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  • Photograph by Sam Javanrouh

Reaping What We've Sown: Canada's Health Profile Continues to Decline

By Dennis Raphael

Today’s reality is the result of yesterday’s decisions. The health of Canadians today is greatly influenced by the policy decisions made at the end of the last century. Our declining health status as a nation is the direct downstream effect of bad choices.

The mid-1990s saw the importation of neo-liberal and neo-conservative ideology into Canada on a scale never before seen. All levels of government began to drastically curtail the resources made available to citizens in general and the vulnerable in particular. In Canada, the not-so-liberal Liberal Party in Ottawa and the not-so-progressive Progressive Conservative Party in Ontario, slashed program spending at the same time they reduced corporate and income taxes for the well-off. In Ottawa, it was called Sound Fiscal Management. In Ontario, this all-out assault on the welfare state was termed The Common Sense Revolution.

I asked myself, is this what we really wanted for Canada?

In the midst of all this in 1996, Richard Wilkinson’s book, Unhealthy Societies: The Afflictions of Inequality, was published. This book documented in great detail the social disintegration that had occurred in the UK as a result of nearly 20 years of Thatcherite rule. The parallel between what happened in the UK and what was happening in Canada was striking. Is this what we really wanted for Canada? I asked.

Almost 20 years later, I can now report that we have paralleled the Thatcherite achievements in Canada. Canada’s standings among wealthy nations on the factors that shape health – the social determinants of health – and health itself has now descended to levels that approach one of the worst health offenders among the member nations of the Organization for Economic Cooperation and Development (OECD), the USA. The table below shows how Canada stands against another wealthy oil-nation like itself, Norway and the USA in these relative rankings.

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Canada now ranks 17th among OECD nations in life expectancy (we were ranked 8th in 1980) and 26th in infant mortality (we were ranked 10th in 1980.) Our low birth weight rate falls behind 11 other nations, most of which are not as wealthy as Canada, and our ratings for child well-being were so poor it led UNICEF Canada to offer a special report on the Canadian situation entitled Stuck in the Middle.

We now spend less of our Gross Domestic Produce on social programs and supports than even the USA! We are amongst the lowest in covering health care expenses through the public system. And if you fall upon bad times, we provide amongst the lowest minimum-income supports. This is the case despite Canada being ranked 11th of 34 OECD nations in overall wealth, i.e., GDP Per Capita adjusted for spending power.

It's high time we learned from the mistakes of recent decades and started investing in a healthier Canada for the generations to come

To my mind, this is due to the growth in social inequality related to governmental withdrawal from managing the economy and implementing public policies that favour the wealthy. But don’t take my word for it. Look at a lengthy report from the OECD summarized here. It highlights growing income and wage inequality, lack of affordable housing, and reductions in income supports to those in need.

And if none of this concerns you, consider that children experiencing deprivation – a key component of Canada’s mediocre performance on child well-being -- not only suffer greater incidence of numerous diseases and injuries in childhood, but are much more likely to suffer from heart disease and adult-onset diabetes as adults regardless of their so-called “lifestyle choices” as adults.

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Photo by Greg Westfall

This massive social experiment has had a very clear result: improvements in health such as life expectancy and reductions in infant mortality in Canada have lagged well behind most other wealthy nations and we can expect this trend to accelerate if no action is taken. In the USA – whose public policies we are increasingly mimicking -- there is evidence that health status is declining in absolute terms

For many of us, it’s too late (see especially this Statistics Canada report of how 40,000 Canadians die prematurely each year as a result of social inequality). However, what we choose to do today is the upstream influence on the health of those to come. It is high time we learned from the mistakes of recent decades and started investing in a healthier Canada for the generations to come.

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Dennis Raphael, Ph.D., is a professor of health policy and management at York University in Toronto. He is co-author of Social Determinants of Health: The Canadian Facts, which can be downloaded at no cost from http://thecanadianfacts.org.

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