Released February 25, 2004

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About CIHI

CPHI Council Members (as of Dec /03)

• Mr. Richard Jock

• Dr. Richard Lessard

• Mrs. Judith Maxwell

• Dr. Cordell Neudorf

• Mr. Ian Potter

• Dr. Gerry Predy

• Dr. Michael Wolfson (Ex-officio)

• Dr. Cameron Mustard (Chair)

• Hon. Monique Bégin

• Dr. Charlyn Black*

• Dr. Catherine Donovan

• Ms. Teresa Hennebery*

• Dr. Clyde Hertzman

* Feb/04 new members: Dr. Doug Willms and Dr. John Millar

CPHI Expert Advisory Group Members

• John Frank (Co-Chair)

• Richard Jock

• Perry Kendall

• Richard Lessard

• Steven Lewis

• Particia Petryshen

• Tom Stephens

• Sherri Torjman

• John Millar (Co-Chair)

• Lorna Bailie

• James R. Dunn

• Cathy Fooks

• Paul Gully

• Michael Hayes

• Teresa Hennebery

• Clyde Hertzman

CPHI Strategic Functions

Knowledge Exchange Knowledge Generation

Policy Synthesis Knowledge Transfer

Improving the Health of Canadians

• First in a biennial report series from CPHI

• Builds on reports on thehealth of Canadians (Fed./Prov./Terr. ACPH)

• Complements How Healthy Are Canadians? and Health Care in Canada reports

Overall, Canadians Are Healthy

But There Are Inequalities in Health

AboriginalPeoples’Health

Income

ECD

Obesity

Income and Health

Income and Health Strongly Linked

Life Expectancy for Men by Neighbourhood Income Quintile, Urban Canada, 1971 and 1996

73.1

75.976.7

77.278.1

67.1

70.6 71.0

72.473.4

60

0

62

64

66

68

70

72

74

76

78

80

Q5

(Poorest)

Q4 Q3 Q2 Q1

(Richest)

Ye

ars

1971 1996

Income Inequality and Health

• Research conducted in a large number of cities in the US, UK, Canada, Australia and Sweden

• Results:– Higher income inequality was related to poor health– When cities were grouped by country, only the 2 countries with

highest income inequality (US and UK) showed this association

Certain Groups More Likely to Have Low Income

0

10

20

30

40

50

60

With 2 or More People With Children Female Lone-Parent

1996

2001

Perc

ent

Low Income by Family Type

Certain Groups More Likely to Have Low Income–Aboriginal Peoples

0

5

10

15

20

25

30

35

40

45

Non-AboriginalCanadians

First Nations Inuit Metis

Perc

ent

Low Income Among Aboriginal Peoples, 2000

Income Inequality Has Risen in Canada

0

0.1

0.2

0.3

0.4

0.5

0.6

Market Income Total Income Disposable Income

Gin

i Coe

ffici

ent

1994

2001

Inequality in Disposable Income Fairly Stable Between 1980 and 1994—Then Disposable Income Began to Increase

Canada Reduces Low Income Among Seniors

Seniors in Poverty, With and Without Taxes/Transfers, Early 1990s

% o

f Sen

iors

in P

over

ty

Without Taxes and Transfers With Taxes and Transfers

0

20

40

60

80

100

43.8 55.7 58.2 58.7 65.5 65.8 68 68.5 70.2 79.9 88.9 91.6

14.4 4.4 5.7 19.6 4.1 7.5 13.5 23.9 21.6 4.8 11.9 6.4

1991 1991 1991 1994 1991 1989 1991 1991 1989 1984 1992 1992

Fin

land

Ital

y

Can

ada

US

Neth

erl

and

s

Germ

any

No

rway UK

Aust

ralia

Fra

nce

Belg

ium

Swed

en

Community-Based Employment Support Programs Effective: Research

Family income

Positive effects on children’s behaviour and academic function

Birth weight

Income—Information Gaps

What we still need to know:

• Relationships between income inequality and health measures beyond mortality

• Relationships between health and different measures of low income and income inequality

• Income as a marker for other social and economic conditions and their relationship to health

Early Childhood Development

ECD Affects Long-Term Health

• Good nutrition

• Good health of mother and child

• Good parenting

• Strong social supports

Early Childhood Development Agreement

• Canada’s Early Childhood Development Agreement signed September 2000

• Acknowledges the importance of early childhood development to health

• The federal, provincial and territorial commitment to:

– improving children’s health – reporting regularly on outcomes

Parental Leave Supports Parents and FamiliesCanada’s parental leave was extended in 2001

• Average time that employed mothers spent away from work increased

• Fathers were also more likely to take leave

6 Months

10 Months

3% 10%

Services for Low-Income Families Make a Difference: Research

• High-quality intervention programs can make a lasting difference in children’s cognitive and emotional development

