Two years ago, we argued Canada pays insufficient attention to the promotion of good health and the collection of data and information on the health of Canadians. The focus has been on health care, the treatment and care of those already in ill health.
Policymakers could argue they did not have the full range of insights needed to implement a more comprehensive set of health policies at the time. However, thanks to a new report from Statistics Canada, there is no longer any excuse.
Unfortunately, the report clings to the custom of equating good health with the absence of disease, especially of chronic conditions, but does report on Canadians’ self-perception of their health status and on the impact of the social determinants of health. It does adopt the correct perspective that health outcomes are not solely the product of health-care services, but predominantly are the function of personal health behaviours (nutrition, exercise, and substance use, for example) and wider socio-economic determinants (such as income, education, and employment).
Almost 60 per cent rated their general health as good or excellent in 2021, relatively stable since 2015. Perceptions of mental health, however, have dropped over the past six years by an alarming 21 percentage points among those 18-to-34 years old, associated with greater prevalence of anxiety and mood disorders.
An income dimension runs through almost every finding. Both general and mental health are perceived to be much poorer among lower-income Canadians. So are multi-morbidity and chronic disease. Other findings are poorer health outcomes and the deficient application of the determinants of good health among Indigenous Canadians.
There are worrying trends. Obesity is high and rising especially among youths. This may relate to a decline in physical activity; only one-third of children aged five to 11 years meet recommended activity levels. Nutrition is also worsening. Smoking and heavy drinking are decreasing but, still, three per cent of Canadians used one of six illegal drugs in 2021, and one per cent used opioid pain relievers problematically.
Fourteen per cent, or 4.7 million Canadians, do not have regular access to a caregiver. Of those using home care services, 475,000 (1.6 per cent of Canada’s population) reported unmet needs, weakening the less expensive and more effective alternative to being institutionalized in long-term care.
With the data now available, now is the time for action.
The report’s key findings provide a clear and comprehensive set of priority policy areas for government:
- Deepen the resolve to address the decline in mental health, especially of the young;
- Making health promotion a cross-cutting inter-ministerial goal to reduce inequalities across income, education, housing and other determinants of health;
- Pay greater attention to nutrition and other ‘lifestyle’ factors, especially for younger cohorts;
- Improve access to primary care, especially in rural and remote areas; and
- Provide seniors with greater access to home and community care.
Hopefully this report will be updated regularly and improved. For example, Statistics Canada should not so automatically link the presence of chronic conditions with ill health. The gradation as to whether one’s health is excellent, good, fair, or poor could be given greater practical meaning. The cross-cutting consequences of some health determinants such as income should be brought together and made clearer.
Nonetheless, this report is a huge step forward for policymaking. It compiles a set of related data that were previously unco-ordinated. It is also extremely well-timed. The Canadian health-care system has been deteriorating over many years to the point of crisis. Holistic, proactive health policy actions are urgently required. This past July, following a meeting of the Council of the Federation, provincial premiers committed to hold a “dedicated health summit aimed at advancing innovative work.” This report shows where the premiers should focus their attention.
Overall, the data gives governments the evidence they require both to act independently and to initiate developments collectively. However, they must act now.
Don Drummond is Stauffer-Dunning Fellow at Queen’s University and a fellow-in-residence at C.D. Howe Institute. Duncan Sinclair is emeritus professor of physiology at Queen’s University. He was inducted into the Canadian Medical Hall of Fame in 2015. David Jones is a policy analyst and economist at the Munk School of Global Affairs, University of Toronto, and TELUS research fellow.
Published in The Hill Times