- Leading Health Challenges
- Health Situation and Trends
- Full Article
Canada, the second largest geographical area in the world, is divided into 3 territories and 10 provinces. Since Confederation in 1867, the country has evolved into a multicultural society with a richly diverse population that contributes to its unique national culture. Canada has the tenth largest economy in the world, fuelled by abundant natural resources and trade. It is a member of the Organization for Economic Cooperation and Development (OECD) and the Group of Seven (G7). In 2013, Canada’s GDP was US$ 1.472 trillion while the GDP per capita was US$ 41,894 (GDP per capita PPP was US$ 42,780) ().
In 2015, Canada’s population reached 35,851,800, almost evenly divided between women and men (50.4% and 49.6%, respectively) and up just 0.9% over the past year. The number of Canadians aged 65 years and older (5,780,900) was larger than the number of children aged 0 to 14 years (5,749,400), a first in Canada (). The proportion of the population aged 65 years and older has doubled in the past fifty years, from nearly 8% of the population in 1961 to 16% in 2011. Figure 1 compares Canada’s population structure between 1990 and 2015.
Figure 1. Population structure, by age and sex, Canada, 1990 and 2015
Canada’s total fertility rate in 2012 was 1.61 births per female with less than half of all births (46.9%) being born to mothers under 30 years of age (). Between 2010 and 2012, life expectancy at birth was 83.6 years for women and 79.4 years for men (). In 2011, about 20.6% of the Canadian population were immigrants, 17.5% of which (3.5% of the total population) had immigrated within the past five years. The country’s rural population fell to 18.9%.
Due in part to public health efforts, such as the introduction of mass immunization, smoking cessation, and seat-belt awareness programs, Canadians are living longer; the country’s infant mortality rates have also declined. In 2014, 59.0% of Canadians aged 12 years and older reported that their health was “excellent” or “very good,” This has been relatively stable over the past decade. In the same year, 71.1% of Canadians reported that their mental health was “excellent” or “very good,” while 73.4% did so in 2003 ().
The number of Canadians living in low-income families has fallen to its lowest level in more than two decades, dropping from 15.2% in 1996 to 8.8% in 2011 (). Further, Canada performs well in many measures of well being in the OECD’s Better Life Index. Among OECD countries, Canada ranks above average in housing, jobs and earnings, education and skills, to name a few. While Canada’s economic position is generally sound, some trends and signals point to pressures going forward that could increase inequality, and that may require attention and action to address vulnerabilities, particularly among specific communities or groups.
Aboriginal peoples represented 4.3% of the total Canadian population in 2011. However, First Nations and Inuit experience much higher rates of poverty, chronic disease, and poor living conditions. In 2011-2012 approximately 22% of off-reserve Indigenous households experienced food insecurity, compared to 8% of all Canadian households ().
Canada’s social programs contribute to ensuring the health and well-being of Canadians by providing income support to those who have experienced job loss through no fault of their own, older persons, persons with disabilities, families and individuals in need, the homeless and those at risk of homelessness, and communities and persons who are facing social challenges. To further improve well-being and promote inclusiveness, investments in social programs and funding have been made to grow the middle class and reduce inequalities among Canadians.
Leading Health Challenges
Critical Health Problems
Research indicates that climate change will expand the geographic range of ticks carrying Lyme disease further into Canada. Projections estimate that by 2020, over 80% of the population in Eastern and Central Canada could be living in areas at risk of Lyme disease. The reported number of Lyme disease cases have steadily increased over the last five years, with 266 cases reported in 2011 and 917 reported in 2015 (). Canada is taking a multi-jurisdictional, multi-partner approach to address Lyme disease risk assessment, surveillance, laboratory diagnosis, and policy support, as a way to build a resilient system that can cope with emerging/re-emerging diseases.
Antimicrobial resistance is a serious threat to Canadians, and the Government of Canada is taking steps to address it. Prevalence studies estimate that approximately 4.2% of hospitalized patients in Canada will become infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA). While rates of MRSA have been decreasing in Canada since 2009, current MRSA infection rates continue to exceed those observed in the early 2000s. Antimicrobial resistance in other bacterial organisms from community-acquired and food-borne infections also remains a concern. For example, in 2014, antimicrobial-resistant Salmonella bacteria represented 25% of reported human cases of non-typhoidal Salmonella infection. Neisseria gonorrhoeae resistance is also on the rise and is a cause for concern, as the commonly used antibiotic therapies are rapidly declining in efficacy ().
In 2014, the Government of Canada released the Antimicrobial Resistance and Use in Canada: A Federal Framework for Action, which maps out a coordinated, collaborative federal approach to addressing the threat of AMR in three strategic areas of focus: surveillance, stewardship and innovation. The corresponding Federal Action Plan on Antimicrobial Resistance and Use in Canada, released in 2015, outlines the concrete steps that the Government of Canada will take between 2016 and 2019. A key accomplishment under the Action Plan was the launch of the Canadian Antimicrobial Resistance Surveillance System (CARSS) as the national coordinating body for those surveillance systems that gather information about AMR and antimicrobial use in humans and animals. CARSS provides an overall picture of antibiotic resistance and antibiotic use in Canada, which is presented in an annual national report.
Rising Opioid Use
Canadians rank as the second highest per capita consumers of prescription opioids in the world. The use of prescription opioids in Canada increased by 203% between 2000 and 2010. The dispensing of medications has substantially increased in Canada, with considerable variations between provinces (). A parallel increase in the use, and associated harm, of illicit opioids has also been observed. A growing concern related to problematic opioid use is the number of overdoses and deaths, particularly related to fentanyl, a synthetic opioid that is 50 to 100 times stronger than other opioids such as morphine, heroin, or oxycodone.
Between 2009 and 2014, there were at least 655 deaths in Canada where fentanyl (both licit and illicit) was determined to be a cause or a contributing cause (). The situation is particularly worrisome in Western Canada where British Columbia has declared a public health emergency in this regard. The impact of this increased opioid use is felt more acutely among vulnerable populations, such as youth, seniors, First Nations and those living in poverty.
In response to the significant health implications of opioid use, Canada’s federal government is working with provinces, territories, health professionals, law enforcement, and Indigenous leaders to identify innovative solutions to this crisis. These efforts have included amending the “Controlled Drugs and Substances Act (CDSA)” to add substances used in the production of illicit fentanyl, as a means to help address the supply side of this problem (). Additionally, the Government of Canada has recently announced its Opioid Action Plan (), which underscores action in five key areas:
- Better informing Canadians about the risks of opioids: this includes new warning stickers, patient information sheets, and review of best practices
- Supporting better prescribing practices: through the promotion of prescription monitoring programs, examination of pharmacy records, sharing information with PT licensing bodies, and Canada Health Infoway e-prescribing solution
- Reducing easy access to unnecessary opioids: contraindications for approved opioids, prescription requirements for low-dose codeine products, and mandatory risk management plans for certain opioids
- Supporting better treatment options for patients: this includes better and faster access to naloxone, expediting the review of non-opioid pain relievers, and re-examining special requirements for methadone
- Improving the evidence base: bringing together experts in the field to discuss how to improve data collection and the Canadian evidence base.
