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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Canada is the largest country in the Americas , with
10 million km2 of land and a population (pop.) of 30.7 million. About
two-fifths of the country's pop. has origins other than British, French, or
Aboriginal. It has a parliamentary democracy comprised of a federation of 10
provinces and 3 territories. English and French are the two official languages;
there is a dual legal system. Canada has an extensive social security network,
including old age pension, family allowance, employment insurance and social
assistance. Basic health care is provided to all Canadians through a universal
free health care system.
Demography:
In 1997, those less than 15 years old were 20% of the population and 65 years
old and over (12%). Life expectancy at birth in 2000 was 82.1 years for women
and 76.3 for men. There were some 799,000 Aboriginal people - 3 % of the total
pop. The birth rate for Registered Indians is higher than the national birth
rate and 53% of the pop. is under 24 years. Their growth rate is nearly double
that of the national rate and their life expectancy increased by nearly nine
years for both sexes, 1980- 2000, but is still much lower than the national
level of life expectancy. Canada 's pop. is highly urbanized and largely concentrated
in the provinces of Ontario (38%) and Quebec (24%). In 1996, immigrants represented
17 % of the pop. and most immigrants tend to settle in urban areas. In 1998,
there were roughly 324,000 births in Canada or 1.5 live births (lb) per woman
of childbearing age. The crude birth rate for 1998 was 11 lb. per 1,000 pop.
Age-specific fertility rates declined from 119 to 102 per 1,000 pop. for women
in the 25-29 age group 1986-1998. Increasing rates in older ages suggest that
women are waiting until later in life to have children.
Economy:
In 1998, the GDP was Can$ 28,814 per capita. Total health expenditures were
$83.9 billion in 1998, representing 9.3% of GDP. Per capita health expenditure
was $2,776 in 1998. In 2000, the labor force was 15.9 million persons or 66%
of the pop. 15 years old and older; unemployment rate was 7%. Female participation
in the increased from 36% to 60%, 1970-2000. About two-thirds of employees reported
days lost from work due to ill health in 1999. Literacy:
Overall, 99% of the adult pop. is literate. According to the 1996 census, 34%
of Canadians had completed post-secondary education.
Mortality: In 1998, the
age-adjusted mortality rate in Canada was 6.5
deaths per 1,000 population - male (8.3) and female
(5.2). The mortality rates for the territories
reached levels of 10 per 1000 pop.; while the
Aboriginal pop. had a rate of 5.5. Broad group
causes of death were diseases of the circulatory
system with a crude rate of 263 per 100,000;
malignant neoplasms, 204; external causes, 44;
communicable diseases, 39 and conditions of the
perinatal period, 7, 1998. Age-standardized data by
sex revealed that the leading causes of death for
women in 1997 were all circulatory diseases, 188
per 100,000; all malignant neoplasms, (149);
accidents and injuries, (24); pneumonia and
influenza, (19); and diabetes, (15). In 1997, for
males, the age-standardized leading causes of death
were all circulatory diseases, 307 per 100,000;
malignant neoplasms, (230); accidents and injuries,
(60); pneumonia and influenza, (32); and diabetes,
(206).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):
In 1998, the infant mortality rate (IMR) was 5 per 1,000 live births (lb), neonatal
mortality ( 4 ) and post-neonatal mortality, (2 ). In 1997, perinatal mortality
was 6 per 1,000 lb and maternal mortality was 4 per 100,000 lb. IMRs vary substantially
among the provinces and territories, with higher rates found in northern areas
and in regions with a larger percentage of Aboriginal peoples that may experience
IMRs twice as high as the national rate. Perinatal conditions caused 46% of
infant deaths, birth defects (27%), and SIDS (8%). In 1998, 6% of lb had low
birthweight. The rate of preterm births was 7% in 1998. The rate of infant hospitalization
due to injuries was 983 per 100,000 population and infant death due to injury
was 26, 1996-1997. National prevalence of breastfeeding initiation is 75%, but
with marked differences by age, income, marital status, and place of residence.
Schoolchildren (5-9 years):
Injuries are the leading cause of death (41%) among school children 5-9 years,
followed by deaths attributed to cancer (18%). The death rate due to injuries
is 3 per 100,000. Childhood cancer has stabilized over the past 15 years - leukemia
(4 per 100,000), brain tumors (3), and lymphoma (1), but there have been significant
improvements in overall child mortality rates.
