospitalization records, disease registries or direct measurement; and those that are self-reported from population-representative surveys where respondents identify having experienced, being diagnosed with or living with a variety of diseases and injuries as well as rating their quality and state of general and mental health. Most of these indicators are presented as rates or proportions of the overall Canadian population.

Life expectancy

Life expectancy in Canada has increased dramatically over the past century to the point where a person born here today can expect to live for about 80 years, based on current death rates in all age groups.139 Over a lifetime, some periods may be spent in less than full health, but it is estimated that Canadians can expect to live the equivalent of 70 of those 80 years in full health.140 This number is arrived at using a health-adjusted life expectancy, which is a measure of overall population health that takes into account the effects of illness and disability on peoples’ quality of life. Consequently, Canadians can expect to live a long life, with the expectation that a good health-related quality of life will be enjoyed for most of those years.

Canadians’ life expectancy at birth in 2004 was one of the highest in the world at just over 80 years – about 2.5 years more than the U.S. and 2 years less than Japan (the highest at 82 years).141 Figure 3.2 shows the steady increase in life expectancy for six OECD countries, including Canada, over the last 25 years. It also shows that Canadian life expectancy is improving, but it is not doing so at the same rate as some other top health-ranked countries such as Japan and Australia.

Figure 3.2 Life expectancy at birth, select OECD countries, 1980-2004

Figure 3.2 Life expectancy at birth, select OECD countries, 1980-2004

Source: Public Health Agency of Canada using Health Canada’s Data
Analysis and Information System (DAIS), Organisation for Economic
Co-operation and Development (OECD) Health Data, 2007.

Socio-economic health gradient describes the enduring pattern of the rise of health status with each level of socio-economic status.142

Although Canada does well overall in terms of life expectancy, certain populations within Canada do not fare as well. In urban Canada, Canadians with lower levels of education have lower life expectancy, as do those living in lower-income neighbourhoods.143

In Figure 3.3, the urban population is divided into quintiles (Q), or fifths, based on the percentage of the population in their neighbourhoods below the low-income cut-offs.144 The 20% of the population in the neighbourhoods with the highest incomes (Q1) have a higher life expectancy than those in each of the neighbourhoods with lower incomes (Q2 to Q5). The effect of health outcomes improving with each increase in income level is known as a social gradient in health.145, 146 Figure 3.3 also shows that the gradient is different for men and women, with a much steeper gradient for men.

Figure 3.3 Life expectancy at birth by neighbourhood income and sex, urban Canada, 2001

Figure 3.3 Life expectancy at birth by neighbourhood income and sex, urban Canada, 2001

Q - population divided into fifths based on the percentage of the
population in their neighbourhood below the low-income cut-offs.
Source: Wilkins et al. (2007), Statistics Canada.

Figure 3.4 illustrates that over time, life expectancy has increased steadily at all income levels.144 The figure also shows, however, that while the gaps between inhabitants in neighbourhoods with the highest and lowest incomes and between men and women are narrowing, they have persisted since the early 1970s with even the lowest-income women having a longer life expectancy than men with the highest income. The size of these gaps is not insignificant – they are in fact equivalent to the increase in many countries’ life expectancies which took more than two decades to achieve (see Figure 3.2).141

Figure 3.4 Life expectancy at birth by neighbourhood income and sex, urban Canada, 1971-2001

Figure 3.4 Life expectancy at birth by neighbourhood income and sex, urban Canada, 1971-2001

Q - population divided into fifths based on the percentage of the
population in their neighbourhood below the low-income cut-offs.
Source: Wilkins et al. (2007), Statistics Canada.

First Nations people listed in the Indian Register, according to requirements set out in the Indian Act, also have lower life expectancy.147, 148 Figure 3.5 shows that while the life expectancy for Registered Indians has increased since 1980, it has remained below that of the general population for both male and female populations.149 Although the gap is narrowing, a persistent difference remains between First Nations people and other Canadians.