Between 2011 and 2015, the number of physicians grew by 13.3% and the number of international medical graduates in the physician workforce increased by 16.4%. From 2011 to 2015, the supply of regulated nurses grew by 6.3%, from 391,085 to 415,864. While the number of health professionals practicing across Canada has increased, some jurisdictions continue to report shortages of qualified health care providers, particularly in rural and remote communities. Provinces and territories, with the support of the federal government, are increasing the number of family medicine residency training positions in underserved communities and providing enhanced training to physicians in rural communities to better address local health needs. In 2015, approximately 11.8% () of regulated nurses worked in rural or remote areas of Canada; by contrast, 17.4% of the general population lived in a rural or remote area ().
In most provinces and territories, nurse practitioners (NPs) are authorized to diagnose a disease, disorder, or condition; order and interpret diagnostic and screening tests; and prescribe medications. Collaboration between nurse practitioners and physicians in primary care settings has been found to significantly lower wait times and improve patient access to care. Hospitals remained the top employer across the nursing professions. Close to 60% of regulated nurses were employed in a hospital setting, 15.1% in community health, 15.2% in a nursing home or long-term care setting, and 10.8% in other places of work ().
There were 415,864 regulated nurses eligible to practice in Canada in 2015. Of these, 390,359 were working in their nursing profession: 76.0% as registered nurses including nurse practitioners, 29.4% as licensed practical nurses, and fewer than 1.5% as registered psychiatric nurses. These proportions have remained relatively steady over the last five years. In 2015, the number of nurses working in direct care areas, by category, were 251,080 registered nurses and nurse practitioners, 97,923 as licensed practical nurses, and 4,750 as registered psychiatric nurses (). That same year, female regulated nurses represented 91.9% of the total workforce ().
In 2015, there were 82,198 active physicians in Canada (), representing an increase of 2.9% over the previous year. Canada has sustained yearly physician increases of more than 2% since 2007, with increases of more than 4% in 2009 and 2011. Currently the number of active physicians in Canada is increasing at a faster rate than that of the population. The physician-to-population ratio (per 100,000 Canadians) grew from 210 in 2011 to 228 in 2015. Over the past 35 years, the number of female physicians increased dramatically: in 1979, 11.8% of physicians were women; by 2015, 40.0% were women.
Health knowledge, technology, and information
Health Information Technology
Digital health technologies play an important role in contributing towards an accessible, efficient, and sustainable health care system and in improving the safety and quality of patient care. Since 2001, the federal government, through Canada Health Infoway, has invested C$ 2.15 billion in digital health technologies, whose main thrust has been putting in place the core elements of a digital health information system electronic health records (EHRs) and electronic medical records (EMRs). Thanks to federal and provincial investments, EHRs are now complete or nearing completion in all provinces and territories and EMR adoption doubled from 37% in 2009 to 73% in 2015 ().
The federal, provincial, and territorial governments also have significantly invested in Telehealth. Telehealth services are the longest-established digital health activities in Canada, providing videoconferencing between patients and health care providers, physician consults, transfer of diagnostic materials, and tele-monitoring of patients. These services are used by some 70 specialties, primarily to attend the nearly seven million Canadians living in rural and remote communities.
Scientific Production in Health
The federal government supports a comprehensive health research agenda across disciplines, sectors, and regions that reflects the emerging health needs of Canadians, the evolution of the health care system, and the information needs of health policy decision makers. Canada’s federal funding agency for health research, the Canadian Institutes of Health Research (CIHR), laid out its five year vision in its strategic plan, Health Research Roadmap II: Capturing Innovation to Produce Better Health and Health Care (2014/15 – 2018/19). The plan identifies four research priorities, including improved patient outcomes; health and wellness for Indigenous Peoples; health promotion and disease prevention; and the treatment of chronic conditions (). Each year, CIHR invests C$ 1 billion to finance the work of 13,000 researchers and trainees.
Environmental Health and Human Security
Efforts to help Canadians adapt to climate change and protect their health and well-being have focused on reducing risks from climate-related infectious diseases, extreme weather events, high temperatures, and poor air quality. Unique challenges faced by Canadians, including by indigenous populations who live in the country’s northern regions have also been addressed. Information and tools are available for public health and emergency management officials to develop technical guidelines on Heat Alert and Response Systems, and for diagnosing and treating heat illness. Such technical guidance is available to health care workers across Canada through online training. A tool has been developed for hospital officials for assessing the resiliency of health facilities to climate change impacts (). Climate change adaptation programming has focused on addressing infectious disease risks associated with climate change. The primary areas of focus are: developing evidence-based approaches; developing practical adaptation resources (e.g., risk maps, models and projections of vector spread) to enhance surveillance, intervention and control of public health risks; and, enhancing local capacity to anticipate, identify, respond and adapt to public health risks arising from climate change. Laboratory diagnostic capabilities have also been enhanced, and a focus has been placed on public education and awareness of infectious diseases (e.g., Lyme disease, West Nile virus) attributed to or exacerbated by climate change.
The Climate Change and Health Adaptation Program (CCHAP) for Northern First Nations and Inuit supported 95 community-based research projects that identified health impacts of climate change and developed adaptation plans and actions, such as a community composting and greenhouse program to increase food security in Arviat, Nunavut, and a watershed management framework developed by the Yukon River Inter-Tribal Watershed Council.
The Government of Canada is committed to making food as safe as possible for consumers. Canada’s Food Safety Program aims to mitigate risks to public health associated with food borne illnesses and other health hazards in the food supply system and to manage food safety emergencies and incidents. In 2012 Canada approved the “Safe Food for Canadians Act,” which modernizes and strengthens food commodity legislation to better protect consumers (). The Act focuses on three important areas: improved food safety oversight to better protect consumers; streamlined and strengthened legislative authorities; and enhanced international market opportunities for Canadian industry (). From an international perspective, Canada consults with and formally notifies foreign governments and international organizations about its regulatory efforts to modernize Canada’s food safety system.
Almost one-third (32%) of Canadians 15 years of age and older in the provinces reported having experienced physical and/or sexual abuse as a child at the hands of a family or non-family member, representing just under 9 million people (). In 2014, 85,402 incidents of family violence were reported to police in Canada. Of these, 40,850 (48%) were violent incidents perpetrated by a current spouse, common-law partner, or ex-spouse; four out of five victims were female. In the same year, 3,161 incidents of family violence against seniors were reported to police. Of these, 19 resulted in death (). Within Canada, the federal government works collaboratively to develop longer-term solutions to financial, physical, emotional, and sexual abuse and neglect through various measures, including addressing potential risk factors and increasing health promotion efforts and developing strategies and interventions to reduce offending, amongst others.
Monitoring the Health System’s Organization, Provision of Care, and Performance
Canada’s publicly funded health care system provides universal access to comprehensive coverage for medically necessary hospital and physician services. The provincial and territorial governments have primary responsibility for the administration and delivery of health services to Canadians. The federal government provides additional services for First Nations and Inuit peoples and covers members of the Canadian Forces, eligible veterans, inmates in federal penitentiaries, and refugee claimants. The federal government is also responsible for health protection and regulation (e.g., of pharmaceuticals, biologics, and food and medical devices), and consumer safety. It plays an important role in health promotion, including the prevention and control of infectious and chronic diseases, disease surveillance, preparing for and responding to public health emergencies and disease outbreaks, and health research.
