Health System Performance: What Matters (A Case Study of Canada and the United States) Clyde Hertzman HELP, CHSPR, HC&E

Female Life Expectancy in Canada vs the United States

Male Life Expectancy in Canada vs the United States

Infant Mortality in Canada vs. The United States,

Infant Mortality per 1,000 Mortality by Neighbourhood Income in Urban Canada, Wilkins R, Berthelot JM, Ng E, March 2001

Infant Mortality Rates: US vs Canada, 1996 CanadaUS CanadaUS Poorest 20%6.5/ Second Second Third Third Fourth Fourth Richest 20% Overall Overall5.27.8

Quantitative Literacy Scores for Youth Aged International Adult Literacy Study, 1994 Parents’ Level of Education Effect Size Level 1 Level 2 Level 3 Level 4 Level 1 Level 2 Level 3 Level 4 Sweden Switzerland Netherlands Germany Belgium Canada USA Poland Ireland N Ireland G Britain New Zealand Organisation for Economic Co-operation and Development and Statistics Canada. (1995) Literacy, economy, and society: results of the first international adult literacy survey. OECD/Ministry of Industry Canada, p 151.

Working Age (25-64) Mortality by Median Share U.S., Canadian, and Australian Metropolitan Areas

National Expenditure on Health in Canada vs the United States

Socioeconomic Gradients in Medically Avoidable Deaths, Canada, “……from 1971 to 1996, the disparity [from income quintile 1 to 5] for causes amenable to medical intervention diminished 60% (1287 age-standardized expected years of life lost per 100,000) in men and 78% (1264 SEYLL per 100,000) in women………” Ref: James, Wilkins, Detsky, Tugwell, Manuel, JECH, 2007.

Purchasing Power Parity Adjusted Gross Domestic Product Per Capita: Canada Vs. The United States

Unemployment Rates: Canada Vs. The United States

Gini Coefficient of Income Inequality: Canada vs the United States

Public Social Expenditure in Canada vs the United States

Redistribution in Canada vs the United States: The Impact of Taxes and Transfers on Inequality

Postmaterialist Values in Canada vs the United States,

Trust in Canada vs the United States

Factoid ……..until 1979, the rate at which immigrants from specific countries of origin obtained citizenship in Canada and the United States was approximately the same….thereafter, the rate in Canada went up and the rate in the US went down, for all groups except Vietnamese………. Ref: Bloemraad

Percentage of Unemployment Insurance Beneficiaries to Total Unemployed for Canada, Germany & USA, Sources: Canadian Data: Statistics Canada Cansim II Series V384606, V385120; American Data: US Department of Labor & Bureau of Labor Statistics; German Data: Schneider 2004 Table 5, p 113

After-Tax Income Gap is Bigger than Ever for Families Raising Children in Canada (ratio of after- tax income in deciles 10 and 1, ) Yalnizyan, 2007

Percentage of Students Vulnerable on One or More scales of the EDI Based on Provincial cutoffs, Wave 1

Percentage of Students Vulnerable on One or More Scales of the EDI Based on Provincial cutoffs, Wave 2

Take home lesson 1 Societal institutions that are determinants of health, and therefore, de facto, integral to the ‘health system’, evolve over historical time, and their impact on health status emerges gradually, too Thus, societies can (unwittingly) undermine population health through policy change

Take home lesson 2 Despite strides in population-based, longitudinal, person-specific data systems, we do NOT have a measurement regime that: is based upon a consensus as to the societal characteristics that support or undermine health monitors these characteristics in an internationally consistent way identifies and monitors ‘leading outcome indicators’ such as ‘gradients’ in health/ socially sensitive populations adequately accounts for the element of time