http://thestar.ca/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1077232209874&call_pageid=991479973472&col=991929131147
Note the web version has a typo... Poor Canadian kids have a 26% income
advantage...
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We're healthier, wealthier, warmer ? we win!
JUDY GERSTEL
When I first started working at WGBH-FM, the Boston public radio station,
lo these many years, they had a daily series of alternating international
current affairs programs, each focusing on a different country. There was
Window on Germany, Window on Czechoslovakia, Window on Greece ... well, you
get the picture.
But one program title broke the pattern. It was called Over The Back Fence.
I told the station manager I found this offensive. "It makes Canada sound
like a cow pasture or an outhouse," I complained.
So I was pleased, after all these years, to read a headline in the Boston
Globe acknowledging that we Canadians are way out front where it really
matters.
"Why Canadians are healthier" was the subject of a column last week in the
Globe Health section. It was illustrated with a fit-looking cartoon
character running with a Canadian flag raised in one hand and wearing an
athletic vest with a number one prominently displayed. Watching from the
sidelines is a grimacing bent man with a cane and an American flag
sprouting from his beanie.
"My fellow Americans: Want a health tip?" the column by Judy Foreman
begins. "Move to Canada."
She explains, "An impressive array of comparative data shows that Canadians
live longer and healthier lives than we do. What's more, they pay roughly
half as much per capita as we do ? $2,163 versus $4,887 in 2001 ? for the
privilege."
Foreman then goes on to explore the possible reasons for Canadian
superiority.
She cites American experts who suggest our single-payer, universal health
care system is responsible for keeping us healthier. Others point to our
different ethnic mix.
Some, it seems, believe we're healthier because we use fewer illegal drugs
and shoot each other less. (You don't have to be an academic to come up
with that one, 'though it's also noted that we do "smoke and drink with
gusto.")
One Harvard professor of health policy and political analysis even suggests
that the difference in seat-belt usage could contribute to the better
health of Canadians.
What is not disputed is the fact that we are healthier.
"By all measures, Canadians' health is better," Johns Hopkins Medical
Institutions professor Barbara Starfield told the Globe. Canadians, she
said, "do better on a whole variety of health outcomes." Among them: life
expectancy at every age, infant mortality, maternal mortality.
I asked a couple of Canadian experts on these matters for their perspective
on what we're doing right.
"I think it's fairly clear that most differences in health have more to do
with general social and economic conditions and less to do with health
care," says Dr. Michael Rachlis, the U of T professor recognized as one of
Canada's leading health analysts and author of the just published
Prescription for Excellence: How Innovation is Saving Canada's Health Care
System.
He agrees that our system of universal health care ? although it could be
organized better, as he eloquently explains in his extremely readable and
insightful book ? is responsible for some of the better health of
Canadians. But, he says, "More of the difference is related to our other
social and economic policies ? equalization that is built into the Canadian
constitution."
Even more adamant about the effect of social determinants accounting for
our better health is York University professor Dennis Raphael.
"The reasons that Canadians are healthier than Americans is that,
traditionally, there has been much more attention paid by Canadian
governments to the basic determinants of health ? adequate income, food and
housing, and what we call the social safety net."
Raphael refers to a 2000 report in the British Medical Journal showing that
those states in the U.S. that have some of the best profiles, including
Vermont, New Hampshire, Minnesota and Washington have public policies that
are very similar to Canadian practices.
"These same states are also much more equal in income distribution than
most U.S. states and look very much like Canadian provinces."
And so, while the Boston Globe cites statistics proving our health is
better than theirs ? life expectancy, infant mortality, even the fact that
more than half of Canadians with severe mental disorders received treatment
compared to little more than a third of Americans ? the real story lies in
other statistics that have more to do with income distribution and the way
social and economic resources are distributed here.
Although the real GDP per capita, indexed at 100 for the U.S., is only 89
for Canada, this country nevertheless spent twice as much on social
expenditures for the non-elderly.
While taxes and income transfer reduced poverty in the U.S. for children
from 25 to 20 per cent, in Canada it was reduced from 23 per cent to 14 per
cent. (And we're still not doing all that well. Finland managed to combat
child poverty by using taxes and transfers to reduce it from 16 per cent to
a mere 4 per cent.)
Low-income Canadian children have absolute incomes 26 percentage points
higher than low-income American children. The average Canadian child has a
2 percentage point advantage in income over the average American child.
Clearly, the difference in the health of Canadians versus Americans has a
lot to do with choices beyond eliminating guns and fastening seat belts.
"One could say that it is Canadian values that are continuing to
differentiate us from the United States," says Rachlis.
The Boston Globe article concludes, "So, should we all move to Canada?
Probably. But it's just too cold."
Not true.
In ways that really count, it's a lot colder down on the other side of the
border.
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