Canada's health status: a public health perspective

Health status assessment and disease surveillance are essential to identify and priorize health issues, to evaluate intervention programs and to plan to meet future needs for health services. Canadians currently benefit by having among the highest life expectancies at birth in the world (81 for females, 74 for males). Disability-free life expectancies for females and males, respectively, were 10.1 and 11.3 years lower for the lowest income quintile compared to the highest. Canada's infant mortality rate in 1990 (7/1000 live births) was one of the lowest in the world but within Canada, the rate in the lowest income quintile (10.5/1000 live births) was almost double that in the highest income quintile (5.8/1000 live births). Fair or poor health was reported by 36% of adult Canadians in the lowest income category in 1990 compared to only 5% in the highest income group. The leading causes of premature death for females in 1991 were breast cancer, coronary heart disease, lung cancer, car crashes, birth defects and suicide; those for males were coronary heart disease, suicide, car crashes, lung cancer, birth defects, and AIDS. Lowest income quintile males had mortality rates at least double those for the highest income quintile for alcohol-related conditions, violence, injuries and emphysema. Cardiovascular diseases, cancer, musculoskeletal diseases, injuries and respiratory diseases imposed the highest direct and indirect economic costs in Canada in 1986. For all of these conditions, improved prevention is possible. For example, the forecasted tobacco-related deaths before age 70 among current male smokers age 15 will far exceed those due to car crashes, suicide, murder, AIDS, and drug abuse combined. Population aging will aggravate trends for many chronic conditions especially those with increasing incidence rates; there will be large increases in the numbers of persons with aging-related cancers, dementias and other conditions. There is an urgent need for Canadian health jurisdictions to ensure that rational priorities, goals/objectives, strategies, and programs are in place to enhance prevention and disease control.