The Truth About Canada (4 page)

The number of low-birth-weight infants is another key standard-of-living indicator. In the period from 1998 to 2004, 21 countries had a better record than Canada in this respect. Canada had low-birth-weight infants in the 6 percent range. All of the following were at or below 4 percent: Iceland, Sweden, Finland, Korea, Estonia, Lithuania, Bosnia and Herzegovina, Albania, and Western Samoa.
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Note once again that many of these countries had lower or much lower GDP per-capita figures than Canada.

The United States had about 7.9 percent of all births classified as low-birth-weight infants.

MORTALITY PER 100,000 POPULATION, 2002

The OECD explains that “mortality rates are, paradoxically, the most common measures of a population’s health, since mortality statistics remain the most widely available and comparable source of information on health problems. Age standardizing death rates remove the effects of variations in the age structure of populations across countries and over time.”

The leading causes of death in OECD countries are related to cardiovascular diseases, cancer, and diseases of the respiratory system. In a list
of 20 OECD countries, Canada has the sixth highest fatality rate in the period 30 days after a heart attack and the eighth highest rate of breast cancer mortality.
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Twenty OECD countries have death rates higher than Canada’s, which is 565 per 100,000. Six have lower rates: Japan, Australia, Switzerland, Iceland, Italy, and Spain, whose rate is almost identical to Canada’s. The lowest mortality rate, at only 449 per 100,000, belongs to Japan, which also tops the life-expectancy list.

Canada has one of the three lowest cerebrovascular mortality rates, but somewhat higher than OECD average lung cancer and breast cancer rates, and a slightly better prostate cancer mortality rate.

Road accidents killed over 120,000 people in OECD countries in 2002. Canada was in 18th place in fatalities per million population, somewhat below the OECD average, as we were in suicides. The highest suicide rates were in Korea, Japan, Finland, and Hungary. The lowest were in Greece, Italy, and the United Kingdom.
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The United Nations estimates that some 56,000 children and adults in Canada were living with HIV at the end of 2003. The adult prevalence rate (ages 15 to 49) was 0.3 percent. Sixty-three countries have lower rates. The U.S. rate of 0.6 percent was double Canada’s.

Some countries have horrific HIV rates. Botswana’s rate was 37.3 percent, Lesotho’s 28.9 percent, Namibia’s 21.3 percent, South Africa’s 21.5 percent, Swaziland’s 38.8 percent, Zimbabwe’s 24.6 percent, and four other countries, all in Africa, have rates over 10 percent. In 2003, there were some 1,000,000 children and adults living with HIV in the Congo, 1,500,000 in Ethiopia, 1,200,000 in Kenya, 1,300,000 in Mozambique, 3,600,000 in Nigeria, a staggering 5,300,000 in South Africa, 1,600,000 in Tanzania, and 1,800,000 in Zimbabwe. There are about 1,000,000 adults and children living with HIV in the United States.
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In 2006, the Public Health Agency of Canada said that almost 15,000 Canadians had HIV/AIDS but didn’t know they did, while some 58,000 other people in Canada were living with the virus at the end of the year, about 80 percent of them men.

OBESITY

In the summer of 2006, Statistics Canada said that the Canadian national average for obesity was a shocking 23 percent. About the same time, a University of North Carolina study said that for the first time there were more overweight people in the world than the number that were undernourished, and that while the number of hungry people was falling slowly, the number of those who were obese was increasing “at an alarming rate.”

Britain and the United States have two of the highest rates of obesity, Japan one of the lowest.

Statistics Canada has also reported that in 2004, 1.6 million young people aged two to 17 were overweight, an increase from 15 percent in 1989 to 26 percent. Of those, 507,000 were considered obese.

In international comparisons, Canada does not do well, with the fourth highest obesity rate in an OECD list of 30 countries. All the following countries have obesity rates less than half of Canada’s: Japan, Korea, Switzerland, Norway, Italy, Austria, Denmark, France, and Sweden. (A recent Statistics Canada study released in June 2006, but using different standards than the OECD, puts the too-heavy figure for Canada at 24.3 percent.) If Canada is bad, however, the United States, where the rate of obesity has more than doubled over the past 15 years, is appalling. Just under 30 percent of Americans over the age of 15 are classified as obese.

