10 Hserv 482 Canada

1. 10 Hserv 482 Canada

2. Learning Objectives • Describe plausible reasons for Canada's good standing in the Health Olympics • List factors that may be involved in the decline in standings over the last decade

3. My Background • born in Toronto, lived there for the first 23 years of my life, went to U of Toronto • lived a year in Montreal in 1970s as an intern at McGill University • lived and worked as a doctor in BC in the 1970s • worked for University of Calgary in 1980s • cared for my father in Toronto nursing home, and BC nursing home • own land in BC • continue to spend much time there • Vancouver, Lower Fraser Valley, Toronto, Montreal, Edmonton • in the mountains (Yukon, Rockies, Selkirks, Coast Ranges)

4. Canada comparisons with the US • Canada a British Colony from 1700s • strong ties with England continued to recent times • social welfare contract: • baby bonus checks • publicly supported education system with no private schools at university level and very few below that • more progressive taxation system • Universal coverage health care since 1960s • 1974 Lalonde Report (New Perspective on the Health of Canadians) • LaGuardia and Toronto airports 2002

6. United Nations Human Development Report 2007

7. BETTER HEALTH MORE EQUALITY Kaplan 1996 BMJ

8. BETTER HEALTH MORE EQUALITY Ross et. al. BMJ 2000

10. Highest Life Expectancy And disability free years Lowest Life Expectancy And disability free years Life expectancy disparity is 16 years

11. Metropolitan Income Inequality and Mortality in North America

12. Siddiqi & Hertzman SSM 2007

13. Life Expectancy Williams-Derry 2002

14. Cascadia 2002 NW Env Wa

15. Seattle Magazine August 2007

16. Infant Mortality: 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

17. Infant Mortality Rates, Status Indians and Other Residents, B.C., 1991-2001 Rate Per 1,000 Live Births Year Sources: BC Vital Statistics Agency, 1997 BC Ministry of Health Planning, 2003

18. LESS EQUALITY VIOLENCE AND INEQUALITY Daly 2001

19. LESS EQUALITY VIOLENCE AND INEQUALITY Daly 2001

21. More PRISONERS MORE EQUALITY Prisoners Wilkinson et. al. SSM 2007

22. More TRUST MORE EQUALITY TRUST Uslaner 02

23. After Willms 1999

24. Better SCHOOL Performance MORE EQUALITY Math and Literacy Scores Wilkinson et. al. SSM 2007

25. UNICEF League Table Educational Well-Being

26. Household Poverty Rates (Household Head Aged 25-64)

27. Solo Poverty% of children living below the poverty line, 1990-1992 Children in solo mother family • Children in two- • parent families Sweden 2.2 5.2 Denmark 2.5 7.3 Finland 1.9 7.5 Belgium 3.2 10.0 Italy 9.5 13.9 Norway 1.9 18.4 Netherlands 3.1 39.5 Canada 7.4 50.2 Australia 7.7 56.2 United States 11.1 59.5 Source: Canada Social Trends, 1996

28. Social Expenditure on Family Benefits as a % of GDP Rank • Sweden 2.23 1 • France 2.13 2 • Norway 1.91 3 • Finland 1.90 4 • Australia 1.36 5 • Canada 0.51 6 • USA 0.22 7 • Source: OECD Social Expenditure Database (1998)

29. Q5/Q1 Mortality Ratios Canada Mortality by Neighbourhood Income in Urban Canada, Wilkins R, Berthelot JM, Ng E,PPA March 2001 Age (yrs)

30. Canada beats USA But Loses Gold to Sweden

31. International comparisons of intergenerational social mobility Higher columns show that people’s social position is more strongly determined by their parents’ position Source: Blanden J, Gregg P, Machin S. Intergenerational mobility in Europe and N. America. Centre for Economic Performance, London School of Economics. 2005

32. More financial mobility MORE EQUALITY Father's and Son's Incomes If poor in US, stay poor Wilkinson et. al. SSM 2007

33. 16 nations, 169,776 people

34. Highest Life Expectancy And disability free years Lowest Life Expectancy And disability free years Life expectancy disparity is 16 years

35. BC/Washington ComparisonsBC WA

36. BC/Washington ComparisonsBC WA

37. BC/Washington ComparisonsBC WA

38. BC/Washington ComparisonsBC WA

39. Income vs. Income Inequality? • In Canada, income inequality health relationship is not as strong as in the US because of other supports that mitigate adverse effects of income inequality • McLeod 2003: prospective cohort study, SAH 94,96, 98 found low hh income associated with poor SAH, but not inc. ineq. (measured in 91 from census in 53 metro. areas) • Sanmartin 2003 Labour market income inequality in NA metropolitan areas: more effect in US than in Canada • Laporte (2003) provincial time-series modeling from 1980 to 1997 look at income and mortality don't find income or income inequality significant but health spending and unemployment predicts mortality better • Daly (2001) find homicide and inc. ineq. related in Canada as in US, with differences in inc. ineq. Explaining lower rates in Canada when lump states & provinces

40. Saez 2005

41. USA Canada Economic Comparisons

43. 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

44. Yalnizyan 2007

45. Yalnizyan 2007

46. United Nations Human Development Report 2007

47. United States

48. USA economic pie shares from 1992 to 2004 the wealth share of the least wealthy half of the population fell significantly to 2.5 percent of total wealth Source Federal Reserve Board Survey Of Consumer Finances and Forbes Pizzigati, Too Much http://www.cipa-apex.org/toomuch/articlenew2006/April24a.html

49. Harvey 2005

50. Health in Canada • Very good in comparison to US • The result of a historical social contract and redistribution that is not income-based • Not because of health care system Sin (2003) looking at children of very poor vs poor & non-poor families in Alberta had higher rates of asthma ER visits despite universal access (all births 850401 to 880331) followed for ten years