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

Our Population, Our Health and the Distribution of Our Health

Infant mortality

The infant mortality rate is a particularly sensitive indicator that, internationally, well reflects the overall human development, health and education status of women and the strength of the public health environment of a nation.^{150, 151} Canada’s infant mortality rate has improved over the past four decades, dropping by 80% from more than 27 deaths per 1,000 live births in 1960 to 5 per 1,000 live births in 2004.^{152, 153}Figure 3.6 illustrates the steady decrease in infant mortality rates for seven OECD countries, including Canada, over the last 25 years.¹⁴¹

Some differences may exist in the way various countries record infant births and deaths, so that infant mortality rates are not necessarily directly comparable. However, for countries similarly developed in comparison to Canada, such differences do not negate the fact that infant mortality rate is still considered a reliable indicator of a country’s overall health and is often used as an international comparison tool.¹⁵¹ Canada’s infant mortality rate is slightly higher than some countries (Japan and Norway have the lowest infant mortality rate at around 3 deaths per 1,000 live births), but it is comparable to Australia and the United Kingdom, and lower than the U.S. (7 infant deaths per 1,000 live births).

Despite the fact that Canada’s infant mortality rate is in line with other OECD countries, some populations within Canada experience higher rates of infant death. Figure 3.7 shows the infant mortality rate over time for low-, middle- and high-income urban neighbourhoods.¹⁴⁴ While the rate is decreasing in all quintiles (despite a moderate increase after 1996), and the gap between the rate in the various quintiles has also been decreasing over time, a significant difference in infant mortality rates still exists between neighbourhoods with the highest and lowest incomes.

Figure 3.6 Infant mortality rate, 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.

Figure 3.7 Infant mortality rate by neighbourhood income, 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.

Infant mortality rates among Aboriginal Peoples and those living in Canada’s northern communities are estimated to be higher than the general population. The infant mortality rate among First Nations people living on reserve is estimated at 7 deaths per 1,000 live births. ¹⁴⁸ This rate may be an underestimate because of current limitations associated with data coverage and quality related to Aboriginal infant births and deaths in Canada.¹⁵⁴ Recent research related to First Nations in British Columbia puts the estimate as high as 7.5 deaths per 1,000 live births for First Nations living in rural areas.¹⁵⁵ The estimated rate in Nunavut (where approximately 85% of the population is Inuit) is more than three times the national rate at 16 deaths per 1,000 live births.^{156, 148}

Self-reported health

Although measured indicators are important, how people feel about their own health is an important indication of overall health status. Despite the inherent limitations of survey data, such as the subjectivity of individual responses, self-reported data can provide useful information otherwise not available. When Canadians are asked about their health, most indicate that they consider themselves to be healthy. The 2005 Canadian Community Health Survey found that the majority of Canadians age 12 and over, about 16 million (60%) report their health as either excellent (22%) or very good (38%).¹⁵⁷ Even more (73%) report their mental health as excellent (37%) or very good (36%).¹⁵⁸

As with other health indicators, however, some Canadians fare less well. Individuals living in households with the lowest levels of education are less likely to report having excellent or very good general or mental health.¹⁵⁹ Figure 3.8 shows that only 47% of individuals living in households with the lowest levels of education (Grade 8 or less) report excellent or very good health. Each additional level of education is associated with an increase in the proportion of those reporting excellent or very good health.

The Aboriginal Peoples Survey 2001 found that slightly lower proportions (56%) of the Aboriginal population aged 15 years and older living off reserve reported their health as either excellent or very good (North American Indian 55%, Métis 58% and Inuit 56%).¹⁶⁰ For those living on reserve, the 2002-2003 First Nations Regional Longitudinal Health Survey found that the proportion reporting excellent or very good health was even lower at 40%.¹⁶¹

Figure 3.8 Proportion of Canadians* with excellent or very good perceived health by highest household level of education, Canada, 2005

* Population aged 12+ years.
Source: Public Health Agency of Canada using Health Canada’s Data
Analysis and Information System (DAIS), Statistics Canada, Canadian
Community Health Survey (CCHS-SHR) 2005.