released february 25, 2004 - canadian institute for health
TRANSCRIPT
Priv
acy,
Con
fiden
tialit
y an
d Se
curi
ty
Com
mun
icat
ion,
Con
sulta
tion
and
Diss
emin
atio
n
Priv
acy,
Con
fiden
tialit
y an
d Se
curi
ty
Com
mun
icat
ion,
Con
sulta
tion
and
Diss
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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 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
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
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 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?
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