Figure 3.5 Life expectancy at birth by sex, Registered Indian and general population, Canada, 1980-2001

Figure 3.5 Life expectancy at birth by sex, Registered Indian and general population, Canada, 1980-2001

Source: Indian and Northern Affairs Canada, Basic Departmental Data, 2004.

Table 3.1 Our health
  Value Description Year
Who we are
Population 31.6 million people 2006
Aboriginal 1.17 million people 2006
First Nations 0.70 million people 2006
Métis 0.39 million people 2006
Inuit 0.05 million people 2006
Immigrant 6.2 million people 2006
By birth place
Africa 0.37 million people 2006
Asia and the Middle East 2.53 million people 2006
Caribbean and Bermuda 0.32 million people 2006
Central America 0.13 million people 2006
Europe 2.28 million people 2006
Oceania and other 0.06 million people 2006
South America 0.25 million people 2006
United States of America 0.25 million people 2006
By years since immigration
Recent (<=10 years) 2.0 million people 2006
Long-term (>10 years) 4.2 million people 2006
Urban population 80.2 percent of the population 2006
Our health status
Life expectancy and reported health
Life expectancy at birth 80.4 years of expected life 2005
Health-adjusted life expectancy at birth 69.6 years of expected healthy life 2001
Infant mortality rate 5.4 deaths per one thousand live births 2005
Excellent or very good health * 60.1 percent of the population aged 12+ years 2005
Excellent or very good mental health * 72.9 percent of the population aged 12+ years 2005
Leading causes of mortality
Circulatory diseases 227.5 deaths per 100,000 population per year 2004
Malignant cancers 209.4 deaths per 100,000 population per year 2004
Respiratory diseases 61.3 deaths per 100,000 population per year 2004
Causes of premature mortality (ages 0 to 74)
Malignant cancers 1,574 potential years of life lost per 100,000 population per year 2001
Circulatory diseases 854 potential years of life lost per 100,000 population per year 2001
Unintentional injuries 640 potential years of life lost per 100,000 population per year 2001
Suicide and self-inflicted injuries 394 potential years of life lost per 100,000 population per year 2001
Respiratory diseases 162 potential years of life lost per 100,000 population per year 2001
Human Immunodeficiency Virus (HIV) 46 potential years of life lost per 100,000 population per year 2001
Causes of ill-health and disability
Living with chronic diseases
Malignant cancers 2.6 percent of the population 2003
Diabetes 5.5 percent of the population aged 1+ years 2004-2005
Obesity 24.3 percent of the population aged 18+ years 2005
Arthritis/rheumatism * 16.4 percent of the population aged 12+ years 2005
Asthma * 8.3 percent of the population aged 12+ years 2005
Heart disease * 4.8 percent of the population aged 12+ years 2005
High blood pressure * 18.3 percent of the population aged 20+ years 2005
Chronic obstructive pulmonary disease * 4.4 percent of the population aged 35+ years 2005
Living with mental Illness
Schizophrenia 0.3 percent of the population aged 12+ years 2002
Major depression 4.8 percent of the population aged 15+ years during a 12-month period 2002
Alcohol dependence 2.6 percent of the population aged 15+ years during a 12-month period 2002
Anxiety disorders 4.8 percent of the population aged 15+ years during a 12-month period 2002
Alzheimer's and other dementias * 6.0-10.0 percent of the population aged 65+ years in North America 2003
Acquiring infectious diseases
HIV 2,300-4,500 estimated number of new cases 2005
Chlamydia 202.2 new cases per 100,000 population 2006
Gonorrhea 33.1 new cases per 100,000 population 2006
Infectious Syphilis 4.6 new cases per 100,000 population 2006

* Denotes self-reported data
Note: Some data may not be comparable. More detailed information can be found in Appendix D: Definitions and Data Sources for Indicators.
Sources: Public Health Agency of Canada using data from Statistics Canada and National Diabetes Surveillance System.

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