This article was originally published in Maclean's Magazine on October 21, 2002
Canadian Health Worsening
Sarah Hamid considered herself a "happy-go-lucky person." A straight-A student with a loving family and a scholarship at Simon Fraser University in Burnaby, B.C., she loved the campus clubs and thrived on sports. Until September of 1996, that is, when at 18, on her first day back for her second year of university, she suffered a debilitating panic attack. Her parents, deeply concerned, took her to a doctor, who prescribed a tranquilizer. The pills settled her down, but her real problem remained undiagnosed.
The symptoms of mental illness crept over Hamid like a cold, damp fog. Cloaked in her dark world, Hamid was sleeping 12 to 16 hours a day. She would weep in class, so much that she'd sneak off to the bathroom so no one could see. "Almost like someone with an addiction," says Hamid, "I was finding places to hide my habit." She ate little and was losing weight. "It got to the point where I was driving home one day and I really wanted to drive the car over the yellow line into oncoming traffic," says Hamid. "I was like, OK, I really have to tell someone." Her doctor diagnosed severe depression. Now 24, Hamid takes an effective anti-depressant, and the crying fits that would overwhelm her for hours once or twice a day now happen only every few months or so and last only maybe 10 minutes.
In one form or another, mental illness strikes one in five Canadians, and there are troubling signs that the situation may be worsening. Hamid is a human face on a disturbing health trend that emerges in new data from Statistics Canada. The number of Canadians at probable risk of depression is climbing, up from 5.2 per cent of the over-12 population in 1994/95, to 7.1 per cent in 2000/01. And it's only one of many health indicators that show a worsening trend.
Also on the rise are asthma, high blood pressure, diabetes and arthritis. Obesity is at epidemic levels and worsening, with 14.9 per cent of Canadians considered obese by international standards. Increasingly, Canadians say pain or discomfort prevents at least a few of their activities. More are drinking heavily, with a particularly notable increase among women. Women also fare worse than men in measurements associated with pain and limitations on activity.
Given those trends, it's not surprising that fewer Canadians rated their own health as either excellent or very good in 2000/01 (61.4 per cent) than in 1994/95 (66.9 per cent). And though it's tempting to blame a lot of those problems on an aging society, for the most part that would be wrong. Only a few indicators - arthritis and rheumatism among them - rise in tandem with an an older population.
There is a paradox here. At the same time as so many health indicators are heading in the wrong direction, life expectancy has risen. Men on average now live for 76.3 years, up 4.9 years from 1979. In that same time, women's average rose 2.9 years, to 81.7. Early statistical data also suggest we seem to be living longer before disabilities set in, says Dr. John Millar, vice-president of research and population health at the Canadian Institute for Health Information (CIHI). So what's going on? It is conceivable, says Millar, that our march toward ever-improving health could be coming to a dead stop. As more Canadians wheeze, ache and groan under the burden of worsening health and swelling paunches, we could soon see life expectancy actually start to decline after centuries of improvement. "It might be just like the stock market," says Millar. "We go for 10 years with a bull market, then suddenly it turns bear on us - these may be the early signs."
Canadians are prepared to swallow a bitter pill for the sake of their health. Polls show a majority are willing to pay more for healthier, longer lives, and the politicians know it. "The issue is not whether we will pay more as a society for health," Prime Minister Jean CHRÉTIEN said this month. "We will." Extra money will likely help heal the ailing health-care system - the aim of both the Senate social affairs committee headed by Senator Michael Kirby, and former Saskatchewan premier Roy Romanow's Royal Commission on health care. To succeed, however, their remedies will have to take into account that Canadians are getting older, the environment is deteriorating and a number of us have developed some really, really bad habits.
This Maclean's Health Report is based on Statistics Canada's biennial Canadian health surveys. It's been tracking data on a selection of health indicators at the national level since 1994 - illustrating some unhealthy trends. The agency has also broken the 2000/01 data down to the health-region level. While the 12 indicators included in this report are by no means the only signs of a community's health, their composite results provide another way of pinpointing where Canadians are having more serious health problems - and where they're faring better.
