This article was originally published in Maclean's Magazine on October 23, 2000
Fitness: Canada's Healthiest Regions
As Simon Whitfield gleefully kicks a soccer ball around with a group of schoolkids, it's hard to imagine anyone fitter or healthier anywhere on the globe, let alone in Canada. With his thrilling come-from-behind gold-medal finish in the first-ever Olympic triathlon in Sydney last month, Whitfield, 25, took his place in the international pantheon of great athletes. Now he is schmoozing with students at a school in the bedroom community of Aurora, north of Toronto. "I've been to as many schools as I could get to in the two weeks since I got home," says the busy athlete who grew up in Kingston, Ont., but now lives and trains in Victoria. "I just think it's important for everyone to talk to kids about surrounding themselves with positive people, setting goals and figuring out how they're going to accomplish those goals."
Whitfield, who has dropped in on the Aurora Montessori School as a favour to a friend whose two children go there, constantly drives home his Olympic message. "It's not about winning gold medals," he says. "It's about being healthy and meeting people and great experiences." Here is an athlete whose life suddenly catapulted into another dimension because he beat the best in the world, telling kids they have "a responsibility to be healthy and to be fit and to love sport" - not so they can win, as he has done, but simply for the good of their health.
Canadians in huge numbers have bought the same message: keep active, eat well, take care of themselves - for the good of their health. Great hospitals and brilliant doctors make a difference. So do miraculous prescriptions and shorter lineups for MRI scans. But it is the way Canadians conduct their daily lives - and the socioeconomic environment they live in - that really determines how healthy they are. In a far-reaching survey, Maclean's second annual report on the status of health in communities across Canada has found two clusters of exceptionally good health: in and around the cities of Toronto and Vancouver. There, the analysts observe, great numbers of people are living well and looking after themselves.
Because of the differences in the importance of the indicators that it counts, the survey does not produce a strict ranking. Instead, a totalling of those indicators in which various communities show the healthiest - and the least healthy - results provides a graphic overview of health successes and challenges across Canada. Of the country's 136 health regions, the survey includes 51 of the most populous, each with more than 100,000 residents - in all embracing fully 85 per cent of Canadians. It compares those regions on the basis of Statistics Canada data covering a spectrum of the 16 key health indicators that are collected on a consistent basis at the health region level across Canada.
The Vancouver and Toronto areas, interestingly, include the same regions that scored top marks in last June's annual Maclean's ranking of the delivery of health services to Canadians. But even more significantly, in the view of many experts, those regions' health successes correlate closely to their high levels of education, employment and income - strong indicators of a community's ability to look after its best interests. And in a phenomenon only recently gaining recognition in Canada and elsewhere, the best health results also go hand in hand with a high concentration of immigrants.
At Statistics Canada, senior analyst Russell Wilkins has looked closely at what is being called "the healthy immigrant effect." It results principally from two selection stages, he notes. "First, there's a self-selection process - who decides to emigrate," says Wilkins. They have to want to leave and be able to leave. "That basically excludes the people who are sick, disabled and in institutions," Wilkins adds. "In other words, we're getting a select group in terms of health." At the Canadian end, most immigrants who are not refugees are chosen from among that select pool of applicants on the basis of superior education, language ability and job skills - characteristics that go hand in hand with healthy lifestyles.
But the healthy immigrant effect has a limited lifespan, Wilkins adds. "Health surveys," he says, "show that the longer immigrants are in the country, the more their health profiles look like the general population's." That is partly because they tend to pick up bad habits, including smoking and less-healthy diets. The same health effect, Wilkins notes, appears to apply to internal migration as healthy residents of parts of Canada that offer little opportunity gravitate to jobs and better futures.
The survey also illustrates the close association between poorer health and the relative lack of socioeconomic advantages in some inner cities and more rural regions. "People who are unemployed, or living in chronic poverty, or socially isolated - the people who are socially disadvantaged - are at risk," says Dr. John Millar, vice-president of the Canadian Institute for Health Information. A decade of research has established that many of those people are more susceptible to disease. "That," says Millar, "is a direct consequence of the stresses they are experiencing and how they impact on their immune systems and their general ability to resist disease and keep themselves healthy."
