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Canada is treading water on a key health care measure, a new report shows

If the classic Shangri-Las song Leader of the Pack was rewritten as an ode to Canadian health care, the title would have to change to Middle of the Pack.

Study after study shows that, when compared with other countries, Canada's health system produces results that are middling.

Now, there is more stinging evidence of mediocrity: In a new report, the Canadian Institute for Health Information examines a commonly used measure of population health called PYLL (more on that in a moment), and how Canada's outcomes compared with 17 other OECD countries over a 50-year period.

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Deborah Cohen, senior research of the Canadian Population Health Initiative at CIHI, neatly summed up the overall conclusion: "It confirms all the other analyses that say Canada is average. But it also tells us we've always been average."


So back to PYLL – an acronym for potential years of life lost – an estimate of additional time a person would have lived had s/he not died before age 70.

It's the kind of calculation that policy wonks love, complicated but informative. Whereas life expectancy tells us how long people are living, PYLL tells us how good a country is at preventing premature mortality – and remember, the younger a person dies, the greater the economic impact, and the more likely that health and social programs are inadequate.

First, the good news: Overall, all countries are doing dramatically better. Over the past half-century, premature mortality has been cut by about two-thirds, even in mediocre countries like Canada.

Further, the gap in outcomes has closed considerably. In 1960, the gap between The Netherlands and Portugal was 10,921 potential years of life lost per 100,000 population; in 2010, the gap was only 2,146 PYLL between the best-performing country, Switzerland, and the worst, the United States.

As always, Canadians can take comfort in knowing, no matter how poorly our health and social-welfare system performs, the U.S. will always do worse. We can also gnash our teeth knowing that, unsurprisingly, Sweden has been the best and most consistent performer in the PYLL measure over the past 50 years.

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What should trouble us though is knowing that countries like Australia, Italy, Spain, Norway and Switzerland have all made considerable improvements in reducing premature mortality relative to other Western countries, while Canada has contented itself with treading water.

In 2010, Canada had a measure of 3,113 PYLL; that's 626 more than Sweden, and 260 more than Australia. The numbers themselves are not that important; but the niggling feeling that many Canadians have that their beloved medicare system is falling in the rankings compared with other countries is borne out in the data.

It is noteworthy too that Canadian women are faring particularly poorly. Since 1990, premature mortality has continued to increase among Canadian women, while it has largely held steady for men.

The CIHI data also look at the progress countries are making in dealing with the main causes of death.

Again, the big picture is stunning – a welcome reminder of the progress we have made in medicine and health promotion over time.

Premature death from cancer is down 40 per cent between 1960 and 2010; for heart disease, it's 85 per cent, and stroke 80 per cent; even so-called "external causes of death" like motor-vehicle crashes, falls and suicide are down 50-per-cent overall.

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Still, if you use a racing analogy, we're plodding back in the pack, while others surge ahead.

For cancer, the PYLL number is 185 more than Sweden for men, and 162 more than Japan for women. The most troubling state in the whole report is perhaps that Canadian women are racing to the bottom when it comes to PYLL concerning lung cancer.

In 2010, Canadian men lost 174 more potential years of life per 100,000 than their counterparts in Japan, and Canadian women 54 more PYLL than those in France.

One of the areas where Canada fares worse is external causes (largely traumatic injuries): Canadian men lost 597 more PYLL than those in The Netherlands, and women 271 more than those in Italy.

The bright spot is stroke, where Canada was outperformed only by Switzerland: Canadian men had 20 more PYLL and women only 11 more than the Swiss.

The frustration with this kind of data is that it doesn't provide any solutions. There is no simple health policy, health and social-welfare model or financing plan that provides the best results. But, as always, the countries with the least economic inequality and the fewest health gaps between men and women seem to fare best.

And while these PYLL measures don't offer up easy fixes, they do tell us "Canada has room for improvement" (to use the politically neutral language of CIHI).

The data also raise important questions, chief among them: "Are we satisfied with being perennial middle-of-the-packers?" and "Should Canada content itself with its well-earned reputation for mediocrity in population health?"

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More


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