The Canada Health Act (CHA) is Canada’s federal legislation for publicly funded health care insurance. The CHA sets out the primary objective of Canadian health care policy, which is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” The CHA establishes criteria and conditions related to insured health services and extended health care services that the provinces and territories must fulfill in order to receive the full federal cash contribution under the Canada Health Transfer (CHT) program. The aim of the CHA is to ensure that all eligible residents of Canada have reasonable access to insured health services on a prepaid basis, without direct charges at the point of service for such services. Box 1 summarizes key health legislation and initiatives.
BOX 1. Canada’s Health Initiatives during 2011-2015
|Health issue||Legislation or initiative|
|Health Inequality and the Social Determinants of Health||
Canada’s “Agency Plan to Advance Health Equity, 2013-2016” lays out concrete actions to strengthen the evidence base on the state of inequalities and interventions to address them; supports routine consideration of health equity and determinants of health in Agency programs, policies, and processes; and engages and leverages action across sectors, levels, and governmental departments to influence determinants of health and support health equity. The plan encompasses three themes that align with three of five domains of the Rio Political Declaration on Social Determinants of Health; its progress is monitored and reported on annually.
The Canadian Institutes of Health Research’s (CIHR) strategic plan for 2014 to 2019 identifies research priorities for the health and wellness of Aboriginal peoples. To this end, CIHR’s “Pathways to Health Equity for Aboriginal Peoples” initiative aims to develop an evidence base for designing, offering, and implementing programs and policies that promote health and health equity in four priority areas: suicide prevention, tuberculosis, diabetes/obesity, and oral health.
|Health and the Environment||
In 2015-2016, through a collaborative effort among all government levels, Canada conducted health risk assessments, health benefit analyses, research, and outreach in support of the Air Quality Management System’s ongoing drive to improve air quality. These efforts included the establishment of the Canadian Ambient Air Quality Standards, the development of residential indoor air quality guidelines and guidance, actions to reduce emissions from transportation and industrial sources, and increased coverage and awareness of the Air Quality Health Index, which provides local current and forecasted air quality along with associated health messaging.
Since 2014, nine drinking water guidelines/guidance documents have been finalized and approved by the federal, provincial and territorial governments.
CIHR’s “Environments and Health” initiative supports research focused on etiology, data platform enhancement, and intersectoral prevention.
The Government of Canada continues to work with provinces and territories, as well as with the World Health Organization, to encourage the adoption of Age-Friendly Communities initiatives that help seniors live safely, enjoy good health, and stay involved. More than 1,000 communities in all ten provinces are making their communities more age-friendly. Dementia Friends Canada, launched in 2015 in collaboration with the Alzheimer Society of Canada, is a digital campaign that reaches individuals where they live and work to increase understanding of what it is like to live with dementia and the small ways that those affected can receive support.
The CIHR Dementia Research Strategy supports research on the latest preventive, diagnostic, and treatment approaches to Alzheimer’s disease and related dementia, in order to contribute to the global pursuit of finding a cure or disease-modifying treatment for dementia by 2025.
The “Federal Initiative to Address HIV/AIDS in Canada” leads in providing funding for preventing the spread of HIV and other blood-borne and sexually transmitted infections; promotes education and awareness; and facilitates access to diagnosis, care, treatment, and support for those living with the disease.
Canada and the Bill & Melinda Gates Foundation are collaborating to develop a safe, effective, and accessible HIV vaccine through the “Canadian HIV Vaccine Initiative.”
|Chronic, Noncommunicable Diseases||
The Public Health Agency’s Multisectoral Partnerships to Promote Healthy Living and Prevent Chronic Disease advances innovative solutions by providing the co-investment needed to test and/or scale-up the most promising primary prevention interventions. This allows the Agency to capitalize on Canadians’ best ideas and to leverage resources to deliver the strongest results.
In adopting the “Declaration on Prevention and Promotion (2010),” federal, provincial, and territorial ministers of health have made the promotion of health and the prevention of disease, disability, and injury a priority for action.
Canada’s federal, provincial, and territorial ministers of health (except Quebec) in 2010 endorsed “Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights,” making childhood obesity and healthy weights a priority (www.towardsahealthiercanada.ca)
In the fall of 2015, the Government of Canada committed itself to introducing plain packaging requirements for tobacco products aimed at protecting young people and others from starting to use tobacco. This initiative will further the Government’s efforts to protect Canadians from the health, economic, and social costs of tobacco use.
CIHR has developed the “Healthy Life Trajectories Initiative,” which will establish linked intervention research teams studying the developmental origins of health and disease in China, South Africa, India, Canada, and other countries. This initiative will support the evaluation and identification of early and timely interventions for non-communicable diseases that can be implemented across the lifespan.
CIHR has partnered with international health research funders to form the Global Alliance for Chronic Diseases, which aims to fund, develop, and facilitate innovative research collaborations between low- and middle-income and high-income countries in the fight against chronic diseases.
|Illicit Drug Use||The “National Anti-Drug Strategy (NADS)” is the federal government’s comprehensive response to fighting illicit drug use in Canada. In 2014, the scope of NADS was expanded to include addressing prescription drug abuse. Canada’s approach includes harm reduction, respect for human rights, and consideration of the social determinants of health within a comprehensive approach that puts health and well-being at the forefront and is based on a firm scientific foundation.|
In 2012 the Mental Health Commission of Canada (MHCC) released the National Mental Health Strategy for Canada “Changing Directions, Changing Lives” which identified a need for enhanced data collection on mental health. In response, the Public Health Agency of Canada developed the Positive Mental Health Surveillance Indicator Framework (Framework), in consultation with stakeholders and experts, to provide a national snapshot of the status of mental health in Canada. The Framework provides the latest data on 5 outcome determinants, and 25 risk and protective determinants of positive mental health.
The 2013 “National Standard of Canada for Psychological Health and Safety in the Workplace,” championed by the MHCC, constitutes a voluntary set of guidelines, tools, and resources focused on promoting employees’ psychological health and preventing psychological harm due to workplace factors.
|Building the Health Workforce||
The “Internationally Educated Health Professional Initiative (IEHPI)” aims to facilitate the development of programs and supports the integration of internationally educated health professionals into the Canadian health work force. The initiative focused on improved access to licensure and increased transparency in the assessment of qualifications, capacity of faculty to work with IEHPs, access to skills upgrading programs, and regional collaboration.
The “Family Medicine Residencies Initiative (FMRI),” introduced in 2011, supports provinces and territories in providing family medicine residency positions and advanced training in rural and remote areas across the country.
The “Aboriginal Health Human Resources Initiative (AHHRI)” has supported training for 450 First Nation health managers in one or more competencies and enabled 570 community-based workers to obtain certification each year. By 2011, there were 2,200 Indigenous students supported in various health careers (nursing, medicine, dentistry).
