New stats calculate the years Canadians can expect to live in full health
LIVING LONG AND LIVING WELL
New stats calculate the years Canadians can expect to live in full health
On an unusually warm weekday morning in early October, Norma Petitti, lean and smartly outfitted in a sporty skirt and blouse, takes a quick last swig from her coffee before dashing off to the Appleby Tennis Club in Burlington, Ont. Petitti, a school social worker who retired two years ago at age 60, is eager to get to her doubles match with friends Brenda Jones, 74, Helena Schlumpf, 72, and Shirley Espey, who would rather not give her age. The tennis is competitive, with long rallies punctuated by strong ground strokes sailing low over the net. “Not bad, eh, for old chickens like us?” Schlumpf says with a grin. Afterward, Petitti sizes up the match, which ends with sweat on everyone’s brow and handshakes all around. “I look at these ladies and say, ‘If I can play tennis until their age, I’m damn lucky,’ ” says Petitti. “It’s inspiring.”
Most Canadians already know that exercise and socializing contribute to a long, healthy life by keeping body, mind and spirit fresh. Still, increasingly creaky baby boomers—the first wave is already into its mid-50s—find themselves wondering how much longer they’ve got, and whether
science is having any luck keeping Father Time at bay. The common if somewhat misleading yardstick has been life expectancy. Canadian women now live an average of 81 years, men 75. Only Japan, Sweden, Switzerland and Iceland have better records among the 30 OECD industrialized countries. But the life expectancy stats have traditionally left an important question unanswered: how many of our latter years will be good ones?
In partnership with the Canadian Insti-
tute for Health Information, Statistics Canada has come up with a new barometer that it calls disability-free life expectancy (page 52). On average, someone born in Canada today can expect to live 67 years free of ailments that limit physical activity. That figure is calculated from census data on disabilities, population estimates, and deaths at an early age that drag down the overall average for longevity.
Looked at another way, from the point of view of the current population aged 65, the picture is much brighter, simply because those who died younger are no longer part of the equation. According to the new calculations, 65-year-olds can expect roughly a decade of active living before disease or injury hobbles them. The focus in health care now, says Dr. Réjean Hébert, scientific director at the Institute of Healthy Aging in Sherbrooke, Que., “is not to add years of life, but to add life to the years.” The challenge, he explains, is to reduce the number of years seniors spend disabled.
The problem is most acute in Nova Scotia’s Cape Breton, which trails all of Canada’s major health regions with a disability-free life expectancy at birth of just 60 years (page 54). The vast rural areas around Sudbury and North Bay, Ont., post only slightly better results. To a large
extent that is predictable, given the health problems generally associated with lower levels of employment, income and education. But the new categories expose a curious paradox in Quebec.
Last year’s Macleans survey of the status of health of residents in 51 Canadian health regions placed 10 of the 11 Quebec regions in the bottom half. Yet it now turns out the province is indisputably Canada’s capital for spry living. Quebec health regions occupy 10 of the top 12 spots
for disability-free life expectancy at birth, with North/West Vancouver and Mississauga/Brampton/Burlington, Ont., the only others to crack the top dozen. Quebec regions also take eight of the 12 top spots in calculating how long seniors can expect to remain nimble. Why?
Part of the answer may lie in the social conditions of central Quebec that have produced the highest concentration of genetic disease in the world, says Dr. Judes Poirier, director of the McGill Centre for Studies in Aging. “It’s because the French-speaking bred together, cousin with cousin and this and that,” he says, “especially in areas isolated in winters.” Poirier suspects deaths attributable to genetic disease, in some cases with an environmental trigger, are important factors in Quebec’s relatively low status of health. Hébert in Sherbrooke agrees, adding that Quebecers who get sick appear to get very sick. “If some lethal diseases are more frequent in an area,” says Hébert, “it’s going to lower the total life expectancy, but also have the opposite effect on the disability-free life expectancy because these people are dying before being disabled.”
Sudbury and North Bay aren’t much better off, but for different reasons. Like many large rural regions, these communities struggle with access to health care,
education, employment, poverty, and higher rates of smoking and drinking. “It’s not just blaming people for their behaviours,” says Dr. Penny Sutcliffe, the medical officer of health for the Sudbury & District Health Unit, “but also trying to make sure that we have environments that are supportive of good health—even things as basic as making sure there are effective smoking bylaws in the communities.” Smoking is a recurring theme. Dr. Catherine Whiting, medical officer of health for the North Bay & District Health Unit, notes that a survey of Grade 7 and Grade 9 students in her area showed the ratio of children who smoke increased from 15 per cent in 1993 to 20 per cent in 1996. “The price of cigarettes in Ontario is one of the lowest in Canada,” says Whiting, “and we know kids are price sensitive.” Federal Health Minister Allan Rock, who has been trying to shift Canadian attitudes towards health promotion and disease prevention, calls tobacco the No. 1 public health issue in the country. In an effort to take the glamour out of smoking, a total ban on tobacco sponsorship of public events like car races goes into effect in 2003. Hitting kids in their meagre wallets is part of the strategy, too, says Rock. “We have been steadily increasing taxes since 1994, most recently in April of this year,” Rock told Macleans. “Those taxes have to continue to rise.”
