The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #73726

Clyde Hertzman, MD, MSc, Human Early Learning Partnership, University of British Columbia, 320 - 2206 East Mall, Vancouver, BC V6T 1Z3, Canada, 604-822-3002, clyde.hertzman@ubc.ca

In 1950, life expectancy in Canada and the US was approximately the same; with a slight US advantage for women and the reverse for men. Over the last half century, Canada has pulled ahead of the US, so that now there is an approximate two year advantage for Canada; on the basis of approximately 30-40% lower age specific mortality, by five year age group, during ages 25-65. This has occurred despite the fact that Canadian immigration rates from low life expectancy countries has consistently been double the United States for most of this period. Canadian and American spending on health care, as a proportion of GDP, tracked closely until the early 1970s, by which time the Canadian universal medicare system was fully in place. Thereafter, Canadian spending rose more slowly as a proportion of GDP; from approximately 7% to 9-10% by the end of the last century, while US spending rose into the 12-15% range, concurrent with relative gains in health status in Canada. During this time period, Canada devoted more spending to the social safety net than the US, and instituted policies to ensure that the 'spirit of redistribution' applied to education; employment security; and retirement. As of today, infant mortality in the poorest quintile of the Canadian population is lower than the US average and life expectancy in the poorest Canadian income quintile is higher than the US average. Income inequality is lower and much less variable across cities and provinces in Canada than in the US. Moreover, the United States shows an 'ecological gradient' in health, such that adult mortality rates rise with rising income inequality across states and metropolitan areas, but not in Canada. At the individual level, socioeconomic gradients in health status exist in both countries, but in Canada, each income quintile has been gaining health status at a similar rate; leading to absolute declines in socioeconomic differences in health status. The same trend has not occurred in the US. Finally, there is no evidence that lower spending on health care in Canada undermines the contribution of health care to health. Canada-US comparisons of hospital mortality; cancer survival rates; etc. do not point to a US advantage and, in some cases, point to a Canadian advantage. Taken together, these observations suggest that the US is spending too much on medical care, and in the wrong way, compared to spending on redistributive programs.

Learning Objectives:

• • understand the population health perspective on medical spending
• • understand Canada-US differences in health status and medical spending
• • understand the relative importance of social spending, compared with medical spending, on health

Keywords: Health Care Politics, Social Inequalities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.