CIHR and the Social Science and Humanities Research Council of Canada (SSHRC) are investing in the Healthy and Productive Work initiative, which aims to bring together a wide range of researchers and stakeholders across sectors. Together they will develop, implement, evaluate and scale up evidence-informed and gender responsive solutions to improve the health and productivity of Canada’s diverse workforce.
|Antimicrobial Resistance||The “Antimicrobial Resistance and Use in Canada: A Federal Framework for Action,” released in 2014, aims to protect Canadians from the health risks related to antimicrobial resistance. The Framework outlines how the Government of Canada, in collaboration with its partners, will seek to reduce the health risks associated with antimicrobial resistance along three pillars: surveillance, stewardship, and research and innovation. The corresponding “Federal Action Plan on Antimicrobial Resistance and Use in Canada,” released in March 2015, outlines the concrete steps that the Government of Canada will take between 2016 and 2019.|
Health Expenditures and Financing
Approximately 70% of Canada’s health expenditures are financed from public sources, which include general revenue raised through federal, provincial, and territorial taxes (such as personal income, corporate and sales). Some provinces also charge their residents a dedicated premium, or tax, to help pay for publicly funded health care services, but non-payment of a premium or tax does not prevent access to medically necessary health services.
Total health expenditures represented 10.9% of gross domestic product (GDP) (C$ 215.8 billion) in 2014 and are forecast to rise to 11.1% in 2016. Health expenditure per capita was C$ 6,073 in 2014, and is forecast to be C$ 6,299 in 2016. Between 2007 and 2016, federal support to the provinces and territories through the Canada Health Transfer increased from C$ 21.8 billion to C$ 36.1 billion (). The public sector share of total health expenditure has remained relatively stable since 1997, at around 70% ().
Hospitals and physicians, are mainly financed by the public sector while the private sector primarily covers the cost of other health professionals (not including nurses) and drugs. In 2014, the latest year for which actual data are available, hospitals, the largest component of health care spending, cost C$ 63.8 billion, or 29.5% of total health expenditures. Outlays for drugs, which account for the second-largest expense category, grew by 2.5% in 2014, reaching C$ 34.6 billion and amounting to 16.0% of total health care spending. In 2014, spending on physicians increased by 4.1%, reaching $32.9 billion or 15.3% of total health care spending ().
Various models of health care teams are emerging across Canada some rely on teleconferencing to carry out work that covers vast distances, while others work in the same setting. Moreover, some teams may be led by physicians or by nurse practitioners, and some may or may not include a wide variety of other providers such as dieticians, psychologists, physiotherapists, occupational therapists, and social workers. In conforming their health care teams, many jurisdictions have chosen to target specific chronic diseases (such as diabetes and heart disease) as a way to maximize expertise around prevalent chronic diseases, enhance the quality of life of those affected, and ease the burden from the more costly acute care sector.
Federal, provincial, and territorial governments have a history of working together to identify and address common challenges facing Canada’s health care system. The 10-Year Plan to Strengthen Health Care (adopted in 2004) set out a shared federal, provincial, and territorial agenda on the renewal of health care, recognizing the need for concerted action in key areas of the health care system. For example, the Plan targeted five priority treatment areas (cancer, cardiac bypass surgery, diagnostic imaging, joint replacements, and sight restoration) for reduction in wait times for non-urgent procedures and more timely access to health care services. In 2015, the Canadian Institute for Health Information (CIHI) reported that, among patients receiving joint replacement, cataract surgery, hip fracture repair, and radiation therapy, roughly 8 out of 10 Canadians were treated within a medically recommended timeframe.
Health Situation and Trends
Health of Population Groups
Maternal and Reproductive Health
In 2010, live births to mothers aged 15 19 years accounted for 4.2% of all births, live births to mothers aged 35 39 years accounted for 14.1%, live births to mothers aged 40 44 years accounted for 2.8%, and live births to mothers aged 45 49 years accounted for 0.12% (). Several community-based programs in Canada address the health of vulnerable pregnant women, children, and their families, including the Canada Prenatal Nutrition Program, the Community Action Program for Children, the Maternal and Child Health Program, and the Aboriginal Head Start in Urban and Northern Communities program. An evaluation of the Canada Prenatal Nutrition Program (CPNP) carried out in 2015 found that the rate of breastfeeding initiation for CPNP participants was equivalent to the general population (88.15% and 88.5% respectively), demonstrating the impact of the program on breastfeeding initiation for vulnerable women (). In addition, a 2009 CPNP study determined that participants with overall high exposure to the program tended to have more positive health-behavior changes than those with lower exposure to the program. They were consistently more likely to breastfeed their infants and, in particular, to breastfeed for longer.
In 2012, the infant mortality rate in Canada was 4.8 deaths per 1,000 live births (). The most common cause of infant death was congenital anomalies (which include a range of conditions such as spina bifida and Down syndrome) (). Congenital anomalies occur in 3% 5% of newborn infants and account for 23.2% of neonatal deaths (). For children 1 14 years old, unintentional injuries, especially related to motor vehicle accidents, were the leading cause of death. After transport accidents, drowning was the most common cause of unintentional injury deaths (). In 2013, 780 children aged 0 to 14 years (17.7 per 100,000) were diagnosed with cancer. The most commonly occurring cancer in this age group is leukemia, which accounts for over one-quarter of all new cases in this age group ().
All provinces and territories have publicly funded immunization programs, with the following routine vaccinations administered free of charge to children 17 years old and under: diphtheria, tetanus, pertussis, polio, rubella, measles, mumps, hepatitis B, Haemophilus influenza type b, varicella, meningococcal C, pneumococcal, and human papillomavirus. Table 1 shows the estimated national vaccination coverage in Canada, compared to the national immunization coverage goals based on the results of the 2013 childhood national immunization coverage surveys ().
TABLE 1. National immunization coverage estimates and immunization coverage goals for children 2 years old, by antigen, Canada, 2013
|Disease/Vaccine||Immunization coverage estimates (%)||National coverage goals (%)|
|Diphtheria (four doses)||76.6||99|
|Pertussis (whooping cough) (four doses)||76.4||95|
|Tetanus (four doses)||76.4||97|
|Polio (IPV) (three doses)||90.9||97|
|Haemophilus influenzae type b (Hib) (four doses)||71.9||97|
|Measles (one dose)||89.7||97|
|Mumps (one dose)||89.4||97|
|Rubella (one dose)||89.4||97|
|Varicella (chickenpox)(one dose)||73.2||85|
|Meningococcal C (one dose)||88.7||97|
|Pneumococcal infection (three doses)||79.2||97|
Health of Adolescents
The latest Health Behaviour in School-aged Children (HBSC) survey shows that approximately one in three boys and approximately one in four girls were classified as overweight or obese by Body Mass Index (), indicating a persistent epidemic of overweight and obesity among young Canadians. A complex and multi-faceted interacting system of factors contributes to these rising rates of overweight and obesity, such as more sedentary “screen time” for children, uneven access to physical activity opportunities, the marketing of foods and beverages high in fat, sugar and/or sodium to children, and increased food availability and increasing portion sizes.
