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September 29, 2023

From: Don Drummond, Duncan Sinclair, David Walker, David Jones and Philipp Gladkov 

To: Canada’s Premiers

Date: September 29, 2023

Re: Statistics Canada identifies deficiencies in Canadians’ health: Governments must address them now

Two years ago, we argued that Canada pays insufficient attention to the promotion of good health and the collection of data and information on the health of Canadians. For too long, ill health has been the focus, its treatment and care sucking up all the money and attention.

Policy makers 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.

Drawn from multiple data sources, it examines Canadians’ self-perception of their health status and on the impact of the social determinants of health. It uses the first results from the newly updated Canadian Community Health Survey, Statistics Canada’s 65,000-respondent annual report. Although its vocabulary clings to the custom of equating good health with the absence of disease, it does adopt the correct perspective that health outcomes are not solely the product of healthcare services, but are predominantly 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 percent of those surveyed rated their general health as good or excellent in 2021, and 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. Lower-income Canadians experience poorer general and mental health and higher 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 other worrying trends. Obesity is high and rising especially among youth. This may relate to a decline in physical activity; only one-third of children 5 to 11 meet recommended activity levels. Nutrition is also worsening. Smoking and heavy drinking are decreasing but, still, 3 percent of Canadians used one of six illegal drugs in 2021 and 1 percent used opioid pain relievers problematically.  

Fourteen percent, or 4.7 million Canadians, do not have regular access to a caregiver. And 475,000 homecare recipients reported unmet needs, which weakens a system that is far less expensive and far more effective than institutional long-term care.  

With all this data now available, it is time for action.

The report’s key findings provide a clear and comprehensive set of priority policy areas:

  • Deepen the resolve to address the decline in mental health, especially of the young.
  • Make 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.
  • Provide seniors with greater access to home and community care.

We hope 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 since so many – think diabetes or any number of heart valves – are now completely manageable. 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 previously uncoordinated but related data. It also extremely well-timed. The Canadian healthcare system has been deteriorating over many years to the point of crisis. Holistic, proactive health policy actions are required urgently. In July, the premiers committed to holding a “dedicated health summit aimed at advancing innovative work”. This report shows where the they should focus.  
Overall, Health of Canadians 2023 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 Queen’s University and Fellow-in-Residence C.D. Howe Institute. Duncan Sinclair is Emeritus Professor of Physiology, Queen’s University. David Jones is Policy Analyst and Economist, Munk School of Global Affairs, University of Toronto and TELUS research fellow. Philipp Gladkov is MPA Graduate, Queen’s University.

To send a comment or leave feedback, email us at blog@cdhowe.org.

The views expressed here are those of the authors. The C.D. Howe Institute does not take corporate positions on policy matters.

A version of this Memo first appeared in the Hill Times.