Canada ‘incredibly average’ on reducing premature mortality compared with peer countries: report

Canada has reduced premature mortality rates tremendously over the past 50 years, but the country is still in the middle of the pack compared with “peer” countries such as Australia, Germany and Japan, according to a new report.

The Canadian Institute for Health Information compared health system performance in Canada to 17 other high-income countries in the Organization for Economic Co-operation and Development (OECD) from 1960 to 2010.

The report’s authors compared potential years of life lost (PYLL) — a measure of premature mortality based on estimating the extra time a person would have lived had he or she not died prematurely before age 70. For instance, someone who dies at 50 would have lost 20 years of potential living.  

“We’ve really improved a lot over 50 years, about 60 per cent we’ve reduced in years of life lost,” said Deborah Cohen, a senior researcher at the institute’s Canadian Population Health Initiative. “But when we look at ourselves relative to other countries in that 50-year span, Canada is incredibly average.”

For potential years of life lost among men due to cancer, Canada was ahead of the pack, but that wasn’t the case for Canadian women, the researchers found.

• Lung cancer kills more Canadian women than in ‘peer’ countries

For lung cancer in particular, Canadian women have lost ground compared with women in peer countries over five decades. It means that in 2010, Canadian women lost more years of potential life from lung cancer than women in most of the other countries.

“We’re actually seeing this incredible move backwards,” Cohen said.

Overall, smoking rates among Canadian men spiked in the 1960s and 1970s, and fell in the ’80s and ’90s. Canadian women were about 20 years behind in taking up smoking and quitting.

In general, Canada’s health-care system doesn’t do a good job in closing gaps in outcomes between men and women, said Dr. Danielle Martin, a family physician at Women’s College Hospital in Toronto who wasn’t involved in the report.

Heart and stroke are the top killer of women, but they represent only about a third of research subjects in studies around heart health, Martin said.

“If you think about the notion of systematic underrepresentation of women in medical research, it probably isn’t surprising that both on the prevention side and treatment side, we’re probably not implementing solutions that will get at the particular health needs of women,” said Martin, a CBC Health contributor.

“We know women are less likely to be referred to cardiac rehab services following a heart attack.”

Martin said the first step is to acknowledge that a gender gap exists. 

“There is a  health gap for women in Canada and it extends from research and prevention from population health, to the way that we design our health-care services,” Martin said, such as only offering services from 9 a.m. to 5 p.m. without child care.  

Martin believes that the ways to address the gap are “well within our grasp.” 

Cohen sees these kind of international comparisons as a conversation starter, to see where Canada’s health-care system shines and how it can be improved.

• Plain cigarette packaging a hit with anti-smoking advocates, but debate about whether it works continues
   

Politicians also have a role to play in shaping policy. On lung cancer prevention, for example, Cohen points to Australia as a role model for introducing plain cigarette packaging. 

On the plus side, Canadian men and women fared well on stroke in the report.

But for potential years of life lost due to traffic collisions, falls, accidental poisonings and intentional self-harm, Canada was average for both sexes and lost ground in the last decade of the analysis.