Since 2010 Canada has seen a decrease in the prevalence of bullying and physical fighting among young people. The percentage of students who reported not having been bullied nor bullying others increased from 65% in 2010 to 70% in 2014 (). Based on data from the Canadian Community Health Survey, the incidence of concussion or traumatic brain injury among adolescents who had an injury in the previous year has increased from 3.4% incidents a year in 2005 to 5.7% incidents a year in 2014. Studies have shown that a large portion of concussion or traumatic brain injury among youth occurs in sports activities and venues ().
Health of the Elderly
The five leading causes of death for persons 65 years old and older in 2012 were cancers (28%), heart disease (21%), cerebrovascular diseases (6.1%), chronic lower respiratory diseases (5%), and diabetes (4%) (). Falls are the leading cause of injury-related hospitalizations among seniors in Canada, and between 20% and 30% of seniors fall each year (). While injuries are not a leading cause of death among the elderly, 58.0% of injury-related deaths of seniors are due to falls. Of those who reported being injured seriously enough to limit normal activities in 2012, 60% were as a result of a fall (). In 2014, chronic conditions were widespread among seniors, with 82.7% living with at least one chronic condition and many experiencing multiple chronic conditions.
As a result of its aging population, over the next 20 years Canada will see a significant increase in the number of people diagnosed with a neurological condition, particularly Alzheimer’s disease and other dementias, as well as Parkinson’s disease (). In 2011, an estimated 310,000 (2%) of Canadians 65 years and older had Alzheimer’s disease and other dementias, a number that is expected to double by 2031 (). Rates of Alzheimer’s disease and other dementias increased similarly in men and women up to age 80 years (approximately doubling every five years after age 70), when the increase became greater in women ().
As part of the effort to reduce stigma and improve quality of life for those living with dementia, Dementia Friends Canada was launched in 2015 in collaboration with the Alzheimer Society of Canada. This digital engagement campaign reaches out where people live and work, to better understand what it is like to live with dementia and suggest small ways that those affected can be supported (). The Government of Canada continues to work as an affiliate to the World Health Organization’s Global Network on Age Friendly Cities and Communities, and collaborates with Canadian provinces to encourage the uptake of Age-Friendly Communities (AFC) initiatives to help seniors live safely, enjoy good health and stay involved in their communities. More than 1,000 communities in all ten provinces are making their communities more age-friendly.
Health of Indigenous Populations
Over 4% of Canada’s population is indigenous. In 2011, 851,560 people identified as a First Nations person (74.9% of which reported being a Registered Indian), 451,795 people identified as Métis, and 59,445 people identified as Inuit, with nearly half the population (46.2%) under the age of 25 years. Nearly one half (49.3%) of on-reserve First Nations have limited road access, while 73.1% of Inuit live in the four regions that make up Inuit Nunangat (the Inuit Homeland), which is primarily accessed by airplane ().
The health status of First Nations and Inuit has steadily improved since 1980, but remains poor compared to other Canadians. The latest figures show that life expectancy for Registered Indians is 70.4 years for males and 75.4 for females (), and 68.3 for males and 73.6 for females living in Inuit Nunangat (). In regions for which Canada has good quality data, infant mortality rates in First Nations remain approximately twice as high compared to the non-First Nations population (). The infant mortality rate within the Inuit Nunangat is approximately three times higher than for the general Canadian population (). The prevalence of communicable and non-communicable diseases is higher in Indigenous Peoples than in the general Canadian population. For example, in 2014, the incidence of tuberculosis among First Nations was about four times higher than amongst the overall Canadian population (see section on tuberculosis morbidity for more information). The highest incidence rate, however, was among the Inuit, at 198.3 per 100,000 population. The 2004 2008 cancer mortality rate among residents of Inuit Nunangat was 96.9 per 100 000, nearly twice as high as the rate for Canada overall (54.9 per 100 000 when age-standardized to the Inuit population) (). The prevalence of diabetes among on-reserve First Nations populations (16.2%) is almost three times that of the Canadian average (6.8%) ().
Although the crude prevalence of diabetes among Inuit has historically been well below the national average, after adjusting for the difference in age structure, the prevalence of diabetes among Inuit was comparable to that in the general Canadian population (). Rapid socio-cultural, environmental, and lifestyle changes experienced by First Nations, Inuit, and Métis populations in the last half century have had a tremendous impact on their health, and have contributed significantly to the higher rates of diabetes and its complications (). For instance, food insecurity has been linked to poor dietary quality and intake, multiple chronic conditions (such as diabetes, heart disease, and hypertension), obesity, mental health issues, poor developmental and educational outcomes, and family stress. Key factors impacting First Nations and Inuit food security include poverty and unemployment; environmental changes affecting traditional food harvesting and consumption; lack of access to the land; loss of cultural identities, traditional knowledge and traditional food practices; geographic isolation; and the unreliable supply, quality, and high prices of market food in remote and isolated communities (). The Government of Canada invests C$ 80.1 million per year in community-based, culturally appropriate healthy living programs, including the Aboriginal Diabetes Initiative to promote healthy behavior and supportive environments in the areas of healthy eating, physical activity, food security, chronic disease prevention, management and screening, and injury prevention policy.
Suicide rates among some First Nations and Inuit populations in Canada are disproportionately higher than among the overall Canadian population. Suicide mortality rates among males (aged 1 19) are 10.7 times higher in areas with a high proportion of First Nations residents (2005 2007) () and 35.0 times higher in Inuit Nunangat (2004-2008), as compared to the rest of Canada (). Suicide mortality rates amongst females (aged 1 19) are 21.3 times higher in areas with a high proportion of First Nations residents (2005 2007) () and 28.4 times higher in Inuit Nunangat (2004 2008), as compared to the rest of Canada ().
In some indigenous communities, the high rate of suicide has been linked to historic trauma, cultural loss, and social upheavals as a result of settlement, colonization, and assimilation policies, such as Indian residential schools. The lasting impact of these experiences include the erosion of traditional cultural practices, family structure, and community support networks, as well as mental health and substance abuse issues, which have contributed to higher suicide rates in some Aboriginal communities (). The recognition that culture is a key protective factor of mental health has led to culturally based and culturally relevant Government initiatives, such as the National Aboriginal Youth Suicide Prevention Strategy (). Health Canada supports multi-disciplinary, community-based mental wellness teams that provide culturally safe and competent mental health services and clinical supports.
Guided by the Canada Health Act, provinces and territories deliver hospital, physician and public health programs to all Canadians, including First Nations and Inuit, but typically do not operate health systems in “on reserve” First Nations communities. In order to support First Nations and Inuit in reaching an overall level of health that is comparable with that of other Canadians, Canada funds or provides several programs, such as:
- Community based programming, including health promotion and disease prevention programs, and public health services on reserve
- Primary care nursing in 80 remote and isolated First Nations communities, where access to provincial or territorial healthcare services is limited
- Home and Community Care currently serving 98% of First Nations communities and 100% of Inuit communities
- Supplementary health benefits through the Non-Insured Health Benefits Program (e.g. drugs, dental care, vision care, medical supplies/equipment, short-term crisis intervention mental health counseling, and medical transportation to access medically-required health services not available on-reserve or in the community of residence)
- Funding for community-based health facilities and capital projects to maintain the health infrastructure needed to deliver health programs and services
- Environmental Public Health Programming, including identification and prevention of environmental public health risks and recommendations for corrective action to reduce these risks in the areas of: drinking water, food safety, environmental contaminants, health and housing, wastewater, and solid waste disposal.