The OECD puts it bluntly: “In many OECD countries, the growth in overweight and obesity rates in children and adults is rapidly becoming a major health concern.” Obesity often brings with it health problems such as hypertension, diabetes, high cholesterol, cardiovascular diseases, respiratory problems, and some forms of cancer.

Over half the adults in the United States, Mexico, the United Kingdom, Australia, the Slovak Republic, Greece, New Zealand, Hungary, Luxembourg, and the Czech Republic are now classed as either overweight or obese.

CORONARY PROCEDURES

For coronary bypass procedures, the figure for the United States of 161 per 100,000 population compares to 98 for Canada and only 70 for the OECD average. For coronary angioplasty procedures, the United States is at 426 per 100,000 population, Canada is at only 140, while the OECD average is 150.

There is much debate as to why the U.S. figures are so high. Switzerland, France, Spain, and Italy have numbers ranging from only 19 to 46 per 100,000 for bypasses, for example. Many suggest that the profit motivation for U.S. doctors and hospitals is a major factor encouraging operations that may, in fact, not be considered necessary in other countries. In the United States, there tends to be more of a “sell your product” healthcare mentality, whereas in Canada and other countries with more public health care, there tends to be more caution about using unnecessary procedures to avoid budgetary problems. Nonetheless, ischemic heart disease mortality rates are much lower in countries such as Australia and Canada than they are in the United States, despite the fact that the United States has by far the highest overall rate of coronary re-vascularization procedures of any OECD country (596 per 100,000, compared to 238 in Canada and 212 in Australia).
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Obviously, the high rates of obesity in the United States contribute to greater heart and other problems.

ACUTE-CARE BEDS

Twenty OECD countries do better than Canada in the number of acute-care beds (in Canada, 3.2 per 1,000 population) while only nine countries have fewer beds, including the United States, at only 2.9. Topping the list is Japan, at 8.9 beds, followed by Germany at 6.6, and Austria and the Czech and Slovak Republics are all at over six acute-care beds per 1,000 population. Canada is below the OECD average of 4.2.
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Canada does poorly compared to other developed countries in MRIs and CT scanners: 16th of 27 countries in MRI units and 19th in CT
scanners. Canada has only 4.5 MRI units per 1,000,000 population, compared to the OECD average of 7.2, and we have only 10.3 CT scanners, compared to the OECD average of 17.6. Japan, at 35.3 MRI units and 92.6 CT scanners, is well ahead of all other OECD countries. Mexico and Poland are at the bottom of both lists.
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In one study, 51 percent of Canadian physicians reported patients facing long waits for diagnostic tests, compared to only 6 percent in Australia.

Can we afford more MRIs? Or perhaps a better question is to ask how is it that we have done so poorly compared to other countries in acquiring such vitally important diagnostic aids? For some answers, see the chapter on taxes in this book.

EXPENDITURES ON PHARMACEUTICALS

Spending on pharmaceuticals has risen dramatically in recent years in OECD countries. Only in Iceland, Greece, Luxembourg, the Czech Republic, and Japan has it declined as a share of total health expenditures (from 1997 to 2007). During these years, pharmaceutical spending in Canada in real terms grew at an annual rate of 6.9 percent. In comparison, in the United States during the same period, pharmaceutical spending grew by an average of 9.5 percent per year. The OECD comparative figure was 5.6 percent.

Among OECD nations, Canada is the third highest per-capita pharmaceutical spender and ninth highest when such spending is measured as a percentage of total health spending. Twenty years ago, drug costs made up about 9.5 percent of our healthcare costs. Today, it’s about 17 percent. Bulk buying, as is done by countries such as New Zealand, would help reduce our current $25-billion drug costs substantially, but our politicians can’t seem to move on what would certainly be an important cost-saving program. In Canada, total personal expenditures on medical and health services amounted to $40.68-billion in 2005, of which just over $15-billion was for drugs and pharmaceutical products. The Canadian Institute for Health Information says,

The category of drugs ranks second after hospitals in terms of its share of total health expenditures. In 1997, expenditure on drugs overtook spending on physician services. The share of total spending accounted for by drugs grew from a low of 8.4 percent in the late 1970s, to 16.6 percent in 2004. In 2007, drugs are ranked second with a share of 17 percent of total health expenditures.

