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

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.

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

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

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

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

* 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.