Cancer and heart disease, the two leading causes of death in Canada, were responsible for over one-half (54.0%) of the 238,617 deaths in 2012 (). Cancer accounted for 30.2% of all deaths in 2012, followed by heart disease (19.7%). The other eight leading causes of death, in rank order, were stroke, accidents (unintentional injuries), chronic lower respiratory diseases (the majority were chronic obstructive pulmonary disease), diabetes, Alzheimer’s disease, influenza and pneumonia, suicide, and kidney disease (Table 2) (). These 10 leading causes accounted for 75.0% of all deaths in 2012, a decrease in comparison with the 80.3% figure for 2000. By age group, there were differences in the leading causes of death. Congenital abnormalities was the leading cause of death for infants under 1 year of age, accidents (unintentional injuries) for those aged 1 to 34, cancer for those aged 35 to 84, and heart disease for those aged 85 and over. For young adults aged 15 to 24, the top three causes of death, in rank order, were accidents, suicide, and cancer. Between 2000 and 2012, age-standardized mortality rates were on a downward trend in general for all 10 leading causes of death. The standardized rates for stroke and heart disease decreased the most (42.4% and 39.7% declines, respectively), while the rate for accidents decreased the least (1.9% decline). The rate for the leading cause of death, cancer, saw a 14.6% decline.
TABLE 2. Ten leading causes of death, by rank, Canada, 2012
|Rank||Cause of death||Number||%|
|1||Malignant neoplasms (cancer)||74,361||30.2|
|2||Diseases of heart (heart disease)||48,681||19.7|
|3||Cerebrovascular diseases (stroke)||13,174||5.3|
|4||Accidents (unintentional injuries)||11,290||4.6|
|5||Chronic lower respiratory diseases||11,130||4.5|
|6||Diabetes mellitus (diabetes)||6,993||2.8|
|8||Influenza and pneumonia||5,694||2.3|
|9||Intentional self-harm (suicide)||3,926||1.6|
|10||Nephritis, nephrotic syndrome and nephrosis (kidney disease)||3,327||1.3|
Notes: Causes of death are coded according to the 10th revision of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10).
At the end of 2014 an estimated 75,500 Canadians were living with HIV and AIDS, up from 68,800 at the end of 2011. Of these, an estimated 16,020 (13,000 19,000) persons were unaware of their HIV infection. At the end of 2014, men who have sex with men were the population most affected by HIV in Canada, accounting for an estimated 49.3% of all prevalent HIV infections. An estimated 31.3% were infected through heterosexual contact and 15.3% from the use of injection drugs (). Approximately 2,570 new HIV infections were estimated to have occurred in 2014, compared to an estimated 2,800 new infections in 2011 (). Women accounted for an estimated 23.2% of new HIV infections in 2014, where heterosexual contact was identified as the main exposure category.
Indigenous peoples (approximately 4% of the country’s population) were disproportionately represented among HIV infections, with an estimated 10.8% of new infections in 2014 and 9.1% of all prevalent infections at the end of 2014. Disproportionate rates of infection have also been noted among people living in Canada who were born in countries where HIV is endemic. This group makes up approximately 2.5% of the Canadian population, but accounted for an estimated 13.9% of new infections in 2014 and 15.0% of prevalent infections at the end of 2014 (). The burden of HIV and AIDS cases in Canada has been concentrated in the four largest provinces-Alberta, British Columbia, Ontario, and Quebec-which, as of the end of 2014, accounted for 92.8% of all HIV-positive test reports since 1985 ().
Between 2004 and 2014, the total number of reported cases of active tuberculosis (TB) disease in Canada remained relatively stable, at approximately 1,600 cases per year (). In 2014, 1,568 cases of active TB disease were reported, representing a 5% decrease from the number of cases reported in 2013 and a corresponding decrease in the overall incidence rate of active TB disease from 4.7 per 100,000 to 4.4 per 100,000. The territory of Nunavut had the highest annual incidence rate at 229.6 per 100,000 population ().
Foreign-born individuals and Canadian-born Indigenous peoples continued to be disproportionately represented among reported cases of TB in 2014. In 2014, foreign-born individuals made up approximately 22% of the total Canadian population but accounted for approximately 69% of reported cases, with a corresponding incidence rate of 13.7 per 100,000 population (). In 2014, Canadian-born Indigenous peoples (approximately 4% of the total Canadian population) accounted for approximately 21% of reported cases, with a corresponding incidence rate of 20.4 per 100,000 population. Within the Canadian Indigenous population, the highest incidence rate was among the Inuit, at 198.3 per 100,000 population. Canadian-born non-Indigenous people accounted for the lowest percentage of reported cases at 10%, for an incidence rate of 0.6 per 100,000 population.
Chronic, Noncommunicable Diseases
Chronic, noncommunicable diseases (NCDs) pose the greatest threat to the health of Canadians. Currently, two out of five Canadians age 12 years and older live with one or more chronic diseases (). Indigenous populations in Canada experience a greater burden from NCDs compared to the rest of the Canadian population, suffering from higher rates of heart disease, diabetes, and asthma, as well as suicide.
According to the Canadian Community Health Survey (CCHS), in 2014, 1.5 million Canadians over the age of 12 (5% of Canadians, 4% of females and 6% of males) reported having heart disease diagnosed by a health professional, and 328,000 Canadians (1%) reported living with the effects of a stroke (). In that same year, according to self-reported data, 1% of the population suffered from stroke; 5% (6% of men and 6% of women) suffered from heart disease (including heart attack, angina, and congestive heart failure); and 18% (figures were similar for men and women) suffered from hypertension or used medication to control high blood pressure. Further, 34% of the population self-reported as overweight (40% of men and 28 % of women); 20% reported that they were obese; and 7% had been diagnosed with diabetes according to medical records (8% of men and 6% of women) (). In 2013, heart attack and heart failure ranked as the third and fourth highest volume inpatient hospitalizations in Canada. More specifically, heart attack and heart failure accounted for 2.4% and 2.0% of all inpatient hospitalizations, respectively ().
Malignant neoplasms are the leading cause of mortality in Canada, with increases in the number of new cancer cases due mainly to a growing and aging population. Between 2000 and 2012, age-standardized mortality rates declined, on average, by at least 2% per year for lung, prostate, and larynx cancers in males; breast and oral cancer in females; and stomach cancer and non-Hodgkin lymphoma in both sexes (). However, between 2001 and 2010, thyroid cancer incidence rates rose an average of 6% per year for males and 4% for females; melanoma of the skin by 2% in males and 3% in females; uterus cancer by 3%; and liver cancer rates rose an average of 2% for both sexes. Between 2000 and 2010, age-standardized incidence rates declined, on average, by at least 2% per year for prostate and stomach cancer in males and for larynx cancer in both sexes. Cancers of the breast, colon/rectum, and lung that were diagnosed between 2000 and the end of 2009 accounted for 37% of 10-year prevalent cases (both sexes combined); breast cancer accounted for 39% of 10-year prevalent cases in females while prostate cancer accounted for 43% of cases in males. As the number of Canadians diagnosed with cancer continues to grow and cancer survival increases, cancer prevalence rises.