Canadas longevity rate will not increase dramatically, however, even if smoking rates drop to zero. Overall life expectancy has risen steadily in most parts of the world. “But even in Jesus’s time, when average life expectancy was about 35, there were people who were 60 and 70,” says Poirier. “It’s just that there were so many people dying at the age of 1 and 2 that it brought down the average lifespan drastically.” By 1900, longevity had crept up to about 45 in the developed world. In the past century, it almost doubled, but again, not because many more people are living into their 80s or longer. Rather, far fewer are dying in childhood.
The human body, even disease-free, seems to hit a wall at about 120 years. The oldest person on record was Jeanne Calment, who died in 1997 in southern France at the very ripe age of 122. In Canada, the number of centenarians is doubling every nine years and is expected to climb to more than 30,000 in 2010 as the boomer bulge works its way through the bell curve of life. But even if all diseases were eliminated, the body would still wear out. The only way to change that, says Poirier, would be to genetically engineer a better human. “And that, of course,” says Poirier, “opens a whole can of worms.” That hasn’t stopped scientists from combing the human genome for a key to a longer, healthier life. Fast August, scientists at the Howard Hughes Medical Institute in Boston announced they had
identified a region of a human chromosome associated with longevity. A study of 137 sets of siblings over 90 identified a segment of chromosome 4 containing several hundred genes. The next step is to narrow the search to identify the gene or genes responsible for long life, says Dr. Chris MacKnight, an assistant professor of geriatric medicine at Dalhousie University in Halifax. Then the task would be to figure out what those genes do, and whether they can be exploited for medical gain. Any impact on longevity, however, is years away. “It’s certainly not a fountain of youth quite yet,” says MacKnight.
While scientists search for a genetic font, the public is seeking new ways to stay healthy and able-bodied. About a third of Canadians have used three or more natural
health products, such as homeopathic or herbal remedies, in the past six months, says Earl Berger, managing director of The Berger Population Health Monitor, an independent, semi-annual newsletter. Many may be gaining great benefits, says Berger, but most don’t tell their doctors about their alternative medications, leaving them at risk of adverse interactions with prescription drugs.
Scientific breakthroughs and alternative medicines aside, some basic health-care issues need to be addressed to improve long-term health. The first are what Dr. Henry Haddad, president of the Canadian Medical Association, calls health disparities. Examples: the poor are more likely to get sick, and aboriginals suffer higher than average rates of diabetes, tuberculosis and cancer. Another problem is children—1.5 million of them—going to school hungry. “That means that their physical and mental development will suffer,” says Haddad.
The environment, Haddad adds, is in need of immediate emergency care. “Studies show that 25 per cent of health problems are environmental in origin,” he says. On mental illness: “People don’t realize it’s the second leading cause of disability and premature mortality in our country. Surprised?” And, says Haddad, we need to deal with an obesity epidemic among children, which puts them at risk of diabetes, heart disease and other ailments.
The picture is far from perfect in old age, as well. On the plus side, there has been a 21-per-cent drop in deaths due to heart attacks over the past 13 years, according to the Heart and Stroke Foundation. Unfortunately, almost half of the survivors continue to have heart-related problems, including a high risk of a second attack. Part of the problem is the lack of rehabilitation programs aimed at teaching patients to reduce their risks, says Dr. Anthony Graham, a foundation spokesman.
Among other prime causes of elderly disability, Alzheimer’s disease afflicts 300,000 Canadians. There’s no cure—the three drugs used to treat Alzheimer’s slow but do not stop the memory loss. Although work is under way on a vaccine that could halt the disease’s spread, the theory behind it is contentious. Another great disabler, cancer, strikes almost two in five Canadians. Then there’s arthritis, “the single largest cause of long-term disability in this country,” according to Denis Morrice, president of the Arthritis Society. “I’ve always said, if you want to do something about health-care costs in this country, do something about arthritis.”
Other attitudes also need changing. There is no reason why someone with a disability cannot contribute to society, says epidemiologist Ian McDowell of the University of Ottawa. “We’ve tried to distinguish between those who may be perfectly healthy but aren’t really doing very much,” he says, “and those who are not healthy but are out there volunteering and basically contributing to society.” The question, according to McDowell, is: “Do we effectively put elderly people who have some mobility problems on the scrap heap, or do we get a little more contemporary with what healthy aging is?”
There is, of course, no single magic solution for staying healthy longer. In Burlington, Norma Petitti concedes she could do more. What she has going for her are her daily exercise, a wide range of interests, many friends and a healthy mind-set. “I really work hard at not being negative
about things,” she says. Yet she’s still trying to come to terms with one big problem: her 46-year smoking habit. She hopes to stop, she says. “I think about it all the time.” Making healthy decisions isn’t always easy, but the payoff can be huge: a longer life, spent disability-free. E33
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