! Parenting skills

! Comprehensive child development services

! Medical and nutritional services

! Low teacher-to-child ratios

! Focus on language development

Supporting Effective Parents and Families

• Montreal Diet Dispensary

• CPNP

• Home visiting

Positive Results

! A reduction in the number of low birth weight babies

! An increase in breastfeeding

! An improved diet for mothers

Early detection and intervention programs:

ECD—Information Gaps

What we still need to know:

• Relative effectiveness and cost of different policies and programs that aim to improve early childhood development

• Effectiveness of programs intended for all children, regardless of income level or risk

Aboriginal Peoples’ Health

Canada’s Aboriginal Peoples

• Life expectancy for Aboriginal Peoples has improved

• Overall, the health status of Aboriginal Peoples remains much worse than that of Canadians as a whole

• There are differences in health status within the Aboriginal population

Health Differences Among Aboriginal Peoples

0

10

20

30

40

50

60

70

Canada Non-Aboriginal

First Nations Inuit Métis

Diabetes

Smoking

Perc

ent

MF

Differences in Health Determinants

14%22%22%7%Unemployment Rate

Work Status (15 Years and Over)

5.3%1.9%4.1%16%Bachelor’s Degree Graduation

Highest Degree (15 Years and Over)

MétisInuitFirst

NationsNon-Aboriginal

Canadians

Community Control and Self-Determination Matters

Youth Suicide Rates by Number of Cultural Continuity Factors Present in BC First Nations Communities

0 1 2 3 4 5 6

Total Number of Cultural Continuity Factors Present

Rat

e p

er 1

00

,00

0

0

20

40

60

80

100

120

140

Policy Trends and Needs

New initiatives are underway that may contribute to improved health for Aboriginal peoples

� Creation of new institutions (e.g. NAHO, AHF)

� Addressing lack of Aboriginal health data(e.g. First Nations Regional Longitudinal Health Survey; Aboriginal Peoples� Survey)

� Transfer of authority and control(e.g. Eskasoni First Nation; Métis Settlement Health Project)

APH—Information Gaps

What do we still need to know?

• More reliable data about health status and the determinants of health of Aboriginal peoples

• Results of increased analysis of existing data

• Impact of assuming authority over health and other services– Did these changes lead to improved health status?

Obesity

Obesity Linked to Health

Obesity

Diabetes

Cardiovascular Disease

Hypertension

Stroke

Gallbladder Disease

Cancer

How Big Is the Problem for Adults?

Obesity Increasing Among Canadian Adults

5.6

9.2

13.4 12.7

14.814.9

Health

Promotion

Survey, 1985

Health

Promotion

Survey, 1990

National

Population

Health Survey,

1994–1995

National

Population

Health Survey,

1996–1997

National

Population

Health Survey,

1998–1999

Canadian

Community

Health Survey,

2000–2001

% o

f A

du

lts

0

2

4

6

8

10

12

14

16

How Big Is the Problem for Children?

Overweight and Obesity Among Children 7 to 13 Years

109

20

910

9

11

2 2

18

23

17

Boys Girls Boys Girls

% o

f C

hil

dre

n

1981 1995–1996 2000–2001

Overweight

Obese

0

5

10

15

20

25

How Active Are Canadians?

Average Hours per Week Spent in Physical Activity by Canadian Children

22

25

28

29

14

1816

16.5

14 15 1414

1995 1996 1997 1998 1999 2000

Nu

mb

er

of H

ou

rs p

er

Week

1–4 Years 5–12 Years Teenagers

0

5

10

15

20

25

30

35

Obesity—What Works?

• Five evidence-based strategies effective for preventing obesity:1. Encouraging breastfeeding2. Reducing television viewing time3. Promoting regular physical exercise4. Implementing comprehensive school health programs5. Implementing community-wide programs

Physical Activity in Canadian Schools

• 54% of schools in Canada have a policy to provide daily physical education classes

• 16% of schools are actually providing daily physical activity (2001)

54%

16%

Obesity—Information Gaps

What do we still need to know?

• How accurate are self-reported BMI measures?

• What are relative contributions of physical activity and diet toobserved trends?

• Which preventive policies and programs work best?

• Why are residents of certain regions less physically active?

Summary and Conclusions

3 Themes of a New Message

• Expanding knowledge – Only 1 in 3 Canadians identified factors affecting health beyond food,

exercise, smoking

• Reducing inequalities– Inequalities in health in Canadian society are largely avoidable,

not inevitable

• Working together– Across sectors and at all levels of society

Related Reports in 2004• Public Views on the Determinants of Health, CPHI

• A Snapshot of Population Health Trends in Canada, CPHI

• What Have We Learned Studying Income Inequality and Population Health?, Ross, N.

• Socio-demographic and Lifestyle Correlates of Obesity, CFLRI

• Overweight and Obesity in Canada: A Population Health Perspective, Raine, K.

• Policy Efforts to Ensure the Health and Development of Children in Early Childhood, Beauvais & Jenson, CPRN

• Seven Years Later: An Inventory of Population Health Policy Since the Royal Commission on Aboriginal Peoples 1996–2003, CPHI

Questions? Comments?