The results largely mirror those of a Maclean's Health Report of two years ago, based on another set of StatsCan data, on longevity and mortality. Once again, North and West Vancouver, Vancouver/ Richmond and Toronto, for instance, are among the leaders, while Ontario's health regions of Sudbury/Sault Ste. Marie and North Bay/Huntsville, as well as Cape Breton, N.S., are cellar dwellers. Overall, five regions in Quebec and four in B.C.'s lower mainland dominate the top 10 positions this year. Seven of the bottom 10 are in Ontario or the Atlantic region.
The new data on one indicator - depression - points to Alberta as a trouble spot. The probable risk of developing depression - at a hefty 9.2 per cent of the population - is higher there than in any other province. Red Deer, where the number reaches 10.9 per cent, is a case in point. The city and its surrounding rural region, located in the busy corridor between Edmonton and Calgary, have undergone rapid growth. A developing economy has boosted the population by nearly 10 per cent since 1997. "You'd think that would be great, and it is," says Dr. Susan Todd, a psychiatrist and the medical director for mental health services in the region. "However, with that it brings a transient population, an increased complexity of needs."
Several factors are at work in raising the incidence of depression. Some newcomers were unhappy with where they lived before, says Todd. Once in Red Deer, they may not have been able to find the job or housing they'd like and can afford. Life can be difficult for the region's large number of single mothers, she adds, and the homeless rate has risen in recent years.
But Red Deer is not without resources. Apart from a major psychiatric hospital (which, in fact, draws some depressed people to Red Deer), it has eight mental-health clinics and other services that work to create awareness and opportunities for treatment. As a result, Red Deer-area residents are more likely to know enough not to wait until the last minute to seek treatment. It remains to be seen, Todd says, whether Red Deer's incidence of depression is on the rise. When StatsCan's regional data was collected in 2000/01, grain prices were so low many area farmers had to sell their land. Todd could see the effects in her patients. "In some families," she recalls, "both husband and wife had problems with depression."
There may be consolation in knowing Canada is not alone in grappling with runaway obesity - but not much. Copious corpulence is a modern-day crisis and the litany of problems associated with it is well-known: dangerously high blood pressure, depression, diabetes, joint ailments leading to arthritis. The situation is getting worse, even as more Canadians say they are active in their leisure time than in the mid-1990s: up to 42.6 per cent from 39.4 per cent.
The numbers tell a grim story. Almost half of all Canadians aged 20 to 64 are overweight or obese. According to Health Canada, more than half of Canadian children are not active enough for optimal growth and development. From 1981 to 1996, the prevalence of overweight children doubled, and obesity tripled for both boys and girls. In April, federal Health Minister Anne McLellan announced the first national physical activity guidelines for children and youth. They recommend that young people increase the amount of time they currently spend being physically active by at least 30 minutes per day.
The Edmonton health region, called the Capital Health Authority, was among the first to recognize the need to involve as many players as possible to battle the bulge. Officials are establishing a monitoring system to track not only child height and weight, but also activity levels and - with the help of University of Alberta academics - sales of high-carbohydrate foods. Another program will attempt to increase physical activity, in the belief that getting kids active early will translate into life-long good habits. But Dr. Gerry Predy, the region's medical officer of health, knows it will be difficult. "Bottom line," he says, "is there aren't a lot of things out there that are known to work." Predy worries that the public is still blasé about obesity. "People know about smoking - everybody knows that," he says, "but they're not aware of obesity in the same way."
Few things are as fundamental to life as being able to breathe clean air. As the debate unfolds over ratifying the Kyoto Protocol for curbing greenhouse gases, CIHI's Millar notes that air quality is the primary environmental factor affecting people's health on a day-to-day basis. "Certainly more people are dying of air pollution than from water or other toxic exposures," he says. Numerous studies connect poor air quality with the prevalence of asthma, which has gone from affecting 6.5 per cent of Canadians aged 12 and over in 1994/95 to 8.4 per cent.
Dr. Thomas Hudson, director of the Montreal Genome Centre, says that while genes play a role in susceptibility to asthma, they're far from the entire answer. "Certainly, genetics could not explain why there's an increase in asthma because we have the same gene pool as our parents," says Hudson. "Differences in our environment are probably responsible for this rise." Our homes are part of the problem. In winter, we seal them to keep in the warmth; in summer, windows are shut tight to give the air conditioner a fighting chance. Dr. Alan Kaplan of Richmond Hill, Ont., chairman of the Family Physician Airways Group of Canada, says our hermetic environment can exacerbate respiratory problems due to dust, dust mites, mould and dirt in air ducts. "There's no question," says Kaplan, "that our environment is getting more toxic all the time."
