Country Report: Canada
Canada, the second largest geographical area in the world, is divided into 3 territories and 10 provinces. It is a member of the Organization for Economic Cooperation and Development (OECD) and the Group of Seven (G7).
In 2015, the country's population was 35,851,800. In 2011, 16% of the population was 65 years old or older, 18.9% was rural, about 20.6% were immigrants, and 4.3% were aboriginal peoples. Between 2010 and 2012, life expectancy at birth for women was 83.6 years, while for men it was 79.4 years. The population grew 29.9% between 1990 and 2015. While in 1990, the structure was stationary for those under 25 years; in 2015, there was a trend toward aging and a predominantly stationary trend in terms of reduced fertility and mortality.
The economy is the tenth largest worldwide, fuelled by Canada's abundant natural resources and trade. In 2013, the per capita gross domestic product (GDP) was US$ 42,780. The country has evolved into a multicultural society with a highly diverse population.
You can find the complete country profile of Canada in PLISA, Health Information Platform for the Americas.
- Antimicrobial resistance in infection treatment is a critical problem in health care. For this reason, the Government of Canada has adopted effective measures to address it.
- In 2014, the Government of Canada drafted Antimicrobial Resistance and Use in Canada: A Federal Framework for Action. This framework establishes a coordinated federal approach to address the threat of antimicrobial resistance in three strategic areas: surveillance, administration, and innovation.
- Accordingly, in 2015, a federal action plan was drafted that proposes concrete measures to be adopted between 2016 and 2019. A key achievement in the action plan was implementation of the Canadian Integrated Program for Antimicrobial Resistance Surveillance. It is a national program to coordinate the surveillance systems that compile information on antimicrobial resistance and the use of antimicrobial drugs in humans and animals.
- That specific surveillance system provides a general overview of antibiotic use and resistance in Canada, which is presented in a national annual report.
Figure 1. Distribution of the population by age and sex, Canada, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization, Platform of Health in the Americas Information (PLAITS).
SELECT BASIC INDICATORS
Source: UN Population and Statistics Divisions, 1990; PAHO; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- 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. Between 2011 and 2012, 8% of households reported food insecurity (up to 22% among off-reserve Indigenous households). First Nations and Inuit populations experienced higher levels of poverty, chronic diseases, and poor living conditions.
- The health status of First Nations and Inuit has steadily improved since 1980, but remains poor compared to other Canadians.
- 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.
- The country's social programs contribute to ensuring the health and well-being of all Canadians; funds have been allocated to grow the middle class and reduce inequalities.
HEALTH SITUATION AND THE HEALTH SYSTEM
- In 2014, 59.0% of the population 12 years or older reported having "excellent" or "very good" health, a situation that has remained relatively stable over the past decade.
- Mortality in children under 1 year was 4.8 deaths per 1,000 live births in 2012, with the most frequent cause of death being congenital anomalies, which occur in 3% to 5% of newborns and account for 23.2% of neonatal deaths.
- Malignant neoplasms are the leading cause of death in Canada, with increases in the number of new cancer cases due mainly to a growing and aging population.
- In late 2014, 75,500 people were carriers of the human immunodeficiency virus; among those, an estimated 16,020 did not know they had the condition.
- In 2014, 1,568 cases of active tuberculosis were recorded (4.4 cases per 100,000 population). The incidence rate among non-indigenous native-born Canadians was only 0.6 cases per 100,000 population, but among people born abroad and indigenous Canadian populations it was 13.7 and 20.4 cases per 100,000 population, respectively.
- Antimicrobial resistance poses a serious threat to the population. Among the measures the government has adopted is the Federal Action Plan on Antimicrobial Resistance and Use in Canada (2015), which includes concrete measures that will be adopted between 2016 and 2019.
- Two of five Canadians 12 years of age or older live with one or more chronic diseases, with Indigenous populations sustaining the highest burden of disease. In 2014, 5% of people over 12 years old reported having had a heart disease diagnosed by a health professional. One percent reported having suffered the effects of stroke, 6% of men and 6% of women had some form of heart disease (including heart attacks, angina, and congestive cardiac insufficiency), and 18% suffered hypertension or took drugs to control hypertension. Furthermore, 34% of the population reported excess weight, while 20% are obese.
- Diabetes prevalence reached 7.6% in 2012, with a higher percentage among those over 80 years old (26.1%). The life expectancy of adults between 20 and 64 years old with diabetes is five years less than that of people who do not have the disease.