This second annual report on the health status of Canadians fleshes out the findings of the inaugural survey. A year ago, Maclean's had Statistics Canada data on just 17 major communities. They included Toronto and Vancouver, and that report pointed to the health advantages in those cities. This year, the addition of data from another 34 regions suggests that the affluent communities on the borders of Toronto and Vancouver are even healthier than their big-city neighbours. The numbers this year are also based on a firmer foundation, drawn from a three-year average of the data from 1995 to 1997 instead of a single year's reports. "That," says senior analyst Jason Gilmore, a principal member of the Statistics Canada team that produced the survey material, "helps smooth out the fluctuations that could appear in any individual year and makes the data more stable."
The results show the sprawling rural regions - including Prince George, B.C., Thunder Bay, North Bay and Sudbury, Ont., and Chicoutimi, Que. - clustered at the lower end of the table. Distances from medical help, lower education, less affluence, fewer job opportunities - those and other factors make good health harder to come by. The survey also points to the special challenges that health authorities face in Quebec and across the Atlantic region in trying to bring levels of health up to national standards.
Across the Prairies, the regions around Winnipeg and Regina show middle-of-the-pack results; Saskatoon fares better with significantly above-average results in five of the 16 categories, including the important life expectancy. But Alberta presents an intriguing paradox: the four regions from that wealthy, high-employment province show only middling results.
Back in Ontario, Simon Whitfield speeds from one appearance to another in Kingston and Toronto until, finally, he's off to the Ironman World Championships in Hawaii to cheer on fellow Canadians. On his way to meet with the Aurora students, he takes a moment to consider his attitude towards physical activity. "Fit people, active people are going to be healthier people," he says. "You only get one crack at life, so you might as well make it a fit one." A philosophy to live by.
Among the Global Leaders
Life expectancy, based on estimated mortality rates as of Jan. 1, 1999:
1. Andorra, 83.5
2. San Marino, 81.5
3. Australia, 80.1
4. Japan, 80.1
5. Canada, 79.4
6. Sweden, 79.3
7. Switzerland, 79
8. Iceland, 79
9. Singapore, 78.8
10. France, 78.6
Source: the World Factbook 1999/CIA
The Healthy Immigrant Effect
Of the 10 regions that are home to the highest proportion of immigrants:
- all but two (Montreal and Hamilton) have life-expectancy rates higher than the national average
- all but one (Montreal) have above-norm average incomes
- all but two (Hamilton and Surrey/Langley, B.C.) have higher than the national rate of post-secondary graduatesAverage income* (residents 15 and over)
Immigrant population: 17.4%
Life expectancy (years): 78.4
Average income (residents 15 and over): $25,196
Postsecondary (graduates aged 25-54): 51.5%
Immigrant population: 47.6
Life expectancy (years): 79.4
Average income (residents 15 and over): 27,532
Postsecondary (graduates aged 25-54): 55.8
Immigrant population: 45.5
Life expectancy (years): 79.2
Average income (residents 15 and over): 25,871
Postsecondary (graduates aged 25-54): 64.4
3. Mississauga/Brampton/Burlington, Ont.
Immigrant population: 35
Life expectancy (years): 80.1
Average income (residents 15 and over): 30,821
Postsecondary (graduates aged 25-54): 55.6
4. Burnaby/New Westminster, B.C.
Immigrant population: 31.6
Life expectancy (years): 79.1
Average income (residents 15 and over): 26,621
Postsecondary (graduates aged 25-54): 57.5
5. North/West Vancouver
Immigrant population: 31
Life expectancy (years): 80.5
Average income (residents 15 and over): 36,691
Postsecondary (graduates aged 25-54): 68
6. Markham/Richmond Hill, Ont.
Immigrant population: 27.2
Life expectancy (years): 79.6
Average income (residents 15 and over): 29,445
Postsecondary (graduates aged 25-54): 55.3
Immigrant population: 26.5
Life expectancy (years): 78.1
Average income (residents 15 and over): 23,567
Postsecondary (graduates aged 25-54): 54.6
8. Surrey/Langley, B.C.
Immigrant population: 25.6
Life expectancy (years): 79.6
Average income (residents 15 and over): 27,211
Postsecondary (graduates aged 25-54): 51
Immigrant population: 24.6
Life expectancy (years): 78
Average income (residents 15 and over): 25,714
Postsecondary (graduates aged 25-54): 50.5
Immigrant population: 20.9
Life expectancy (years): 79.5
Average income (residents 15 and over): 28,963
Postsecondary (graduates aged 25-54): 58.3
Source: Statistics Canada
Maclean's October 23, 2000