COVER

Healthy habits, longer life

WARREN CARAGATA June 15 1998
COVER

Healthy habits, longer life

WARREN CARAGATA June 15 1998

Healthy habits, longer life

Social factors

Being passed through the giant metal doughnut of a computerized tomography scanner, patients in a modern hospital might easily conclude that the wonderful advances in medical science surrounding them are responsible for Canadians living longer than ever. And while there is no disputing the lifesaving capabilities of modern medical care, a host of factors having little to do with high-tech equipment also contribute mightily to making Canada a healthier society. It is a fact that Norman Bethune, the Canadian doctor-hero of the Chinese revolution, noticed back in the 1930s. His contention that the conditions under which people live their lives—in Canada and elsewhere—are more important to longevity than medical treatment has become less controversial and more established with the passing years.

Health professionals now refer to those factors as the “determinants of health.” They include the lifestyle choices people make for themselves, such as diet and smoking, as well as the choices that are made for them, such as the health of an infant’s mother during pregnancy and the wealth of the communities where people live. “Poverty, poor food, unsanitary surroundings, contact with infectious [lesions], overwork and mental strain are beyond our control,” a frustrated Bethune wrote in the 1930s. Decades later, a discussion paper adopted by the country’s health ministers in 1994 noted in a similar vein that “factors such as living and working conditions are crucially important for a healthy population.”

As Canadians debate how much money their governments should earmark for health care, some observers note that spending on hospitals and doctors may be one of the least effective ways

of improving the health of Canadians. “There is mounting evidence,” the health ministers’ document said, “that the contribution of medicine and health care is quite limited and that spending more on health care will not result in further improvements in population health.”

And while eating greens, keeping fit and not smoking are widely accepted as ways to improve health, the most important factors seem to be income and social status. The more control people have over their lives, the healthier they tend to be. “As your poverty goes up, unemployment goes up and education level goes down, you find increasing mortality,” says Dr. John Millar, B.C. provincial health officer. “It’s sort of a straight line relationship.” Overall, citizens of wealthy countries live longer than those of poor countries. Similarly, within Canada, residents of wealthy provinces generally live healthier and longer lives than their fellow citizens in poorer provinces.

Ranking poorly on health risks and social and economic measures, Newfoundland also fares badly in measurements of people’s health. That province has the shortest life-span for women, the second-shortest life span for men, the highest mortality rate from heart disease and the second-highest infant mortality rate in the country. On the other hand, British Columbians tend to live long and prosper. Its women live the longest, its heart disease mortality rate is the lowest, and its proportion of smokers is the smallest.

Millar says he is not surprised by British Columbia’s good showing. But differences between provinces are relatively small, he cautions, and mask more significant differences within provinces. In British Columbia, people in urban areas have a life expectancy five years greater than people in northern and rural areas. Within Vancouver itself, there is a similar gap between the wealthy of Point Grey and the impoverished of the Downtown Eastside. Statistics on B.C. natives show an even wider difference, of 12 years less than the best life expectancies. “I don’t think there’s any room for gloating,”

Not just medicine

Social factors, status at birth and lifestyle choices—with rankings in red—play a big role in determining health. A high ranking (low number) indicates a poorer health status. The composite ranking includes weight data shown in the map (right). The territories are not ranked because some data are not available.

"F NS PE NB QC ON MB SK AB BC YT NT Canada Percentage of Less than Grade Low bwthweight women having 9 educahon~ babsest Smokerstt J Pap smear~ttt 24.6 1 16~8J~jI 1 17.5 - 5.48 7 25.69 5 85.87 4 19.1 4 10.45 11.1 5.963 27.262 89.126 15.2 10 22.1 2 13.5 2 13.3 4.62 10 27.24 3 88.46 5 19 5 19.7 3 12.7 3 16.5 4.78 9 26.21 4 85.31 3 23.41.16.25 10.54 18.1 5.954 29.061 76.081 17.7 9 12.5 9 7.1 7 10 6.06 1 22.44 9 85.23 2 20.6 3 15.1 7 5.3 10 12.6 5.5 6 23.95 7 90.79 9 18.3 8 15.9 6 5.4 9 13.2 5.58 5 23.98 6 92.6 10 18.4 7 10.9 10 5.7 8 7.5 5.99 2 23.12 8 89.52 8 19.6 4 12.7 8 9.7 6 7.4 5.29 8 19.88 10 89.31 7 Wa 9.2 Wa 5.7 4.26 Wa Wa Wa Wa 8.4 Wa 20.4 6.94 Wa Wa Wa 19.7 14 8.4 12.1 5.84 24.29 84.49 *Ties * *Based on percentage of household income spent on necessities * * *~asonally adjusted, for population over 14 years * * **percentage of population over 14 years t Newborns less than 2,500 g as a percentage of live births if Percentage of population over 11 years smoking cigarettes daily ff1Percentage of women over 17 who reported ever having a Pap smear

How healthy are Canadians?

Selected key measures of health with rankings in red.

A high ranking (low number) indicates a poorer health status. The composite ranking follows the same principle. The territories are not ranked because some data are not available.

Life Life Infant mortality Cancer deaths Heart disease expectancy: expectancy: per 1,000 per 100,000 deaths per Suicide rate per Composite Composite men women live births pop. 100,000 pop. 100,000 pop. total ranking NS PE NB QC ON MB SK AB BC YT NT Canada * 74.9 2* 74.9 2* 73.9 1 75.2 5 75.1 4 76.1 9* 75.4 7 75.3 6 76 8 76.1 9* 70.9 69.8 75.7 80.5 80.8 80.8 81.2 81.5 81.4 80.7 81.5 81.3 81.8 84.4 75.8 81.4 1 3* 3* 5 8* 7 2 8* 6 10 7.9 4.9 4.6 4.8 5.5 6 7.6 9.1 7 6 12.8 13 6.1 2 8 10 9 7 5* 3 1 4 5* 189.3 5 209.8 1 206.7 2 192.6 4 202.6 3 179.6 7 184.6 6 171.6 9 173.9 8 166.3 10 209.8 284.6 184.5 216.6 1 188.4 4 212.6 2 188.9 175.1 8 175.7 7 188.2 5 173.7 9 177.3 6 155.6 10 232.3 170.5 175.2 6.5 10 12 5 8.6 9 12.1 4 19.4 1 9.4 8 10.6 6 14.3 3 16.2 2 9.6 7 34.5 31.6 12.9 21 23 27 30: 31 43 29 36 34 51 n/a n/a 2 3 5 6 9 4 8 7 10 n/a n/a

Composite total of all rankings Composite rank 23 1 39 4* 39 4* 32 3 27 2 53 7 52 6 54 8 59 9 62 10 n/a n/a n/a n/a

says Millar. With all the measurements pointing to education’s pivotal role in determining health, finishing the homework may be an even better strategy than finishing the broccoli.

WARREN CARAGATA