- In 2013, 76% of the adults reported alcohol consumption, and 21% consumed it at a level of risk. 17% of adults over 25 years of age reported tobacco use, which continues to be the main avoidable cause of premature death in Canada. Consumption of cannabis among those over 15 years of age was 8% for adults aged 25 or older. It is estimated that 0.9% of the population consumes cocaine or crack; 0.6% hallucinogenic drugs; 0.4%, ecstasy; and 0.2%, methamphetamine.
- Overweight and obesity (according to Body Mass Index) affects around one-third of boys and one-fourth of girls. Contributing factors are sedentary lifestyle in childhood, unequal physical activity, the marketing of foods and beverages rich in fats, sugar, or sodium, increased availability of food, and larger portion sizes.
- The federal government plays an important role in relevant areas such as health promotion, the prevention and control of infectious and chronic diseases, disease surveillance, preparedness and response to public health emergencies and disease outbreaks, as well as research on health topics. It is also responsible for health protection and regulation (including the regulation of the pharmaceutical products, biologicals, food, and medical devices) and consumer safety.
- The purpose of health policies is to protect, promote, and restore the physical and mental well-being of the residents of Canada and facilitate reasonable access to health services, without financial or other barriers.
- The health system provides access to comprehensive coverage of medical and hospital-based services. The Canada Health Act sets forth the country’s publicly funded health insurance, which facilitates “reasonable access to health services without financial or other barriers.”
- Approximately 70% of health expenditures are publicly financed, primarily through taxation. Some provinces also charge their residents a dedicated premium to help pay for the cost of health care; non-payment of this fee does not prevent access to necessary health services.
- In 2014, total health expenditures represented 10.9% of GDP, with per capita health expenditure at 6,073 Canadian dollars. The public sector assumes approximately 70% of total health expenditures. Hospitals and physicians are primarily financed through the public sector, while the private sector primarily covers the cost of other health professionals (excluding nurses) and drugs.
- The 10-year Plan of Action to improve health care (adopted in 2004) established 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 system.
- In 2015, there were 82,198 active physicians (228 physicians per 100,000 population) and 415,864 registered nurses, with shortages in some jurisdictions, particularly remote rural areas. In most provinces and territories, nurses can provide some diagnoses and treatments.
- Significant investments have been made in telehealth through computer support for video conferences between patients and health care providers, medical consultations, transfer of diagnostic materials, and remote monitoring of patients. Some 70 specialties use telehealth resources, mainly to serve the almost seven million residents who live in remote rural communities.
- The federal Government supports a comprehensive agenda of research on health topics in an array of disciplines, sectors, and regions. This research yields a better understanding of the population’s emerging health needs, how the health system is evolving, and the information needs of those who formulate health policies.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The health system offers universal coverage of essential health-care needs. However, some gaps in care have begun to emerge related to population aging and the increase in chronic diseases.
- 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.
- Since 2012, the health system has been challenged by fiscal constraints, the high cost of new technology, and the aging of the population. The provincial and territorial governments are investing considerable resources to transform and strengthen their health care systems, particularly to support home-based health services, palliative care, and mental health.
- More use is being made of digital health technologies, with efforts to improve connections and expand their use in health care. The system of home-based telehealth is noteworthy, which has been proven to reduce emergency room visits and hospitalizations.
- The government’s strategy regarding the social determinants of health seeks to improve the social infrastructure, strengthen socioeconomic opportunities and conditions for the middle class, promote inclusive growth, and reduce poverty and inequalities. The Government plans to develop a 10-year plan to improve housing conditions.
- Reducing health inequalities will continue to be a national priority. Of particular concern is the need to improve the social and health conditions of the indigenous populations. The Government is implementing concrete actions to improve the socioeconomic status of indigenous people and communities, improve health centers, and establish appropriate health programs and services.
- Active work in health promotion also continues, including a multi-year strategy for healthy eating, with support to improve access to and the availability of nourishing food. The Public Health Agency of Canada has set up innovative and multisectoral partnerships to promote healthy lifestyles and address chronic disease prevention. Prevention will be a key element for combating the increase of chronic diseases.
- Mental health also is a key priority, with increased incidence as a consequence of the growth of the population over 65 years old, a group found to have a greater proportion of mental health problems.
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