We like to think of Greater Vancouver as one of the best places to live in Canada, if not in the world. Yes it is — especially for those of us living in the most affluent neighbourhoods. Those in the poorest neighbourhoods, however, are dying younger than their rich neighbours, sometimes by many years. And the gap between them was getting wider even before the opioid-overdose crisis and the COVID-19 pandemic became twin health emergencies.
That’s an easy conclusion to draw from a recent study published in the journal Health & Place. Of course it’s more complicated than that, but it still seems paradoxical that a region as prosperous as Greater Vancouver should see some people die years younger than others living just a few kilometres away.
The study involved UBC researchers working with the Institute for Health Metrics and Evaluation at the University of Washington and with Imperial College, London. Its ambitious goal was to track life expectancy and major causes of deaths in Greater Vancouver over a quarter-century, from 1990 to 2016. Moreover, they broke the numbers down to the census-tract-level — in effect, neighbourhood by neighbourhood. Overall, the study offers an invaluable portrait of our collective health before the pandemic.
Find the interactive map by going here and scrolling down.
In some ways, it paints a very flattering portrait. Even the poorest males, in the tenth percentile, had a median life expectancy in 2016 of 77.6; that is, half died before that age and half later. For tenth-percentile females, median life expectancy was 82.5.
But in the 95th percentile, the richest five per cent of our population, median male life expectancy was 87.1. For females in the 90th percentile, it was 90.8. The poor were paying with almost a decade of their lives for the privilege of living here.
The study makes a striking observation: “Between 1991 and 2016, there was a downward trend in the LE [life expectancy] gap, whereby the lowest gap was observed in 2001 (6.9 years for females and 7.9 for males), but this reversed and increased by 1.4-1.6 years between 2001 and 2016.” By a wild coincidence, 2001 was the year the BC Liberals won a huge majority over the NDP and ran the province under Gordon Campbell and then Christy Clark until 2017.
British researchers noticed a very similar effect during Margaret Thatcher’s years in power: Around 1980, British and Japanese life expectancy were about the same, but then, as the U.K. income gap widened, British lives grew shorter. In Japan, with a much narrower income gap, life expectancy rose to among the highest on the planet.
What we’re dying of
And what have Great Vancouver residents been dying of? Between 1990 and 2016, deaths from cardiovascular diseases, neoplasms (cancers) and unintentional injuries dropped sharply. Clearly, we’ve been exercising more, smoking less, and taking care of ourselves, at least up to a point.
But we’ve also seen a 10 per cent increase in neurological disorders, a catch-all term that can include everything from Alzheimer’s to eating disorders to meningitis. Other noncommunicable diseases like diabetes mellitus and kidney disease rose by almost four per cent.
And while the richest of us had little to fear from infectious diseases in 1991, the poorest were already contending with (and dying from) HIV-AIDS and sexually transmitted infections at 12 times the rate as the richest. The poorest faced seven times the rate of maternal and neonatal disorders. They died of neoplasms at over four times the rate of the richest.
“By 2016,” the study notes, “the absolute inequality increased the most for neurological [73.4 cases per 100,000], nutritional deficiencies, [14.8 per 100,000] and other noncommunicable diseases [12.2 per100,000]... while the relative inequality gaps increased for all diseases, except for neoplasms.”
Also by 2016, the bottom 10 per cent were dying of HIV-AIDS at 17 times the rate of the top, and 10 times as often from maternal and neonatal disorders. People were living longer and dying sooner almost within eyeshot of one another: “Within the City of Vancouver, we observed a 10-year gap in LE for males in [census tracts] located within 5 kilometres of each other.”
Urban policies as death sentences
The study also notes changes in time, with life expectancy inequality decreasing from 1991-2001 and then increasing: “Underlying societal trends, key changes to the health services and their delivery, urban policies and/or economic tools enacted during these time periods may explain why inequality has increased since 2001 and particular for certain groups, such as males.” The researchers found that opioid overdoses and other unintentional poisonings rose about 300 per cent between 2014 and 2016, “and accounted for 32 per cent of the decline in life expectancy.”
These are just some of the findings of the study, and they point to further inquiry: we may find, for example, that some of the increase in mortality from neurological disorders stems from people living long enough to develop Alzheimer’s and other dementias. Deaths from kidney disease and diabetes should push us to improve nutrition for everyone, especially for the poor.
In general, however, the report only confirms what has been understood for a good half-century or more: policy passed into law can improve health or weaken it, lengthen life or shorten it. B.C. government policies lengthened life in the 1990s, and shortened it from 2001 to 2016. That left many of us already dangerously weakened when the pandemic hit.
Our policies on matters like paid sick leave further weakened those who couldn’t afford to stay home from work when they were sick, while the affluent could work from home and order groceries online. And predictably, our poorest neighbourhoods got hit the hardest in the pandemic.
COVID-19 isn’t going away any time soon, and even if it becomes a low-grade endemic nuisance like most influenzas it will take an ongoing toll. COVID-19 survivors will have to deal with long COVID and perhaps lifelong consequences. Even this pandemic probably wasn’t the Big One. We’ve seen five million deaths in two years; the 1918-19 influenza pandemic may have killed 50 million or more in that time period. Other unknown viruses are out there, and climate disasters will return with numbing frequency.
Our health-care system is dangerously stretched and facing unprecedented occupational health and safety threats. Those with “routine” medical needs are being missed or delayed, becoming collateral damage.
The top 10 per cent set the policies that decreed the early deaths of the bottom 10 per cent, and many of the rest of us in the middle. Now they — or we — need to set new policies that will protect everyone’s health and lifespans. Even if the rich don’t like it, they will have longer to brood over their misfortunes than the rest of us will.