Adolescents (10-14 and 15-19 years): Leading
causes of death among adolescents 10-14 years were external causes (52%) and
cancer (13%). Among 15-19 year-olds, external causes were 75% of deaths for
males and 66% among females. Respiratory conditions, including allergies and
asthma, were the main problems for those 12-17 years, 1997-2000. The most prevalent
medical conditions were allergies (15%) and asthma (12%). Depression was the
most common psychosocial condition affecting adolescents, especially women aged
15-19. There is a high rate of suicide, mainly among young men with that for
the Aboriginal population being much higher. In 1998-1999, 28% of youth aged
15-19 smoked daily or occasionally. The percentage that reported regular alcohol
consumption increased from 5% in 12-14 year-olds to 61% in 18-19 year-olds.
Teenage pregnancies declined significantly over the past 20 years. The highest
rates of chlamydia (115 per 100,000 population) and gonorrhea (17) are among
females aged 15 to 19 years.
Adults (20-59 years): In
1998-1999, 76% of women 18-69 years reported having had a Pap smear within the
preceding three years. A survey revealed that approximately 24% of the population
aged 15 years and older were smokers - deaths attributable to tobacco each year
were estimated at 45,000. There was no difference in the prevalence of obesity
between adult men and women.
Elderly (60 years and over): In
1998, about 3.7 million or 12% of the population were 65 years old or older,
1980-1996; the age-standardized death rate for seniors declined 12%. Heart disease
and cancer continue to be the main causes of death among seniors. Only 17% of
seniors 65-74 years of age and 13% of seniors aged 75 and older reported no
chronic illnesses, 1998-1999. Arthritis and rheumatism were the most common
chronic conditions, followed by high blood pressure, allergies, and back problems.
In 1997/1998 seniors represented 36 % of all hospital admissions for injury
that year. It is estimated that 4% of seniors living in the community have been
victims of some form of abuse.
The disabled: Disabilities
were reported by 18% of those 12 years and older, 1998-1999. Overall, 25% of
Canadians in the lower income levels reported some kind of long-term disability,
compared to 14% in the highest income levels. Aboriginal people remain at higher
risk for illness and premature death than the national level.
Indigenous population: Leading
causes of death among indigenous peoples were injuries and poisonings, with
a crude rate of 154 deaths per 100,000 population. They suffered about three
times more chronic diseases than the general population and the suicide rate
is 2-7 times higher. The IMR for Indian populations was 14 per 1,000, 1996 -
almost three times higher than the national average than the national average.
In 1996, the unemployment rate of indigenous ranged from 26%-29%.
Analysis by type of health problem Vector-borne diseases:There
have been 1036 cases of imported malaria reported over the past five years.
There was no yellow fever.
Diseases preventable by immunization: Poliomyelitis
was eliminated in 1994 and measles was on the decrease in 1998. In 1997, 94%
of targeted children had received immunization for measles, mumps, and rubella;
85 % had received immunization for diphtheria, pertussis, and tetanus; 86%,
for poliomyelitis; and 74%, for Haemophilus influenzae type b. In 1999, 28 cases
of measles were reported; mumps (117); rubella (68), 1998. There were 46 cases
of Haemophilus influenzae type b and immunization coverage was 75%, 1998.
Infectious diseases: Cholera
is not endemic in Canada; all cases are imported. In 1998, campylobacteriosis
was the most commonly notified enteric infection, with 14,236 cases and a rate
of 47 per 100,000; salmonellosis, (23); E. coli infections, (5), 1998.
Chronic communicable diseases: In
1998, there were 1,798 cases of tuberculosis (TB), with a rate of 6 per 100,000
population. There were 114 deaths from TB, 1997. TB was a reported as a coinfection
in 1,975 cases of AIDS, 1997. Leprosy is not common in Canada.
Acute respiratory infections: In
1997, 304 Canadians died from influenza; cases reported by laboratories were
higher than for any influenza season in 10 years, 1999/2000. Pneumonia caused
7,728 deaths in 1997, occurring mostly in senior citizens.
