Hello, I am a nurse in the USa and saw this article and thought you may find it interesting.
My fellow Americans: Want a health tip? Move to Canada.
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.
Exactly why Canadians fare better is the subject of considerable
academic debate. Some policy wonks say it's Canada's single-payer, universal
health coverage system. Others point to Canadians' different ethnic
mix. Some think it's because they use fewer illegal drugs and shoot each
other less with guns, though they do smoke and drink with gusto.
Still others think Canadians are healthier because their medical system
is tilted more toward primary-care doctors and less toward specialists.
And some believe it's something more fundamental -- a smaller gap
between rich and poor.
Perhaps it's all of the above. But there is no arguing the basics.
"By all measures, Canadians' health is better," said Dr. Barbara
Starfield, a university distinguished professor at Johns Hopkins Medical
Institutions. Canadians "do better on a whole variety of health outcomes,"
she said, "including life expectancy at various ages -- 1, 15, 20, 45,
65, 80, you name it."
According to a World Health Organization report published last year,
life expectancy at birth in Canada is 79.8 years versus 77.3 in the
United States (Japan's is 81.9.). Canada now ranks fifth in life expectancy
at birth (after Japan, Sweden, Hong Kong and Iceland), while the United
States ranks 26th, according to the United Nations Human Development
Report.
"There isn't a single measure in which the US excels in the health
arena," said Dr. Stephen Bezruchka, a senior lecturer in the School of
Public Health at the University of Washington in Seattle. "We spend half of
the world's health care bill and we are less healthy than all the other
rich countries.
"Fifty-five years ago, we were one of the healthiest countries in the
world. What changed? We have increased the gap between rich and poor.
Nothing determines the health of a population [more] than the gap between
rich and poor."
Infant-mortality rates also show striking differences between the
United States and Canada, according to Dr. Clyde Hertzman, associate
director of the Centre for Health Services and Policy Research at the
University of British Columbia in Vancouver. To counter the argument that
racial differences play a major role, Hertzman compared infant mortality for
all Canadians with that for white Americans between 1970 and 1998. The
white US infant mortality rate was roughly six deaths per 1,000 babies,
compared to slightly more than five for Canadians.
Maternal mortality shows a substantial gap as well. According to data
published last year by the Organization for Economic Cooperation and
Development, an international think-tank, there were 3.4 maternal deaths
for every 100,000 births among Canadians compared to a 9.8 among all
Americans.
And more than half of Canadians with severe mental disorders received
treatment, compared to little more than a third of Americans, according
to the May-June 2003 issue of Health Affairs.
Dr. Steffie Woolhandler, an associate professor at Harvard Medical
School, general internist at Cambridge Hospital and staunch advocate of a
single-payer system, said she believes "the summary of the evidence has
to be that national health insurance has improved the health of
Canadians and is responsible for some of the longer life expectancy."
On the other hand, there are some causes of death that wouldn't be much
affected by having the government pick up the health care tab -- like
homicide. And the United States, Bezruckha said, has "the highest
homicide rate of all the rich countries."
"Other things might be differences in seat-belt usage," said Robert
Blendon, a professor of health policy and political analysis at the
Harvard School of Public Health. "We are also disproportionate consumers of
illegal drugs, much more than Canada, so it's cultural. The health of
Americans would be better if we had universal health care, but there are
some things that a single-payer system wouldn't fix, but which would
leave one country looking healthier in the statistics." In some respects,
the health care system is "the tail on the dog," said Dr. Arnie
Epstein, chairman of the department of health policy and medicine at the
Harvard School of Public Health. "It's other aspects of the social fabric of
different countries that seem to have a major impact on how long people
live."
Like ethnicity. In the United States, African-Americans and Latinos
"face problems of housing, stress and low income which have nothing to do
with a single-payer system," Blendon said. Canada has a large number of
Asian immigrants, he said, but they, like Asian immigrants in the
United States, tend to do well on health care measures.
The bottom line is that Canada is doing something right, even if "the
reasons are not totally understood," said Kominski of UCLA.
So, should we all move to Canada? Probably. But it's just too cold.
Judy Foreman is a freelance columnist who can be contacted at
foreman@globe.com.
© Copyright 2004 Globe Newspaper Company.
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