Health System Performance: What Matters (A Case Study of Canada and the United States)

1. Health System Performance: What Matters(A Case Study of Canada and the United States) Clyde Hertzman HELP, CHSPR, HC&E

2. Female Life Expectancy in Canada vs the United States

3. Male Life Expectancy in Canada vs the United States

4. Infant Mortality in Canada vs. The United States, 1960-2002

7. Infant Mortality per 1,000 Mortality by Neighbourhood Income in Urban Canada, Wilkins R, Berthelot JM, Ng E, March 2001

8. Infant Mortality Rates: US vs Canada, 1996 Canada US Poorest 20% 6.5/1000 --- Second 5.2 --- Third 5.1 --- Fourth 4.7 --- Richest 20% 3.9 --- Overall 5.2 7.8

9. Quantitative Literacy Scores for Youth Aged 16-25. International Adult Literacy Study, 1994 Sweden Germany Level 1 Level 2 Level 3 Level 4 Switzerland Effect Size Netherlands Belgium Canada USA Poland New Zealand Ireland N Ireland G Britain Parents’ Level of Education Organisation for Economic Co-operation and Development and Statistics Canada. (1995) Literacy, economy, and society: results of the first international adult literacy survey. OECD/Ministry of Industry Canada, p 151.

10. Working Age (25-64) Mortality by Median Share U.S., Canadian, and Australian Metropolitan Areas

11. National Expenditure on Health in Canada vs the United States

12. Socioeconomic Gradients in Medically Avoidable Deaths, Canada, 1971-1996 “……from 1971 to 1996, the disparity [from income quintile 1 to 5] for causes amenable to medical intervention diminished 60% (1287 age-standardized expected years of life lost per 100,000) in men and 78% (1264 SEYLL per 100,000) in women………” Ref: James, Wilkins, Detsky, Tugwell, Manuel, JECH, 2007.

13. Purchasing Power Parity Adjusted Gross Domestic Product Per Capita: Canada Vs. The United States

14. Unemployment Rates: Canada Vs. The United States

15. Gini Coefficient of Income Inequality: Canada vs the United States

16. Public Social Expenditure in Canada vs the United States

17. Redistribution in Canada vs the United States: The Impact of Taxes and Transfers on Inequality

18. Postmaterialist Values in Canada vs the United States, 1990-1991

19. Trust in Canada vs the United States

20. Factoid ……..until 1979, the rate at which immigrants from specific countries of origin obtained citizenship in Canada and the United States was approximately the same….thereafter, the rate in Canada went up and the rate in the US went down, for all groups except Vietnamese………. Ref: Bloemraad

21. Percentage of Unemployment Insurance Beneficiaries to Total Unemployed for Canada, Germany & USA,1976-2006 Sources: Canadian Data: Statistics Canada Cansim II Series V384606, V385120; American Data: US Department of Labor & Bureau of Labor Statistics; German Data: Schneider 2004 Table 5, p 113

22. After-Tax Income Gap is Bigger than Ever for Families Raising Children in Canada (ratio of after-tax income in deciles 10 and 1, 1976-2004) Yalnizyan, 2007

23. Percentage of Students Vulnerable on One or More scales of the EDI Based on Provincial cutoffs, Wave 1

24. Percentage of Students Vulnerable on One or More Scales of the EDI Based on Provincial cutoffs, Wave 2

25. Take home lesson 1 • Societal institutions that are determinants of health, and therefore, de facto, integral to the ‘health system’, evolve over historical time, and their impact on health status emerges gradually, too • Thus, societies can (unwittingly) undermine population health through policy change

26. Take home lesson 2 Despite strides in population-based, longitudinal, person-specific data systems, we do NOT have a measurement regime that: • is based upon a consensus as to the societal characteristics that support or undermine health • monitors these characteristics in an internationally consistent way • identifies and monitors ‘leading outcome indicators’ such as ‘gradients’ in health/ socially sensitive populations • adequately accounts for the element of time