Rabies: There
were no cases of human rabies reported in Canada in the 1990s.
HIV\AIDS: At
the end of 1999 there were an estimated 49,800 Canadians living with HIV/AIDS,
a 24% increase from 1996. Approximately 4,190 Canadians became infected with
HIV in 1999. From 1996-1999 there were increases in new HIV infections per year
among homosexuals (30%), heterosexuals (26%) and females (48%), but a 27 % decline
in the number of new infections among injection drug users. The incidence rate
of AIDS cases in Canada in 2000 was about 17 per 1,000,000 population with a
M:F ratio of 8.3:1.
Sexually transmitted infection (STIs): In
1999, there were 41,676 cases of chlamydia; 5,381 cases of gonorrhea; and 187
cases of syphilis.
Nutritional and metabolic diseases: Residents
in remote areas tend to eat diets higher in fat, sodium, and sugar resulting
in occurrence of anemia, dental problems, obesity, and non-insulin-dependent
diabetes. Several surveys have shown that the proportion of overweight men and
women have increased steadily between 1984 and 1998/1999, from 22% to 37% among
men, and from 14% to 26% among women. In 1997 there were 5,699 deaths from diabetes
but it was a contributor in probably five times as many additional deaths. The
age-standardized mortality rate for diabetes was 21 per 100,000, 1997, but the
prevalence of diabetes among Aboriginal peoples is about triple the national
rate. While 4% of Aboriginal females are diagnosed with diabetes, the rate is
0.4% among non-Aboriginal female youth.
Cardiovascular diseases:Cardiovascular
disease is the leading cause of morbidity, mortality and hospitalization due
to illness for men and women. In 1997, deaths from cardiovascular disease were
79,457 (37%). The crude mortality rate from cardiovascular diseases was 263
per 100,000; females (258) and males (267) in 1998.
Malignant neoplasms: Malignant
neoplasms are the second leading cause of death among adults. Men outnumber
women by 5% for incidence, and by 13% for mortality. Prostate, lung, and colorectal
cancers contribute 50% of new cases among men; breast, lung, and colorectal
cancers make up 50% of new cases for women. Lung cancer accounts for almost
one-third of cancer deaths in men and one-quarter in women. Breast cancer incidence
increased steadily over the past three decades with breast cancer incidence
at 105 cases per 100,000 population and a mortality rate of (27). In 1999, the
incidence rate of prostate cancer was 118 per 100,000, while the mortality rate
was 30, in 2000. Colorectal cancer is the third most common cancer for both
men and women; incidence and mortality rates have steadily declined, especially
among women.
Accidents and violence: In
1997 injuries were 4% of deaths. Motor vehicle traffic accidents were the major
cause of death due to unintentional injury, (35%); falls (29%), drowning (6%),
and fires (3%). In 1997 there were 3,681 suicides. Men were four times more
likely than women to commit suicide. Men have an age-standardized death rate
from suicide of 20 deaths per 100,000, compared with 5 for women. Suicide among
the Aboriginal population has been reported to be 2 to 7 times higher than the
national rate. There were 581 homicides reported in Canada in 1997, a decline
of 9% from 1996. In 1999, children and youth under the age of 18 comprised 60%
of all sexual assault victims and 20% of all physical assault victims.
Oral health:64%
of women and 60% of men aged 12 years and older reported having made a dental
visit during 1996/1997. Income level and dental insurance were the most powerful
determinants for access to dental care. Most communities across Canada use fluorinated
drinking water.
Remerging diseases: In
1998 there were 155 reported cases of meningococcal infections, viral meningitis
(887), pneumoccocal meningitis (158), and other bacterial meningitis (80). Prevalence
of bronchial asthma, particularly among the young is on the rise.
RESPONSE OF THE HEALTH SYSTEM Health reform: Health
Canada (HC) develops policies and programs to improve health and reduce inequities.
In 1997, key areas discussed were values, striking a balance, determinants of
health, and evidence-based decision making. A Health Transition Fund provided
Can $150 million over four years to finance national, provincial, and territorial
projects and innovations to modernize health services and health delivery. To
support health research, the federal government launched the Canadian Institutes
of Health Research (CIHR), 2000. The health care system is financed mainly through
federal and provincial taxes, administered mostly publicly, and delivered privately.
