# Healthy Populations

## The Healthy Populations domain considers the physical, mental, and social wellbeing of the population. It examines life expectancy, lifestyle and behaviours, and the circumstances that influence health such as access to health care.

Healthy Populations captures both the overall health of the population (“health status”) as well as factors that influence health (“health determinants”). This broad perspective is used because individuals’ lifestyles and behaviours are constrained and shaped by broader social factors such as how food is distributed and priced, how houses are constructed and located, how urban transportation is designed, how accessible health care and recreational services are, and how we interact with the natural environment.

### Healthyhabitsmeet troubling trends

The overall trend for Healthy Populations is positive, but it masks troubling changes in recent years. Even though flu shot rates are up, fewer teens than ever are smoking, and we are living longer, not all of the signs are good. Canadians’ ratings of their overall health status and their mental health have declined since the late 2000s, coinciding with the downturn in the economy. Diabetes has more than doubled. One in five people have a health or activity limitation, and fewer people have a family doctor. And certain groups of Canadians are hurting more than others.

Healthy Populations domain raw data

Life expectancy for Canadians at birth is now over 82 years — one of the highest in the world. We have seen a steady increase every year since 1994 when life expectancy was just over 78 years. Life expectancies do not vary much regardless of where Canadians live with the exception of our northern territories. In Yukon, Northwest Territories, and Nunavut, life expectancy is on average 75.1 years — more than 7 years less than the national average.

Women continue to live longer than men — 83.6 years compared to 79.4 years in 2012 — but the gap is closing. Between 1994 and 2009, life expectancy for men increased by 3.8 years, compared to 2.3 years for women.

## ...But do not necessarily feel healthier

The percentage of Canadians reporting their health as very good or excellent in 2014 is 4.1% lower than in 1994. The percentage peaked in 1998 at 69.1% of Canadians who considered themselves as having better health and dove in 2003 to 58.4%. Since then, the percentage has shifted very little, remaining between 59% and 60%.

Gender, age, and income are all related to Canadians’ ratings of their health. Slightly more women than men report better health as do Canadians under the age of 45 years. Self-rated health is very much linked to income. More than two-thirds of Canadians (68.7%) with household incomes over $80,000 per year report very good or excellent health while well under half of Canadians (43.9%) in households with annual incomes less than$40,000 feel as healthy.

## More than 1 in 5 Canadians live with a health or activity limitation

Increasing numbers of Canadians are living with health or activity-related limitations, and as the population ages, the numbers could continue to increase. In 1994, 84.9% of Canadians reported no limitations, but by 2014, that percentage had fallen to 78.5% — a drop of 6.4%. As with self-reported health, people living in low income households were more likely to have health or activity limitations.

## Diabetes is skyrocketing…

Diabetes rates more than doubled over the past 21 years — from 2.6% of the population in 1994 to 6.7% in 2014. Diabetes rates are higher among men (7.5%) and especially for those living in low income households (10.4%). More critically, the incidence of diabetes is especially high among First Nations peoples over 45 years of age at 19%. In comparison, only 11% of non- Indigenous people over 45 report having diabetes.

## …And despite improvements, mental health saw a post-recessionsetback

Almost 7 in 10 Canadians rate their mental health as very good or excellent. In 2001, over two-thirds of Canadians (67.1%) reported that their mental health was very good or excellent and by 2014, the percentage had risen by 4% to 71.1%. The percentage of people with better mental health had in fact reached a peak of 74.8% in 2007, however, and has steadily declined following the 2008 recession. The decline was evident among both men and women, and was felt most significantly by people living in low income households.

## Teen smoking is down significantly…

By 2014, only 7.7% of Canadians aged 12 to 19 years were smoking occasionally or daily. This represents a 171% rate of decline from the 20.9% of teens who were smokers in 1994. The change was even more pronounced for young women — just over 7% reported that they smoked in 2014.

## …But promoting good health remainsa challenge

Only 1 in 3 people are getting their flu shot. While the percentage of Canadians getting immunized against influenza increased by 6.7% between 2001 and 2014, the overall percentage remains strikingly low — only about one-third (32.5%) got their flu shot in 2014. Rates are generally higher among women and much higher among older Canadians — more than half of those over the age of 65 were immunized against influenza in 2014 (58.6%).

Access to family doctors is declining. While the majority of Canadians do report having a regular doctor, since 1994, that majority has slowly been declining. Almost 9 in 10 Canadians (88.6%) had a doctor in 1994, but that number slipped to 85.1% by 2014. More residents in Ontario and in all of the Atlantic provinces report having a regular doctor than in the western provinces. Of greater concern, however, is a majority of residents of the Northwest Territories (58.1%) and especially Nunavut (84.6%) do not have a regular doctor. This lack of access in northern Canada represents a serious gap in health provision.

## Conclusion

Overall progress for the Healthy Populations domain is positive despite roller-coaster trends since 1994 that mask troubling recent changes in Canadians’ health. Life expectancy continues  to increase and teen smoking is plummeting, but gains made in overall and mental health have fallen back, especially since the recession of 2008. While most Canadians enjoy reasonably good health, almost 12% of Canadians — nearly 3.5 million people — feel their health is poor or just fair.

Even more Canadians report having very good or excellent mental health, but the percentage of Canadians whose mental health is poor or fair has risen since the recession to more than 6% — almost 2 million people. Further, more Canadians than ever before — 6.5 million in 2014 — are reporting a health-related limitation that prevents them from fully participating at home, work, school, or in other activities.

While individuals must be proactive in taking responsibility for their own health by eating more nutritious foods, exercising, and getting immunized, communities have a similar responsibility to ensure access to those nutritious foods, to develop and maintain livable and walkable environments, and to create the conditions that support population health. Most urgently needed, however, are new and innovative policies and programmes that are tailored to reduce disparities in health status for different social groups — especially where it concerns Canada’s Indigenous people.

Action is needed on social justice and equity-oriented measures, a point strongly reinforced in the final report of the World Health Organization’s Commission on Social Determinants of Health.3 Focusing on the social determinants of health — factors such as income, education, employment, housing, social connectedness, and our community spaces — is “upstream” thinking4 that recognizes these are the conditions that most affect our health and wellbeing. By developing policy that strives to reduce inequalities in these conditions, we can create healthier lives and communities.

## Healthy Populations indicators tracked 1994 to 2014

• Life expectancy at birth in years
• Percentage of population that rates their overall health as very good or excellent
• Percentage of population that rates their mental health as very good or excellent
• Percentage of population with an absence of health or activity-based limitations
• Percentage of daily or occasional smokers among teens aged 12 to 19 years
• Percentage of population with self-reported diabetes
• Percentage of population getting influenza immunization in past year
• Percentage of Canadians with a regular medical doctor

3. Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, CH: World Health Organization.

4. Meili, R. (2012). A healthy society: How a focus on health can revive Canadian democracy. Saskatoon, SK: Purich Publishing.