Pan American Health Organization

Canada

  • Introduction
  • Leading Health Challenges
  • Health Situation and Trends
  • Prospects
  • References
  • Full Article
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Overall Context

Flag of CanadaCanada, 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

Source: Pan American Health Organization, based on the United Nations

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

Emerging Diseases

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

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:

  1. Better informing Canadians about the risks of opioids: this includes new warning stickers, patient information sheets, and review of best practices
  2. 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
  3. 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
  4. 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
  5. Improving the evidence base: bringing together experts in the field to discuss how to improve data collection and the Canadian evidence base.

Human resources

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.

Food safety

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.

Violence

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

Health Policies

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.

Health Legislation

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.

Seniors 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.

HIV/AIDS 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.
Mental Disorders 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 ().

Health Services

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.

Prospects

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.

References

1. United Nations Development Programme. Human development report 2015 [Internet]. New York: UNDP; 2015. Available from: http://hdr.undp.org/sites/default/files/2015_human_development_report.pdf Accessed on 4 July 2016.

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Reference/Note:

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.

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