At the national level, the Federal Department of Health, HC, sets and administers
national principles of the health system and assists the provincial/territorial
health systems through funding transfers. In addition, HC provides direct service
delivery for specific groups such as veterans, military and indigenous populations.
HC is responsible for national health protection, disease prevention, and health
promotion. The administration of the health care system largely rests with the
provinces and territories, and includes comprehensive coverage for medically
insured health services. Each of the ten provinces and three territories has
a MOH charged with the operation of the health care system. Most of the hospitals
private, not-for-profit institutions that are run by community boards of trustees,
voluntary organizations, or local municipalities. Some addiction centers and
long-term care facilities are run privately and operate for profit. All Canadians
are covered for medically necessary physician and hospital services. Many Canadians
obtain private supplemental insurance.
Organization of regulatory actions: In
addition to conducting national disease surveillance and health research and
risk assessments, the Federal Minister of Health is responsible for regulatory
functions to safeguard the quality and safety of food, water, drugs, consumer
products, therapeutic devices, cosmetics, chemicals and pesticides. Generally,
however, a mix of federal, provincial, and territorial government offices, as
well as NGOs governs regulations for many health services and products. To facilitate
portability and reciprocity between different provinces and territories, the
Medical Council of Canada establishes qualifications and maintains the
Canadian medical register: HC's new Health
Products and Food Branch ensures the safety and quality of the Canadian food
supply, drugs, and natural health products. The Health Products and Food Branch
of HC is responsible for regulation of biological drugs, blood products, genetic
therapeutic products, tissues and organs. The Healthy Environments and Consumer
Safety Branch (HECSB) within HC ensures the safety and effectiveness of consumer
products. The Canadian Environmental Protection Act is administered by the Minister
of the Environment, but it grants the Minister of Health the responsibility
to control such things as toxic substances, air and water pollution. HECSB also
administers the Tobacco Act, which restricts tobacco product advertising and
governs the labeling of tobacco product packaging.
Health promotion services: In
1997, HC announced "Gathering Strength: Canada's Aboriginal Action Plan," which
sets a new course for policies for Aboriginal peoples. The 1999 budget also
announced an investment of Can$ 190 million over three years to improve the
health of First Nations and Inuit people. Community-based programs reach more
than 100,000 children and parents in more than 1,000 communities each week.
Food supplementation is a key community intervention and is accompanied by counseling
on nutrition, lifestyle issues, and family violence. In 1998, federal, provincial,
and territorial ministers responsible for seniors released the National Framework
on Aging. The Canadian Strategy on HIV/AIDS allocates Can$ 42.2 million annually
for HIV/AIDS policy development, programming, and research and surveillance.
Health analysis: The
federal Department of Health also monitors disease incidence and mortality,
identifies and assesses health risks, and provides epidemiological and laboratory
surveillance through its Population and Public Health Branch.
Water: Water
sewage, and waste management services are operated by provincial, territorial,
regional, and municipal authorities, in collaboration with the ministries of
the environment. Approximately 99% of the population have safe drinking water,
and about 95% have adequate disposal facilities. The Saint Lawrence Vision 2000
Development Fund was established to support research on human health consequences
from contamination of the Saint Lawrence River.
Air quality: Air
quality is the responsibility of the federal government, through HC's Healthy
Environments and Consumer Safety Branch.
Food safety: HC
is responsible for administering the Food and Drug Act at the national level
but shares enforcement and implementation of food safety measures with the federal
Department of Agriculture, the Canadian Food Inspection Agency, and provincial
and territorial governments.
Organization of individual health care services:
Outpatient, Emergency, and inpatient and Family
physicians are the first points of contact with the health care system for most
Canadians. The Office of Nursing Policy was developed by HC in 1999, and is
charged with advising the federal Department of Health on the nursing perspectives
on health issues. Most hospitals that provide emergency and inpatient services
are nonprofit facilities administered by nongovernmental boards of directors.
In some larger cities, hospitals have become highly specialized to address problems
of orthopedics, heart, cancer, and children's or women's health. Private, for
profit hospitals represent less than 5% of all hospitals provide mostly long
term care facilities or specialized services. The federal government operates
hospitals that serve the military, veterans, and Aboriginal peoples.