Overall, where do public healthcare dollars go in Canada? In 2006, 30 percent went to hospitals and 9.6 percent went to other healthcare institutions. Some 13 percent went to physicians, 11 percent to other healthcare professionals, and about 15.9 percent went for capital costs, public health costs, and administration. The share spent on health research was 1.6 percent.
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SMOKERS

The World Health Organization says that tobacco is the second major cause of death in the world and is directly responsible for about one in ten adult deaths worldwide, or about five million deaths each year.

Canada has the lowest percentage of OECD adults smoking tobacco daily, some 17 percent, followed by the United States and Sweden at 18 percent. Ten other countries are below the OECD average of 26 percent. The countries with the worst records are Greece, at 35 percent, Hungary, 34 percent, Luxembourg, 33 percent, and 12 other countries, including Bulgaria, Japan, Spain, Russian, and Ukraine.
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In many countries, there is a large gender difference. For example, the rate of smokers is 63 percent of men in Korea and only 5 percent of women. In Canada the percentage of men who smoke fell from just under 44 percent in 1981 to 22 percent in 2005, and for women from 32 percent down to 16 percent in 2005 during the same years. Only 1 percent of the women in Cuba smoke and only 17 percent of the men. In Japan, only 15 percent of the women smoke, but 47 percent of the men do. In
the United States, 19 percent of the women still smoke and 24 percent of the men.

Canada has the highest percentage of people in the industrialized world using marijuana on a regular basis, more than four times the global rate. Of Canadians aged 15 to 64, 16.8 percent smoked marijuana or used other cannabis products in 2004. The number of Canadians using marijuana doubled over the past decade.
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ALCOHOL CONSUMPTION IN LITRES PER CAPITA

The OECD 2003 average for individual alcohol consumption was 9.6 litres. Eight OECD countries had a lower average consumption in 2003 than did Canada (at 7.8 litres). Turkey was the lowest, at only 1.5 litres, followed by Mexico at 4.6 litres, Norway at 6.0, Iceland at 6.5, Sweden at 7.0, the Slovak Republic and Japan at 7.6. The level in the United States was 8.3 litres. The highest alcohol consumption was in Luxembourg, at 15.5 litres. France’s average consumption was 14.8 litres, Ireland’s was 13.5 litres, and Hungary’s was 13.4 litres. Eleven other countries were above the OECD average.

In most OECD countries, there has been a reduction in alcohol consumption and in deaths from liver cirrhosis. According to the OECD, wine consumption has been increasing in many traditionally beer drinking countries. Alcohol consumption in Italy and France has dropped substantially, but it has increased substantially in Iceland and Ireland.
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Finally, with all of our system’s problems, a report confirms the advantages of Canada’s healthcare system over the American system. In April 2007, a report in
Open Medicine
, a new online Canadian medical journal, said,

Canada’s much-maligned health system produces as good or better outcomes as the vaunted U.S. system, and it does so at less than half the cost.

A team of 17 Canadian and U.S. healthcare researchers
crunched data from 38 existing studies from both countries published between 1955 and 2003.

Canadian patients had at least as good an outcome as their American counterparts, if not better.

The authors said that “the fundamental message of this study is that the solutions to Canada’s healthcare problems lie not in resorting to U.S. style private funding or for-profit delivery, but rather in strengthening publicly funded health care delivered by not-for-profit providers.”
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Regarding the ongoing pressure for a two-tier healthcare system in Canada, here are the words of Dr. Arnold S. Relman, Harvard emeritus professor of medicine, and emeritus editor-in-chief of the
New England Journal of Medicine
, who favours the elimination of all for-profit facilities: “The facts are that no one has ever shown, in fair, accurate comparisons, that for-profit makes for greater efficiency or better quality, and certainly have never shown that it serves the public interest any better. Never.”
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