|
Why
Canadians are Healthier My Fellow Americans: Want a
health tip? Move to Canada. Exactly why Canadians fare
better is the subject of considerable academic debate.
Some policy wonks say it’s Canada’s single-payer,
universal health coverage system. Others point to Canadians’
different ethnic mix. Some think it’s because our neighbors to
the north use fewer illegal drugs and shoot each other less with
guns, though they do smoke and drink with gusto, albeit somewhat
less than Americans. Still others think Canadians
are healthier because their medical system is tilted more toward
primary care doctors and less toward specialists. And some believe
it’s something more fundamental: a smaller gap between rich and
poor. Perhaps it’s all of the
above. But there’s no arguing the basics. “By all measures,
Canadians’ health is better,” says Dr. Barbara Starfield, a
university distinguished professor at Johns Hopkins Medical
Institutions. Canadians
“do better on a whole variety of health outcomes,” she says,
including life expectancy “at various ages, 1, 15,20, 45, 65,
80, you name it.” According to a World Health
Organization report published in 2003, life expectancy at birth in
Canada is 79.8 years, versus 77.3 in the US. (Japan’s is 81.9.)
According to a different set of statistics published in 2003 from
the Paris-based Organization for Economic Cooperation and
Development (OECD), a 30-nation think tank, Canada’s life
expectancy was 79.4 and America’s, 76.8. Put yet another way, Canada
now ranks fifth in life expectancy at birth (after Japan, Sweden,
Hong Kong and Iceland), while the US ranks 26th,
according to the United Nations Human Development Report. “There isn’t a single
measure in which the US excels in the health arena,” says
Dr. Stephen Bezruchka, a senior lecturer in the School of
Public Health at the University of Washington in Seattle. “We spend half of the world’s
health care bill and we are less healthy than all the other rich
countries.” “Fifty-five years ago, we
were one of the healthiest countries in the world,” Bezruchka
continues. “What changed? We have increased the gap between rich
and poor. Nothing determines the health of a population [more]
than the gap between rich and poor.” Gerald Kominski, associate director of the UCLA Center for Health Policy Research, puts it the Canadian comparison this way. “Are they richer? No. Are they doing a better job at the lower end of the income distribution? For lower income individuals, they are doing a better job.” At a meeting last fall of the
American Public Health Association, Dr. Clyde Hertzman, associate
director of the
Centre for Health Services and Policy Research at the University
of British Columbia in Vancouver, analyzed data showing that
Canadian women now outlive American women by two years and men, by
two and a half years. During the last quarter
century, he says, all income groups in Canada also showed gains in
life expectancy, During much the same period in the US, death
rates widened between America’s rich and poor, according to a
2002 study in the International Journal of Epidemiology by
American and Australian researchers. Infant mortality rates also
show striking differences between the US
and Canada. To counter the argument that racial differences
play a major role, Hertzman compared infant mortality for all
Canadians with that for white Americans between 1970 and 1998.
The white US infant mortality rate was roughly 6 deaths per
1,000 babies, compared to slightly over 5 for Canadians. Maternal mortality shows a
substantial gap as well. According to OECD data published in 2003,
there were 3.4 maternal deaths for every 100,000 births among
Canadians, compared to a 9.8 among Americans. And more than half of
Canadians with a severe mental disorder received treatment,
compared to little more than a third of Americans, according to
the May/June 2003 issue of Health Affairs. Dr. Steffie Woolhandler, an
associate professor at Harvard Medical School, general internist
at Cambridge Hospital and staunch advocate of a single-payer
system, believes “the summary of the evidence has to be that
national health insurance has improved the health of Canadians and
is responsible for some of the longer life expectancy.” On the other hand, there are some causes of death that wouldn’t be much affected by having a single payer system – like homicide. And the US has “the highest homicide rate of all the rich countries,” notes Bezruckha of Seattle. “Other things might be
differences in seat belt usage,” adds Robert Blendon, a
professor of health policy and political analysis at the Harvard
School of Public Health. “We are also disproportionate consumers
of illegal drugs, much more than Canada, so it’s cultural.
The health of Americans would be better if we had universal
health care but there are some things that a single payer system
wouldn’t fix, but which would leave one country looking
healthier in the statistics.” In some respects, the health
care system is “the tail on the dog,” says Dr. Arnie Epstein,
chairman of the department of health policy and medicine at the
Harvard School of Public Health. “It’s other aspects of the
social fabric of different countries that seem to have a major
impact on how long people live.” Like ethnicity. “The
Canadians don’t normally publish health data by ethnicity and in
the US, we do,” adds Blendon. In the US, African-Americans and
Latinos “face problems of housing, stress and low income which
have nothing to do with a single payer system.” Canada has a large number of Asian immigrants, he notes, but
they, like Asian immigrants in the US, tend to do well on health
care measures. The bottom line is that Canada
is doing something right, even if “the reasons are not totally
understood,” says Kominski of UCLA. So, should we all move to
Canada? Probably. But it’s just too cold.
|
