SOCIETY

GOOD HEALTH, FOR LESS

We’re much healthier than Americans, even though we pay half as much for health care

ALEXANDRA SHIMO July 7 2008
SOCIETY

GOOD HEALTH, FOR LESS

We’re much healthier than Americans, even though we pay half as much for health care

ALEXANDRA SHIMO July 7 2008

GOOD HEALTH, FOR LESS

SOCIETY

We’re much healthier than Americans, even though we pay half as much for health care

ALEXANDRA SHIMO

Maybe it’s the sea air, rolling Prairies and mountain streams. Maybe it’s the public health care. Maybe it’s the fact that we eat twice as many fruits and veggies. But whatever it is, one thing’s for sure: Canadians are a lot healthier than Americans.

It’s an issue that used to be hody debated, but a few years ago a massive Harvard Medical School study settled it once and for all. The study analyzed surveys of more than 8,000 people and found that not only are Canadians thinner and more active than Americans, but we’re less likely to have almost any disease you can think of, including diabetes, asthma, heart disease and major depression. International comparisons by other groups have since proved beyond a doubt that the hale Canadian is alive and well, literally. When you look at lifespan and infant mortality—the leading indicators of a country’s health—we beat the Americans hands down. Canadian men now have life expectancies of 77-8 years, compared to 75-2 years in the U.S., while our women are living 82.6 years compared to 80.4 years south of the border. Meanwhile we have only 5.3 infant deaths for every 1,000 live births, compared to 6.8 in the States.

The fact that we’re healthier than Americans is astounding when you realize that they spend enough per person each year on health care to buy each and every one of them a slightly used Honda Civic. In 2005 their combined public and private expenditure was US$6,401 per person, while we spent just US$3,326. So how come we’re so healthy? Most experts agree it’s a combination of three factors: we take better care of ourselves, we take better care of our poor, and we only intervene with medical treatment when necessary.

We take better care of ourselves by eating well and exercising more. It’s boring—but it works. Here we probably owe a huge debt to the blinding smiles and bulging biceps of ParticipAction’s Hal and Joanne, and even the colourful concentric rings of Canada’s Food Guide. A recent Arizona State University study found that our public education campaigns, coupled with better quality produce (apparently the best apples get shipped here and Americans have to make do with what’s left over), have resulted in Canadians devouring twice as many servings of fruits and vegetables per day as our U.S. cousins. We’re also much less likely to report living a sedentary lifestyle (6.5 per cent of us admit to being chronic couch potatoes, versus 13.6 per cent in the States), and we’re less likely to call ourselves obese (18 per cent of us have trouble seeing our toes, compared to 32 per cent in the U.S.).

CANADIANS LIVE LONGER AND HAVE LESS DISEASE

No matter what indicator you look at—lifespans, infant mortality, or prevalence of disease—they all say the same thing: Canadians are healthier. Not bad, considering they pay almost twice as much for care.

Sources

Life expectancy, infant deaths, obesity, health care costs (all 2005): OECD Health at a Glance 2007; heart disease and diabetes (2002): "Access to Care, Health Status, and Health Disparities in the United States and Canada,” American Journal of Public Hëa/th, July 2006

Dr. Stewart Cooper, who moved to North Carolina after working as a family practitioner in Canada for 20 years, says part of it is cultural. America is indeed a nation of Homer Simpsons, addicted to doughnuts, Twinkies and greasy triple-burgers with bacon. “When it comes to food, Americans have a culture of

more,” he says. “They like all-you-can-eat buffets, large portions, and bottomless drinks. Canadians tend to show more restraint.” He notes that Canadians have fewer cars per capita too, and we’re much more likely to hoof it to the corner store. June O’Neill, an economics professor at the City University of New York, adds that Americans also seem to have more faith that their system can cure them if things go wrong, so they may take fewer preventative measures. “Americans don’t take as good care of themselves because they tend to assume

that doctors will be able to fix them whatever they do,” she says. “We have a lot of expensive, high-technology medical treatments, and people assume that doctors will be able to solve their health problems once they get sick.”

AMERICANS SPEND ENOUGH ON HEALTH CARE EACH YEAR TO BUY EVERY CITIZEN A USED HONDA CIVIC

The fact that we take better care of our poor through our public health system also seems to boost our overall standing. Harvard Medical School’s Dr. Steffie Woolhandler, who coauthored the U.S. versus Canada analysis, says that if you compare only the Americans who have good health insurance to Canadians, we come out about the same. It’s the poor health of the uninsured Americans that tips the balance in our favour. Many studies have concluded that the main problem with the American system is that a lot of sick people can’t afford to use it—even people with insurance. In the U.S., “people without health insurance have always had financial problems when they got sick,” says Cathy Schoen, senior vice-president of the Commonwealth Fund. “What’s new is that we’re seeing a sharp spike in the number of people with health insurance who still can’t afford their medical bills.” It’s estimated that about 25 million Americans who have insurance still have problems paying their bills, mainly because of high deductibles, limits on what the insurance company will pay for (pre-existing conditions are often not covered), and maximum payout amounts. Because of those high costs, a shocking 31 per cent of Americans who have insurance have decided to forgo care they needed at some point, while 68 per cent of those without insurance have done the same. Meanwhile in Canada, only 12 per cent say they have gone without care because of the cost.

Of course the Americans who can afford it do get great care. There’s more high-tech equipment, such as MRIs and CT scanners, more specialists per person and, yes, much shorter waiting times. A Commonwealth survey of sicker adults revealed that Canadians are twice as likely to wait four hours or longer in the emergency room than their American counterparts. We also have to wait longer to see our specialists, and we are four times more likely to wait four months or longer for elective or non-emergency surgery such as hip replacements. “If you told an American they would have to wait three months for a mammogram or something like that, they would find it completely unacceptable,” says Dr. Ferial Ladak, who now practises in Sherbrooke, Que., after working for 22 years in the States. Canadians, on the other hand, complain a little, then quietly wait.

Some believe that longer waiting times aren’t always a bad thing. Canadian doctors are more likely to adopt a wait-and-see approach, says Ladak. They tend to steer clear of invasive procedures and see if the body can mend itself first. For instance, if you have a back problem in Canada, doctors will try acupuncture, cortisone injections, and physiotherapy before surgery, whereas in America, the operating theatre is often the first stop. But according to a study of back surgeries by the University of Kansas Medican Center, while the Canadian approach is cheaper, it doesn’t produce worse long-term results. “Too much medicine isn’t always a good thing,” says Ladak.

So do your part to keep Canada healthy: eat your greens, go for a walk, and fork out those taxes to pay for our public system. And yes, bite your tongue too, as you sit there hour after hour, clutching your tattered copy of Maclean’s, patiently waiting to see the doctor.