The Canadian Chronic Disease Surveillance System (CCDSS) reported an increase in the age-standardized prevalence of diagnosed diabetes in Canada, from 4.8% in 2001 to 7.6% in 2012; representing an average annual increase of 4.2%. More than 2.7 million (7.7%) Canadians aged 1 year and older (7.2% of females and 8.3% of males) were living with diagnosed diabetes (type 1 and 2 combined) in 2011-2012. The prevalence of diagnosed diabetes was lower among children and adolescents aged 1 19 (0.3%) than among adults aged 20 and older (9.8%) Among adults, the prevalence increased with age from 4.5% among those 35-49 to 24.6% among those aged 65-79 and 26.1% for those aged 80 and older (). The number of prevalent cases for diagnosed diabetes is projected to be over for 4 million by 2020 (). The age-standardized incidence rates of new diagnoses of diabetes increased from 660 per 100,000 population in 2001 to a high of 761 per 100,000 in 2007, with an average annual increase of 2.2%; they decreased thereafter to 662 per 100,000 in 2012, representing an average annual decrease of 2.2% (). The increase in diabetes prevalence rates is likely attributable to the high rates of obesity and overweight and the ageing of the Canadian population ()(). Adults aged 20-64 years old with diabetes had a life expectancy five to ten years lower than their counterparts without diabetes ().
Mental illness and addictions rank third in terms of disability adjusted life years (), with one in every three Canadians experiencing mental illness or addictions in their lifetime (). In 2012, 11.3% of Canadians aged 15 or older reported experiencing a major depressive episode at least once in their lifetime, and 2.6% reported experiencing bipolar disorder. Generalized anxiety disorder affected 8.7% of the population at some point in their lives (). Schizophrenia affects 1% of the Canadian population and onset is usually in early adulthood (). About two-thirds of Canadians, who felt they needed mental health services, reported that their needs were met ().
According to the Mental Health Commission of Canada, by 2041 seniors will have the highest rate of mental illness in Canada. One in four seniors live with a mental health problem or mental illness, and as this population grows so too will the need for mental health services (). The most common mental illnesses after age 65 are mood and anxiety disorders, cognitive and mental disorders due to a medical condition (including dementia and delirium), substance misuse (including prescription drugs and alcohol), and psychotic disorders (). Among seniors, men account for the majority (about 80%) of deaths by suicide. In addition, males over the age of 85 experience the highest rate of suicides among seniors (). Indirect costs related to mental illness in Canada have been shown to range from C$ 11 to C$ 50 billion ().
Risk and Protection Factors
Despite decades of efforts to combat it, tobacco use continues to take its toll on the Canadian population. There are over five million tobacco users in Canada (including 4.2 million current cigarette smokers or 15% of all Canadians aged 15 years and older); moreover, the decline in the rate of tobacco use among youth witnessed since 2003 has slowed. Approximately, 87,000 Canadians become daily smokers and 37,000 Canadians die prematurely from smoking related diseases each year. Tobacco use remains the leading preventable cause of premature death in Canada. In 2013, the prevalence of past 30-day use of at least one tobacco product was 13% among youth aged 15 19; 24% among young adults aged 20 24; and 17% among adults aged 25 years and older ().
In 2013, 76% of Canadians (or 21.9 million persons) reported having consumed an alcoholic beverage in the previous year. There was a higher prevalence of males than females reporting past-year alcohol use (81%, or 11.5 million males, and 71%, or 10.4 million females). Sixty percent (60% or 1.3 million) of youth aged 15 to 19, 83% (2.0 million) of young adults aged 20 to 24 and 77% (18.6 million) of adults aged 25 years and older reported past-year drinking (). Among Canadians who consumed alcohol in the past year, 21% (representing 16% of the population aged 15 years and older, or 4.4 million persons) exceeded Canada’s Low-Risk Alcohol Drinking Guidelines (LRDG) for chronic effects and 15% (representing 11% of the population aged 15 years and older or 3.1 million) exceeded that guideline for acute effects ().
The guidelines were exceeded by young adults aged 20 to 24 years at higher rates than among youth aged 15 to 19 and adults aged 25 years and older. Twenty-nine percent (29% or 575,000) of young adult drinkers versus 20% for both youth drinkers () and adult drinkers (3.5 million) exceeded the guideline for chronic risk, while the acute-risk guideline was exceeded by 23% () of young adult drinkers compared to 15% () of youth drinkers and 14% (2.5 million) of adult drinkers ().
The prevalence of past-year cannabis use among Canadians aged 15 years and older was 11% (3.1 million) in 2013, unchanged from 10% (2.8 million) in 2012. The prevalence rate in 2013 among youth aged 15 to 19 (22%, or 469,000) and among young adults aged 20 to 24 (26% or 635,000) was higher than that among adults 25 years and older (8%, or 1.9 million). Past-year use of the most commonly reported illicit drugs after cannabis was estimated to be less than 1% for each cocaine or crack (0.9%, or 259,000), hallucinogens (0.6%, or 163,000), ecstasy (0.4% or 111,000), speed/methamphetamine (0.2% or 48,000) (). Furthermore, although rates are low, psychoactive pharmaceutical drug abuse has emerged as an issue of significant concern. In 2013, 0.3% of Canadians 15 years age or older reported past year abuse of pain relievers and 0.1% reported the abuse of stimulants. There were too few Canadians who reported abuse of sedatives, measured by use for the experience, the feeling they cause or to get high, for the estimate to be reportable (). In 2014-2015, 4.0% of youth in grades 7 12 reported using at least one psychoactive pharmaceutical to get high. The prevalence of abuse of pain relievers was the highest at 3.0% ().
Opioid use is on the rise in Canada. For a full discussion of this issue, please see the subsection on “Rising Opioid Use” within the section of “Leading Health Challenges.”
Between 2012 and 2015, fiscal constraints, the high cost of new technology, and the aging of the baby-boom generation (those born 1946 to 1965) added to the challenges faced by the Canadian health care system. . Efforts to stem the growth of health spending while improving access to health care services has been a major priority during these years, which has contributed to low wait times for specific interventions such as cataract and knee replacement surgery (). Advances in population health across federal, provincial/territorial, and community levels are noteworthy: for example, Canada’s survival rates for breast, cervical, and colorectal cancer are at least slightly higher than the OECD average (), and tobacco smoking among adults has been successfully reduced. On the other hand, obesity rates among children and adults are higher than in other OECD countries ().
Canada’s system of universal coverage for medically necessary hospital and physician services has served Canadians well, but gaps have begun to emerge in providing care to an aging population and its associated increase in the incidence and prevalence of chronic conditions. To cope with these challenges, experts and governments agree that, moving forward, Canada’s health care system must continue to shift service delivery from acute-care settings into the community and the home to better meet the evolving health needs of Canadians.
