Canadians face more years of struggle to escape the death spiral of health care

Grain-harvesting in Saskatchewan. Wind farms in the eastern province of Ontario. Transgenic crops and offshore oil-drilling in British Columbia. Canada has such a massive reliance on the natural world as health care that its best-health indicators start to look bad.

Canadian patients see fewer doctors, hospitals and nurses. There are more doctor shortages than in any developed country. And Canada’s leading ailment is asthma.

But there is much that is good in Canada’s public health care system. Canada is the safest and healthiest of Group of Seven nations. Its life expectancy is 15 years longer than the average for the developed world. Its infant mortality rate is the lowest in the developed world, at 4.4 deaths per 1,000 live births.

“Canadians lead the OECD in health care coverage, access, and quality. In short, the system is performing better than the comparable OECD nations,” said Diane Coyle, the senior director of C. D. Howe Institute’s Wellness Policy Research Initiative. “There is some good news there.”

Canadians are not turning to the public health care system in their time of need. For every 100 deaths in the population, about seven more die in the public health care system. That is 21 percent higher. A wider and deeper analysis of the health of Canada’s population in 2018 compared with 2016 shows some troubling trends. Overall, life expectancy in Canada is now 76.3 years — just 0.3 years below the average of 76.4 years across the OECD. Average life expectancy in Canada was 76.3 years in 2016, according to the Canadian Institute for Health Information (CIHI).

Spiraling lifetime mortality may cause families to change their health behaviors. Life expectancy as children declines dramatically after childhood, particularly if a family has health conditions. In 2002, life expectancy for newborns in Canada was 78.8 years. That number fell in 2003 by 0.5 years, fell again in 2006 by 0.8 years, and fell further in 2013 by 0.8 years. And it has fallen again in 2018, this time by 0.8 years. Among the deaths affecting the most vulnerable and disadvantaged: those involving the elderly and the infirm.

Between 2016 and 2018, the life expectancy for non-smoking Canadians aged 60-64 fell by one year.

This trend suggests that deteriorating health systems have longer-term implications. Studies of dementia have shown that “life expectancy in the developing world is likely to be further eroded if health systems continue to go through rapid structural transformation,” said Coyle. “And the same is true for the developing world’s ageing populations.”

Life expectancy may be deteriorating because Canadians are dying earlier than in other OECD countries, in response to changes in the public health system. For example, the number of Canadian children in emergency rooms for minor ailments is rising, a reflection of a public health system that is catering to Canadians with more complicated medical issues.

It may be easier to evade child health problems but, in the future, Canadians will need public health care, unless the health system can adapt.

The erosion of life expectancy will force Canadians to rethink their health system. It will force the health minister to reexamine funding priorities.

The rising incidence of gout may be a sign that pre-adolescent depression will soon overtake gout as the most common mental health issue among adolescents. “If the public health system continues to become more of a safety net, then we’re going to be seeing this [gout] on the rise,” said Coyle.

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