Canada a World Leader in Health? Not Exactly

Every year the World Health Organization publishes World Health Statistics, a compendium of data from 194 countries. This year’s theme is “monitoring health for the SDGs” — the Sustainable Development Goals that member nations have committed to achieving by 2030, things like universal health coverage, treatment for HIV and improved sanitation.

Canadians might expect to have already reached those goals, and in some cases we have. In others, we’re surprisingly far behind — and in at least one case, I’m not sure our high ranking can be believed.

WHO points out that “almost half of all deaths globally are now recorded with a cause,” meaning that more than half are not so recorded. So many of WHO’s statistics must be taken as estimates. Canada and other developed nations are pretty reliable, though, so we have reason for both pride and embarrassment.

World Health Statistics 2017 lists the SDGs and then shows how well each country is reaching them. In the case of maternal mortality, for example, we are number one in the Americas with just seven maternal deaths per 100,000 live births. The U.S. comes in second, with 14 deaths. So we’re beating the Americans.

But the nations of the European region are doing much better than we are. Four countries share top spot with just three maternal deaths per 100,000 births: Finland, Greece, Iceland and Poland.

We’re also number one in the Americas for the mortality of children under five, with only 4.9 deaths per 100,000 children. Cuba comes second with 5.5 deaths, and the U.S. is third with 6.5 deaths. Once again Europe beats us all. Luxembourg has just 1.9 deaths, and 29 nations do better than our 4.9.

Canadians between ages 30 and 70 have the least chance in the Americas of dying from cardiovascular disease, cancer, diabetes or chronic respiratory disease — just 9.8 per cent. Again we beat the U.S. (13.6 per cent), and again the Europeans beat us, with Iceland leading (8.3 per cent) and six other countries doing better than we do.

Suicide? We lose 12.3 out of every 100,000 Canadians this way, a little better than the Americans’ 14.3. Antigua and Barbuda has a suicide rate of 0.

A dubious distinction: Our love affair with alcohol

In one field we’re dead last in the Americas. Canadians are the heaviest drinkers in the Western Hemisphere, knocking back the equivalent of 10 litres of pure alcohol per person every year. We drink even the Americans (9.3 litres) under the table. And we can only marvel at how Lithuanians outdrink the rest of Europe (18.2 litres).

We may be proud of our 91 per cent vaccination coverage, but four American nations are at 99 per cent, and Americans are at 95 per cent. Forty-one European nations have better than a 91 per cent vaccination rate.

Similarly, we’re number two in health-care workers per 100,000, with 119.5 to Cuba’s 155. But the U.S. is right on our heels with 117.8. And 20 European nations have more health-care workers than we do.

Canadians like to compare our homicide rate (1.8 per 100,000) with that of the gun-loving U.S. (5.3). Both look like Utopia compared with the murder rate in Honduras (85.7), but 29 European countries have lower homicide rates than Canada’s. So we look good compared to the U.S., and especially to Honduras and Haiti.

But even some of our top scores are open to question. For example, we’re said to be tied for number one with Barbados, Belize and Uruguay in having 100 per cent safe drinking water. That will surprise Canadians living in over 1,200 regions with boil-water advisories. And 35 European nations are also at 100 per cent.

WHO says 100 per cent of Canadians have access to safely managed sanitation, which is good to hear. Yet again 13 European nations can say the same and another nine are at 99 per cent.

Our spending on essential government services, including health, is number five in the Americas, at 18.8 per cent of our revenues. Nicaragua spends 24.8 per cent and the U.S. spends 21.3 per cent. Five European countries, including Switzerland, the Netherlands, Germany and Sweden spend more of their revenues on health than we do. Forty-eight spend less. Among them, Finland spends only 12.4 per cent of revenues on such services, while maintaining a high level of public health and a life expectancy of 71 years compared to our 72.3 years.

Time for new approaches

As Canadians age and our health-care system must meet ever more demands, we should stop congratulating ourselves and seriously consider new approaches. André Picard, the country’s best health reporter, recently observed that we have the “least universal” universal health-care system in the world.

We likely have just three federal elections between now and 2030. It will take an explicit commitment by all parties to ensure that we achieve our Sustainable Development Goals in 13 years. As the U.S. under Donald Trump imposes brutal cuts on its health agencies and researchers, we will be under pressure to do the same. Instead, we should be studying European health-care systems for every good idea (and every good health expert) we can steal.

That would pay off handsomely: We’d be spending less while expanding services, and attracting brilliant students and scientists who no longer feel welcome in the U.S. Our kids, properly vaccinated, would be healthier. Seniors, properly cared for, would be healthier too — and the sandwich generation wouldn’t have to worry so much about their kids and their parents.

All it will take is a strong competitive drive to own the public health podium. If we can overtake and underspend the Europeans, while offering truly universal health care, even the Americans might stop and ponder the error of their ways.