Canadian federal, provincial/territorial, and local governments recognize that the health system must become more patient-centered and responsive to current needs, while remaining sustainable over the longer-term. Provincial and territorial governments have been investing significant efforts and resources to transform and strengthen their health care systems ().
The full benefit of digital health technologies has yet to be realized. While the core elements of a digital health information system are clearly in place, efforts must now focus on better connecting and wider use of these technologies in order to reap the promise of digital health to transform the delivery of health care. In this regard, in 2016, C$ 40 million in federal funding was allocated to Infoway for building a multi-jurisdictional e-prescribing system. With home care a priority for the federal government, interest also has grown in tele-homecare. Through telehomecare programs, health care providers remotely monitor patient data and support patients and caregivers in learning new skills to manage their condition from home. This has been shown to reduce emergency room visits and hospitalizations. In 2016 Infoway was allocated C$ 10 million in federal funding for telehomecare projects.
The federal government has committed to work collaboratively with provinces and territories to improve health care through a new multi-year health accord. Health ministers at the federal and provincial/territorial governments have been working to identify those priorities and actions that will have the greatest impact in transforming health care systems, such as supporting the delivery of more and better home care services, including palliative care; improving access, affordability, and appropriate use in relation to pharmaceuticals; fostering innovation in the organization and delivery of health care services; and better access to mental health services. Health ministers have also worked with Indigenous leaders to determine areas of shared priority, and to improve the coordination, continuity, and appropriateness of health services for Indigenous Peoples ().
Reducing health inequalities will continue to be a national concern. All government levels are working together to better understand how social and economic structures, systems, and policy approaches affect health, and how health and social gains can be better addressed collaboratively. Health inequalities experienced by Indigenous peoples is of particular concern, and the federal government is working with partners, including provincial and territorial governments, to provide effective, sustainable and culturally appropriate health programs and services to First Nations and Inuit. The Government is investing C$ 8.4 billion over the next five years to improve the socioeconomic conditions of Indigenous peoples and their communities. Specifically, the Government is investing C$ 270 million over the next five years to replace and renovate health facilities such as nursing stations, health centers, and treatment centers in First Nations communities, as well as C$ 141 million over the next five years to improve the monitoring and testing of on-reserve community drinking water. To support the mental wellness needs of First Nations and Inuit Communities, the Government is providing over C$ 300 million in 2016, including support for mental health promotion, addiction and suicide prevention, crisis response services, treatment and aftercare.
The Government of Canada is actively working to help Canadians make healthier food choices for themselves and their families. The multi-year Healthy Eating Strategy, includes legislative, regulatory and policy initiatives focused on reducing sodium and industrially produced trans fat in processed food, labeling of sugar and food colors, restricting marketing to children, strengthening nutrition and ingredient labeling, as well as plans to transform the dietary guidance provided through the Canada Food Guide. The Government of Canada also supports increased access to and availability of nutritious foods by updating and expanding the Nutrition North Canada program, a retail subsidy to help make perishable nutritious foods more accessible and more affordable to residents of isolated northern communities without year-round (road, rail, or marine) access ().
Prevention will be a key element in stemming the rise in chronic diseases. In an effort to place greater emphasis on prevention, the Public Health Agency of Canada (PHAC) has been advancing innovative, multi-sectoral partnerships to promote healthy living and address chronic disease prevention. These partnerships and funding models, which may take different forms, focus on addressing integrated risk factors that underlie the major chronic diseases (i.e., physical inactivity, unhealthy eating and tobacco use), and on achieving measurable results. Since 2013, PHAC has invested C$ 49 million in contributions programming through its “Multi-sectoral Partnerships to Promote Healthy Living and Prevent Chronic Disease” initiative and has leveraged C$ 43 million from other sources ().
Addressing mental health is also a key priority for the Government of Canada. Specific priorities in mental health promotion and mental illness prevention include working with provincial and territorial governments to make access to high quality mental health services available for Canadians who need them. In addition, the Federal Framework for Suicide Prevention, which outlines the Government of Canada’s approach to suicide prevention, focuses on raising public awareness and reducing its stigma, disseminating information and data to help prevent suicide, and promoting the use of research and evidence-based practices in suicide prevention.
Immunization rates among children in Canada remain below national immunization coverage goals at two years of age, despite the existence of a publicly funded immunization program for children under 17. Parental acceptance and uptake of vaccines are influenced by various factors. The vaccine hesitancy phenomenon has been associated with a rise in concerns over vaccine side effects, exacerbated by anti-vaccination social media and online information sources. Yet, a study published by C. D. Howe indicates that the most often reported reasons given by parents who do not have their children immunized are barriers to access, complacency, or procrastination, not because they actively object to vaccines (). To help address these challenges, in 2016 the Government of Canada announced C$ 25 million over five years to update the national immunization coverage goals and disease reduction targets, improve Canada’s ability to identify under- and un-immunized Canadians, and develop a focused program to improve vaccine access and uptake.
The Government’s investments in social infrastructure will be an integral part of Canada’s strategy to strengthen the middle class, promote inclusive growth for Canadians, help lift more Canadians, including children and seniors, out of poverty, and reduce inequalities. To that end, Canada has committed to develop a 10-year infrastructure plan with initial investments totaling C$ 3.4 billion over two years that will help expand safe, adequate and affordable housing (including shelters for victims of violence), prevent and reduce homelessness, support early learning and child care, renew cultural and recreational infrastructure, and improve community health care facilities on reserve.
The new Canada Child Benefit, which consolidates former child benefits and provides additional support to those who need it most, will lift an estimated 300,000 children out of poverty in 2017. For seniors, the Guaranteed Income Supplement top-up was increased by C$ 947 annually, which more than doubles the former maximum top-up. Furthermore, the increase in the age of eligibility for Old Age Security benefits from 65 to 67, which was scheduled to take place in 2023, has been cancelled.
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1. Low-income cut-off: the prevalence shows the proportion of people living below the low income cut-offs within a given group. Low-income is defined as the income levels at which families or persons not in economic families spend 20% more than average of their before tax income on food, shelter and clothing.
2. Registered psychiatric nurses are currently regulated in the four Western provinces (Manitoba, Saskatchewan, Alberta, British Columbia) and in Yukon; however, Yukon numbers are omitted from this data.
3. For the remainder of this chapter, currency values will be given in Canadian dollars. In 2015, the Canadian dollar was greatly devalued compared to the US $, which makes it impractical to convert the Canadian currency to the US currency.
4. An EHR is a system of secure digital repositories that make up an individual’s medical history (including medication profiles, lab results, diagnostic imaging results, etc.) while an EMR is an office-based system at the point of service (e.g. physician’s office).
5. Canada uses the Low-Risk Alcohol Drinking Guidelines (LRDG) as a basis to report alcohol consumption in the seven days prior to taking the survey. People who drink within the low-risk alcohol drinking guidelines consume no more than the recommended quantity of alcohol within the number of days specified, whereas those who exceed the guidelines consume more alcohol than recommended within the stated timeframe.