The health of Canada's communities

Life expectancy in Canada is among the best in the world and has been for several decades. However, health status is by no means evenly distributed across Canada's communities, according to a new study.

For example, life expectancy - an important indicator of a population's health - varies from 65.4 years in the Région du Nunavik, Quebec, to 81.2 years in Richmond, British Columbia.

To some extent, such disparities can be attributed to socio-demographic differences between communities, since life expectancy within a community is associated with factors such as the unemployment rate and the proportion of people with a postsecondary education. Consequently, comparisons between communities are more pertinent if they are made among those that are socio-demographically similar.

To facilitate such comparisons, this study is based on 10 peer groups of health regions (labelled A to J). These groups were created from the 139 health regions defined by provincial ministries of health. Each peer group contains 5 to 34 health regions with similar socio-demographic profiles, using data from the 1996 Census. The principal socio-demographic characteristics of these peer groups are presented in the study.

The characteristics used to cluster health regions into peer groups included population size, average number of years of schooling, percentage of aboriginal and visible minority populations, population density, unemployment rate, income inequality, average income, percentage of lone parents, the elderly and those with low income, and the extent of inter-municipality migration since the previous census. Health- and health care-related characteristics were deliberately not used to form the peer groups in order to highlight whether or not socio-demographically similar communities were also similar in terms of their health-related characteristics.

This study compares these peer groups, and the health regions within each peer group, on the basis of key health indicators such as life expectancy and self-perceived health, as well as health-related risk factors, such as smoking, heavy drinking, obesity, stress levels and depression. It also explores reasons why residents of some regions enjoy better health than those of other regions.

The article The health of Canada's communities provides data in tables for each health region. A separate table is also available for each of the 10 peer groups to facilitate comparisons between the health regions within the peer group, as well as to Canada overall.

Socio-demographic and health-related risk factors both important for regions' health status

Before examining the health regions with each of the 10 peer groups, the analysis considered all 139 health regions together. Socio-demographic factors played an important role, accounting for 25% to over 55% of the variations in health status measures between communities. Even after controlling for each region's socio-demographic characteristics, higher daily smoking rates and higher heavy drinking rates were associated with shorter life expectancies. Similarly, higher obesity rates, higher daily smoking rates, and higher depression rates were associated with shorter disability-free life expectancies.

Regions' health status quite variable within peer groups

Even though socio-demographic characteristics were strongly associated with health status, there was still a considerable degree of variation in life expectancy across health regions within each peer group. Differences of three to five years in life expectancy between the top and bottom health region in the group were evident in most peer groups.

People living in largest cities generally most healthy

People living in the peer groups encompassing the nation's largest cities and urban centres (groups A and B) were among the healthiest in Canada. The health regions in these two peer groups are characterized mainly by their population size, and by high levels of education and high proportions of visible minority population.

Residents of the health regions of groups A and B had the longest life expectancies and disability-free life expectancies in the country. Compared with the Canadian average of 78.3 years, life expectancy for group A (Canada's largest cities) was half a year longer and for group B (some of Canada's second-tier cities), 1.3 years longer. However, these peer group averages mask considerable variation within both groups, as much as three years in life expectancy.

Residents of groups A and B tended to have healthier behaviours than the average Canadian. About 18% of residents in these peer groups were daily smokers in 2000/01, compared with the national average of 22%. The rates of obesity and heavy drinking for these groups were the lowest among the 10 peer groups.

Richmond, British Columbia, stood out as an exceptional health region within one of the healthiest peer groups (group A). Life expectancy in Richmond was the highest in the country at 81.2 years, close to three years longer than the national average. Richmond residents had healthy lifestyle practices. Smoking and obesity rates were the lowest in the country.

The Région de Montréal-Centre had the lowest life expectancy in group A, at 77.9 years. It also had the highest daily smoking rate, highest obesity rate, highest rate of heavy drinking and highest stress rate within group A.

Northern communities least healthy, but also not as stressed

Groups C and F contain remote northern communities, representing a small proportion of Canada's total population. Education levels in these communities are low and these groups had the lowest life expectancies and disability-free life expectancies in Canada.

The rates of smoking, obesity and heavy drinking for these groups were above the national averages. Residents of these northern communities, however, were less likely to report high levels of stress.

There were other favourable statistics for these two peer groups. The exercise rate for group F was better than the national average, and the depression rate for group C was the lowest in the country at 5%.

Again, these peer group averages mask considerable variation within both groups.

Groups consisting mostly of rural health regions

Three groups are made up mostly of rural health regions, predominantly from Canada's eastern provinces (peer group D) and Canada's Prairie provinces (peer groups E and G). Life expectancies for these groups were shorter than the Canadian average, but longer than the life expectancies for the northern communities. At the same time, within each of these peer groups, there were health regions with health status above the Canadian average, as well as those below.

Similar to the northern groups, these rural groups had smoking rates, obesity rates and heavy drinking rates above the nation's averages, but lower stress rates.

For example, the Région de la Gaspésie-Îles-de-la-Madeleine in Quebec distinguished itself favourably with regard to health behaviours within group D. Residents there were less likely to be obese, less likely to be infrequent exercisers and less likely to drink heavily than group D's residents as a whole. Life expectancy, however, was at the peer group average.

These kinds of discrepancies between health status and health behaviours for some health regions raise challenging questions for future analyses - what is it about these communities that makes the expected relationships between health risk factors and health status stronger or weaker from one region to another? Future analyses with the CCHS will address this question.

A description of the method used to formulate these peer groups is provided in a previously released report, Health region peer groups (82-221-XIE, free), available on Statistics Canada's Web site (http://www.statcan.gc.ca). From the Our products and services page, choose Free publications, then Health.

The article The health of Canada's communities, 2000/01, no. 1 (82-003-SIE, free) is now available on Statistics Canada's Web site (http://www.statcan.gc.ca). From the Our products and services page, choose Free publications, then Health.

For more information, or to enquire about the concepts, methods or data quality of this release, contact Margot Shields (613-951-4177; margot.shields@statcan.gc.ca), Health Statistics Division.