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HEALTH SENSE

Why Canadians are healthier

My fellow Americans: Want a health tip? Move to Canada.

An impressive array of comparative data shows that Canadians live longer and healthier lives than we do. What's more, they pay roughly half as much per capita as we do -- $2,163 versus $4,887 in 2001 -- for the privilege.

Exactly why Canadians fare better is the subject of considerable academic debate. Some policy wonks say it's Canada's single-payer, universal health coverage system. Others point to Canadians' different ethnic mix. Some think it's because they use fewer illegal drugs and shoot each other less with guns, though they do smoke and drink with gusto.

Still others think Canadians are healthier because their medical system is tilted more toward primary-care doctors and less toward specialists. And some believe it's something more fundamental -- a smaller gap between rich and poor.

Perhaps it's all of the above. But there is no arguing the basics.

"By all measures, Canadians' health is better," said Dr. Barbara Starfield, a university distinguished professor at Johns Hopkins Medical Institutions. Canadians "do better on a whole variety of health outcomes," she said, "including life expectancy at various ages -- 1, 15, 20, 45, 65, 80, you name it."

According to a World Health Organization report published last year, life expectancy at birth in Canada is 79.8 years versus 77.3 in the United States (Japan's is 81.9.). Canada now ranks fifth in life expectancy at birth (after Japan, Sweden, Hong Kong and Iceland), while the United States ranks 26th, according to the United Nations Human Development Report.

"There isn't a single measure in which the US excels in the health arena," said Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle. "We spend half of the world's health care bill and we are less healthy than all the other rich countries.

"Fifty-five years ago, we were one of the healthiest countries in the world. What changed? We have increased the gap between rich and poor. Nothing determines the health of a population [more] than the gap between rich and poor."

Infant-mortality rates also show striking differences between the United States and Canada, according to Dr. Clyde Hertzman, associate director of the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver. To counter the argument that racial differences play a major role, Hertzman compared infant mortality for all Canadians with that for white Americans between 1970 and 1998. The white US infant mortality rate was roughly six deaths per 1,000 babies, compared to slightly more than five for Canadians.

Maternal mortality shows a substantial gap as well. According to data published last year by the Organization for Economic Cooperation and Development, an international think-tank, there were 3.4 maternal deaths for every 100,000 births among Canadians compared to a 9.8 among all Americans.

And more than half of Canadians with severe mental disorders received treatment, compared to little more than a third of Americans, according to the May-June 2003 issue of Health Affairs.

Dr. Steffie Woolhandler, an associate professor at Harvard Medical School, general internist at Cambridge Hospital and staunch advocate of a single-payer system, said she believes "the summary of the evidence has to be that national health insurance has improved the health of Canadians and is responsible for some of the longer life expectancy."

On the other hand, there are some causes of death that wouldn't be much affected by having the government pick up the health care tab -- like homicide. And the United States, Bezruckha said, has "the highest homicide rate of all the rich countries."

"Other things might be differences in seat-belt usage," said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "We are also disproportionate consumers of illegal drugs, much more than Canada, so it's cultural. The health of Americans would be better if we had universal health care, but there are some things that a single-payer system wouldn't fix, but which would leave one country looking healthier in the statistics." In some respects, the health care system is "the tail on the dog," said Dr. Arnie Epstein, chairman of the department of health policy and medicine at the Harvard School of Public Health. "It's other aspects of the social fabric of different countries that seem to have a major impact on how long people live."

Like ethnicity. In the United States, African-Americans and Latinos "face problems of housing, stress and low income which have nothing to do with a single-payer system," Blendon said. Canada has a large number of Asian immigrants, he said, but they, like Asian immigrants in the United States, tend to do well on health care measures.

The bottom line is that Canada is doing something right, even if "the reasons are not totally understood," said Kominski of UCLA.

So, should we all move to Canada? Probably. But it's just too cold.

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.

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