We are also, it seems, less physically able to cope. A theory gaining ground holds that a modern preoccupation with cleanliness - daily showers, anti-bacterial soaps, scrubbed floors - keeps children's systems from developing the natural immunity they require to ward off airborne assaults that lead to asthmatic attacks. "Because we're so clean," says Kaplan, "the immune system isn't as good at fighting stuff."
About the only thing going for our gasping lungs is our declining inclination to light up a smoke. Since the mid-1990s, daily smokers have declined steadily, from 24.3 per cent of the population over 11 to 21.5 per cent.
Also on the increase: arthritis. As we grow older, our susceptibility rises dramatically - at 65, Canadians have a 55-per-cent chance of being afflicted. The statistical bulge of the baby boomers is like a tsunami ready to plow straight into a foundering health-care system. By 2016, we can expect a 50-per-cent increase in the number of people suffering from arthritis, says Dr. Dianne Mosher, a Halifax-based rheumatologist and co-author of Living Well With Arthritis. Meanwhile, Canada has only 270 specialists in the disease, and fewer than a dozen graduate each year. "In our region, if you needed your knee replaced right now, you probably wouldn't get it for a year or more," she says. "What does that mean by 2016? Well, the government has to address this."
As for alcohol use, social scientists have come to expect that as a population ages, drinking becomes more frequent but amounts consumed each time decline. That's not what StatsCan has found. Binge drinking, in fact, has gone up. The percentage of Canadians who pound back five or more alcoholic drinks at least 12 times a year was 13.9 in 1994/95. Six years later, it's 20.1. Men are still the big boozers, but the incidence of heavy drinking among women almost doubled during that period.
The overall increase doesn't surprise Edward Adlaf, a research scientist at the Centre for Addiction and Mental Health in Toronto. A study by the centre in the early 1990s indicated a rise in binge drinking among school kids from Grade 7 through high school. Today's numbers are a "continuation of a trend that started somewhat earlier in a younger group," says Adlaf, adding the rise corresponds with a decreasing perception among young people of the risks associated with alcohol use. Kathryn Graham, a senior scientist also with the centre but based in London, Ont., says the findings need to be fleshed out. "If it means that more women are drinking wine with dinner," says Graham, "that's less troublesome than more women going out Friday night and having 15 drinks."
Women come out on the wrong end of the equation in other parts of the study, as well. Asthma strikes 9.9 per cent of them; just 6.9 per cent of men. They get arthritis at three times the rate of men. They're twice as likely to be hit by major depression, although the rates seem to even out after age 55. Hormones are one factor at work, says Lorraine Greaves, executive director of the British Columbia Centre of Excellence for Women's Health. She also points to a tendency among women who act as caregivers to delay seeking medical attention for themselves. And because they often outlive their spouses, women frequently have no one to care for them. "The other thing that comes into this," says Greaves, "is that women generally have less money than men."
Statistically speaking, the rich among us have a better chance of living to a ripe old age. A Statistics Canada study covering the years 1971 to 1996 suggests the longevity gap between the rich and poor has narrowed from 6.3 to five years. However, Dr. Clyde Hertzman, a professor in the department of health care and epidemiology at the University of British Columbia, worries it may be widening again because of cutbacks in the social safety net since that survey ended. "There's a real question of how things will progress from here on in," says Hertzman.
He cites Sweden as a useful model of social planning. With a population roughly that of Ontario, it spends two per cent of its gross domestic product on family policy. Canada spends half of one per cent. "They have a program of cash transfers to families with children that makes it almost mathematically impossible to live below the poverty line," says Hertzman. As a result, the proportion of poor single-parent families in Sweden is one-tenth of Canada's.
It boils down to giving kids a chance. What happens in early life is known to have a huge impact on how healthy they'll be as adults. In the Chrétien government's Throne Speech last month, the Liberals pledged more money for the poor, in particular for early-childhood education and daycare. Setting children off on the right track holds enormous potential for reducing the strain on the health-care system. "If we get that right," says Hertzman, "we could make a huge difference." If not, we risk our children's future health, and we overload a system already in danger of flatlining.
Maclean's October 21, 2002