How Canada Performs

Canada Gets Middle-of-the-Pack Results in Health and Society

Brenda Lafleur, Program Director, Forecasting and Analysis

October 26, 2009

Canada performs better than the United States in Health and Society outcomes, but barely merits a top-10 ranking among the world’s leading countries in How Canada Performs: A Report Card on Canada. Although Canada earns overall “B” grades in the Health and Society categories, the Conference Board’s annual socio-economic analysis reveals some glaring weaknesses, particularly in the areas of poverty and management of chronic diseases.

Society: Poor Results in Poverty and Social Cohesion

In the overall Society category—which measures 17 indicators in the areas of social cohesion, equity, and self-sufficiency—Canada ranks ninth, an improvement of one place from last year. Canada’s overall “B” remains consistent with its grades in this category over the past two decades.

With more than 12 per cent of the working-age population living in poverty, Canada ranks 15th out of 17 countries—a “D” grade—ahead of only Japan and the United States. Canada’s record on child poverty is hardly better—a 13th-place ranking and a “C” grade. Even though Canadians take pride in having conquered seniors’ poverty in recent decades, Canada’s elderly poverty rate doubled from 2.9 per cent in the mid-1990s to 5.9 per cent in the mid-2000s.

Despite poor results in poverty and indicators of social cohesion—such as assaults—Canada has moved up to ninth place due to higher grades in income mobility (the extent to which income levels can change across generations) and our acceptance of diversity.

Economy-Society Links

The overall rankings in the Society category have Denmark, Norway, Sweden, and the Netherlands all earning “A” grades, while the United States and Japan are the two “D” performers among the 17 countries ranked. Norway, the Netherlands, and Denmark are also among the top five performers in the Economy category of How Canada Performs, suggesting that a strong economy does not have to come at the expense of a strong social fabric.

Health: Middle of the Pack

Canada has been at the centre of much of the U.S. health-care debate, both criticized and praised by opponents and advocates of health-care reform. When one looks beyond the narrow cross-border comparison to other developed countries, one finds that Canadians’ health status is in the middle of the pack. Canada ranks 10th among the 16 comparator countries in overall health outcomes and earns a “B” grade (data was not available for Belgium). The United States is the worst performer in the comparison and gets a “D” grade. Canada ranks ahead of the U.S. in all but one indicator of health status—mortality rate due to cancer.

While Canada obtains no “D” grades in any of the 11 indicators of health status, “C”s in the mortality due to diabetes (14th place), mortality due to musculoskeletal diseases (10th place), and infant mortality (15th place) should be raising alarm bells. These results should incent Canadians to adopt a model of health care that focuses on sound primary care practices and on preventing and better managing chronic diseases.

Canada is slightly above average—ranking seventh—on a new indicator that measures patient safety: mortality due to medical misadventures.

Leaders Focus on Determinants of Health

Japan is once again the top-ranking country in the Health category. Japan turned a “C” in the 1960s into a sustainable “A” in the 1970s and continues to achieve strong health outcomes. Switzerland, Italy, and Norway have also earned “A” grades. Most top-performing countries have achieved better health outcomes through actions on the broader determinants of health—such as environmental stewardship and health promotion programs that focus on changes in lifestyle, along with education and early childhood development.

Japan's "A" ranking is likely attributable to lifestyle factors, such as healthy diets and active living, healthy physical environments, and a high-performing health-care system. However, its strong performance maybe be compromised in the near future if it does not address low grades in child and elderly poverty, income inequality, and social isolation, all of which are important determinants of health.

How Canada Performs: A Report Card on Canada is the Conference Board’s annual benchmarking analysis, which the Board has conducted since 1996. The Conference Board assesses Canada’s performance against that of leading countries in the domains of Economy, Health, Society, Innovation, Environment, and Education and Skills.