What makes Canadians sick?

Ken MacQueen on the state of Canadian health care

Stuck in the middle

Andy Clark/Reuters

On March 28, Maclean’s hosts “Health Care in Canada: What Makes Us Sick?,” a town-hall discussion at the Mack Theatre, Confederation Centre of the Arts, Charlottetown. The free event—focusing on the social conditions that influence the health and longevity of Canadians—is held in conjunction with the Canadian Medical Association (CMA). It will be broadcast by CPAC. The conversation on the health impact of disparities in income, education, housing and employment continues in April in the magazine, at a town hall in Calgary, and online at

As Canadians, we love our health care system to death. But in fact health care systems around the world—be they publicly or privately funded and all the variations in between—are but one part of the complex web of social supports and personal and governmental decisions that determine our life course. Health care may be a misnomer, and we have an effective—if expensive—“illness care system” to mend us when we break, as many participants noted during the town hall meetings staged this winter by Maclean’s and the CMA in Winnipeg and Hamilton. But set Canada against its peers—the world’s wealthiest democracies—and we are at best a middling performer when it comes to health outcomes. Many blame a waning concern for creating the living and working conditions that maintain healthy lives.

The Conference Board of Canada, an independent body researching economic and social policy issues, publishes one of the most comprehensive comparisons of international health outcomes. Its most recent survey, “How Canada performs,” puts Canada a mediocre 10th place among 17 industrialized nations. It is well behind the leading nations on such key indicators as infant mortality and deaths due to cancer, diabetes and such musculoskeletal diseases as arthritis, osteoporosis and muscular dystrophy—though Canada’s relative rate of health spending exceeds the top six countries that outperform it: Japan, Switzerland, Italy, Norway, Finland and Sweden. It’s true that Canadians are living longer and with better outcomes for many diseases, but other wealthy countries are improving at faster rates, said Dr. Gabriela Prada, director of health innovation, policy and evaluation for the conference board.

“Why are those other countries doing better in terms of the overall health performance?” she asks. “One of the things they do well is they have a social net that is stronger than in Canada.” The deterioration of social supports, in part a perceived political need to remain competitive with America’s tax regime, is reflected in rising health costs and poorer outcomes, she said.

Dennis Raphael, a professor of health policy at York University, is another researcher who says burgeoning health care costs are the result of governments straying from the kind of social-welfare activism of the Depression and the post–Second World War era that saw the implementation of medicare, public pensions, unemployment insurance and federal and provincial affordable housing initiatives. “Our relative declines in standing on numerous health and quality-of-life indicators have been the result,” he wrote recently in the Canadian Journal of Public Health. Canadian politics have become more in sync with the American model of lower taxes, greater income disparity and fewer social supports—a dubious path to follow, Raphael says.

Whatever one thinks of American-style free enterprise and rugged individualism, there’s much evidence the U.S. is an underperformer in providing the good life—if one defines the American Dream as including good health and longevity for a wide swath of its population. “The U.S. should never be Canada’s benchmark,” said Prada. “Never.”

A searing report released this year by the U.S. National Research Council and Institute of Medicine found American health outcomes have been falling behind almost all wealthy nations for the past 30 years, despite spending more per capita on health care than any other country. “Not only are their lives shorter, but Americans also have a long-standing pattern of poorer health that is strikingly consistent and pervasive over the life course,” says U.S. Health in International Perspective: Shorter Lives, Poorer Health, a comparison with 16 other rich nations including Canada, Japan, Australia and Western European countries.

The study found the U.S. at or near the bottom among 17 nations in life expectancy, infant mortality, low birth weight, injuries and homicides, teen pregnancies and a host of chronic diseases. Among the root causes of the problem were relatively high poverty rates, high levels of income disparity, a lack of health insurance for many and lower levels of educational attainment, it said.

While Canadians have generally better health outcomes than Americans, researchers in both countries warn health costs are increasingly unsustainable. Total Canadian spending on health care hit $200 billion in 2011, or $5,811 per person—just six per cent of that going to public health, with its mandate for disease prevention and health promotion. Health costs more than doubled in 11 years and will worsen: 44 per cent of spending goes to those over age 65, a group growing at three times the rate of the overall population, the conference board report said.

A Canadian Senate committee, chaired by now-retired Conservative senator Dr. Wilbert Keon, issued a similar warning in a 2009 report. After extensive public hearings, it concluded: “There could be devastating long-lasting consequences on health and well-being with growing health disparities, income inequalities and housing and food insecurity . . . investing in population health should be an integral part of the discussion on economic recovery plans.”

Although many fixes are long-term, there are a few imaginative initiatives under way. New Brunswick, with some of the highest relative health spending in the country, created a Crown agency, the Economic Social and Inclusion Corp., with a mandate to reduce poverty and improve social and health outcomes.

“We’re not going to improve literacy rates quickly, we’re not going to deal with obesity overnight,” says Brian Duplessis, co-chair of the corporation and a former director of Fredericton’s homeless shelters, after years of working internationally for a major corporation. “But there are short-term investments that would show significant results on the bottom line.” A 12-unit subsidized apartment built in Fredericton by the John Howard Society has proven its worth. A study tracked the interactions of its residents with police, hospitals, detox units and other agencies when they were homeless or in shelters. After getting housing, and factoring all costs and interventions, “the net savings for those 12 people was $212,000 in one year,” Duplessis says.

The non-partisan Crown agency and board includes senior government and municipal officials and politicians, an opposition politician, members from business, non-profits and those in poverty. Duplessis hopes its initiatives will also pay dividends, with localized programs for things like rural transportation and food security, as well as ambitious plans for social assistance reform and a prescription drug program for the 70,000 families in the province without drug coverage.

“The irony is, we’ve decided a welfare state is a bad thing and we supposedly want to run government like a business,” he says of the prevailing North American zeitgeist. Even if you buy that, and he doesn’t, “you’re not investing where you’re going to get you’re biggest return.” Not only is there a business case for investing in people, there are the intangibles, he says, “like doing the right thing.”

The 7 p.m. Charlottetown town hall will be moderated by Maclean’s Ken MacQueen, with opening remarks by Dr. Anna Reid, CMA president. The panel features Dr. Jenni Zelin, P.E.I. Food Security Network; Brian Duplessis, New Brunswick Economic and Social Inclusion Corp.; Maclean’s Political Editor Paul Wells.