Canada - World Health Organization Regional Office for Europe

4
Health systems in transition Canada
In terms of a health system serving populations in Canada, four factors
should be considered: (1) demographic ageing; (2) rural and remote communities
and populations; (3) cultural diversity resulting from high rates of immigration;
and (4) unique rights and claims pertaining to Aboriginal peoples and their
historic displacement and marginalization relative to the majority of Canadians.
Each of these issues is summarized below.
Despite the demographic ageing of its population since 1970, Canada has
a smaller proportion of older citizens than most countries in Western Europe.
Moreover, Canada’s age dependency ratio – defined as the ratio of children
(1–14 years) and senior adults (≥ 65 years) to the working-age population – is
also lower than in the five comparator countries (Table 1.2).
Table 1.2
Selected human development indicators for Canada and selected countries, 2011
Selected indicators Canada Australia France Sweden
Human Development Index global rank
(actual index value)
6
(0.908)
2
(0.929)
20
(0.884)
10
(0.904)
United
Kingdom
28
(0.863)
United
States
4
(0.910)
Gross national income per capita (PPP US$) 35 166 34 431 30 462 35 837 33 296 43 017
Total expenditure on health, per capita
(PPP US$), 2007
Age dependency ratio (ratio of population
0–14 and 65+ to population 15–64 years),
per 100 people
3 900 3 357 3 709 3 323 2 991 7 286
44.5 50.7 54.9 54.2 50.1 52.0
Income Gini coefficient, 2000–2010 a 32.6 35.2 32.7 25.0 36.0 40.8
Mean years of schooling 12.1 12.0 10.6 11.7 9.3 12.4
Political voice (% of population who voiced
opinion to public official) a
20 23 23 29 24 32
Gender inequality rank in the world 20 18 10 1 47 34
Adolescent fertility rate, 2011*, per 1000 women
aged 15–19
14.0 16.5 7.2 6.0 29.6 41.2
Life expectancy at birth, years 81.0 81.9 81.5 81.4 80.2 78.5
Health-adjusted life expectancy, years 73 74 73 74 72 70
Overall life satisfaction, 2006–2009,
scale of 0 (least) to 10 (most)
Sources: UNDP (2011) for income Gini coefficient, political voice and death rates; a UNDP (2010).
Note: * Annual average for 2010–2015 (UNDP, 2011).
7.7 7.5 6.8 7.5 7.0 7.2
Senior adults made up 14% of the population in 2009 compared to 9%
in 1980, but they are projected to constitute 23% of the population by 2030
(Statistics Canada, 2009). The decrease in family size over time has served to
cushion the age dependency ratio, with the birth rate declining from 15 per 1000
population in 1980 to 11 per 1000 population in 2005 (Table 1.3).