Specialized services: Public
health units operate under the direction of a regional medical officer of health.
Public health units provide: maternal and child health counseling programs,
immunizations, school health education, health surveillance and STD clinics,
food safety, and nutrition information. Mental health programs are under the
responsibility of the provinces and territories. Mental health services at this
level are provided through primary healthcare, general hospital psychiatric
units, community mental health centers, specialized treatment facilities, psychiatric
hospitals, community providers, and several community based organizations. Childhood
immunizations are usually administered by general practitioners, family physicians,
or through a public health unit; they are under provincial or territorial jurisdiction.
Long term and continuing care services are organized on two levels: institutional
based care and home based care. The institutions involved range from residential
care facilities that provide only limited health services, to intensive, chronic
care facilities. Home care is delivered under many organizational structures,
and similarly numerous funding and client payment mechanisms.
Health supplies:
Private pharmaceutical companies develop drugs, including vaccines and serums.
The Division of Immunization at HC helps the provinces and territories in immunization
programs. The National Advisory Committee on Immunization, formulates guidelines
on the use of vaccines and provides timely medical, scientific, and public health
advice related to vaccines and prophylactic agents.
Health technologies:
At the federal level, assessment of health related technologies falls under
the mandate of the Canadian Coordinating Office for Health Technology Assessment
and under similar provincial level assessment agencies. The Therapeutic Products
Directorate at HC also is involved in the evaluation and monitoring of medical
devices.
Human resources:Registered
nurses have steadily declined: in 1989, there were 80 per 10,000 population
but in 1999, (75). Nurses are increasingly working part time (45%). In 2000,
there were 57,052 physicians, or 19 physicians per 10,000 population. Most physicians
are concentrated in urban areas. The vast majority of health professionals in
Canada need university training and requires certification by provincial and
territorial licensing bodies.
Research: The
Canadian Institutes of Health Research (CIHR) was created in 1999. The federal
Department of Health's Therapeutic Products Directorate is the national authority
that evaluates and monitors the safety, effectiveness, and quality of drugs,
medical devices, and other therapeutic products. The Department of Health's
Information, Analysis and Connectivity Directorate oversees key aspects of information
and The Canadian Institute of Health Information is responsible for developing
and maintaining the national health information system.
Health sector expenditure and financing:Total health expenditures in current Canadian dollars
were forecasted to reach Can$95 billion in 2000 - equivalent to about 9% of
GDP. Health expenditures by governments authorities in 1998 were estimated at
Can$58.8 billion, equivalent to Can$1,946 per capita. This accounted for 70%
of total health care spending. Private sector spending by households and insurance
firms in 1998 totaled Can$ 25 million. The private sector accounted for 30%
of total expenditures in 1999. Hospital care represented the largest share of
health expenditures in 1998 (33%), drugs (15%). Building on the recommendations
of the National Forum on Health, governments are working towards the long-term
goal of a national prescription drug benefit program. In 1998, direct federal
spending on health accounted for 5% of publicly financed health care spending.
In 1998, out of pocket expenses represented the largest share of private sector
financing (55%), followed by private health insurance (37%) and nonconsumption
expenditures (8%).
External assistance:HC
has pursued partnerships in health with various countries in the Americas including
Cuba, Mexico and Costa Rica. Areas addressed included violence against women;
and laboratory testing for enteric pathogens, PAHO, and 20 Latin American and
Caribbean countries. The Canadian International Development Agency (CIDA) is
responsible for 80% of Canada's development assistance. As part of a new framework
for poverty reduction, programming will be strengthened in four key areas: health
and nutrition; basic education; HIV/AIDS prevention and care; and child protection.
CIDA will increase its investments in these four areas from 19% to 38% of its
total budget and will increase total expenditures to Can$ 2.8 billion over the
next five years. CIDA has been a collaborator with PAHO on nutrition and health
issues such as HIV/AIDS projects with (CAREC), a national immunization program
in Haiti, the Vaccine Preventable Diseases project (SIREVA), measles eradication,
disaster relief, communicable diseases, rehabilitation of landmine victims,
and the Canadian Consultant Technical Assistance Fund.
