Healthy people, healthy places
At first glance, the question "How healthy are Canadians" is a simple one. However, "health" is a broad concept and difficult to capture with any single measure. For this reason a variety of indicators are presented to help describe the "state of complete physical, mental, and social well-being" that defines health according to the World Health Organization1.
The first of these indicators are subjective asking Canadians how they feel about their general health, their mental health, and their life stress. What is interesting about these self-perceived measures is that people rate their health in relative terms comparing themselves with others in the community and their expectations2. Respondents who report very good or excellent health may indeed be experiencing physical health problems (independent of clinical diagnosis) – positive responses may reflect their ability to cope with and adapt to changing circumstances, to satisfy their needs and fulfill their roles within their families and communities even in the presence of illness or disease. These abilities are part of a broader definition of health3.
Although "health" is a positive concept, it is often measured by the presence of specific conditions, such as arthritis and diabetes. As opposed to acute, infectious diseases, these are chronic conditions that reflect the type of health concerns that are most prevalent in Canada and other developed countries with aging populations. Longevity allows more time for chronic conditions and their consequences to develop and progress.
Symptoms and other outcomes of disease are also indicators of population health. Chronic pain is useful as it reflects both comorbidity and disease severity. The likelihood of experiencing chronic pain increases with age, and it can have a major impact on quality of life4. Like chronic pain the indicator, participation and activity limitation is not disease specific; it provides evidence of how disease processes interfere with life.
Risk factors, rather than outcomes of disease are useful indicators of population health status. Being overweight or obese, for example, is a risk factor for many conditions including Type 2 diabetes, cardiovascular disease, high blood pressure, osteoarthritis, and some cancers, and in itself may limit activities and lower perceptions of health.
Based on the selected health indicators, Canadians are generally healthy, and from 2003 through 2008, the health status of the population remained quite stable. Nonetheless, there are enduring differences between the health of men and women. Women are generally less likely than men to be overweight or obese, or to have diabetes. For all other indicators, with the exception of self-perceived health on which ratings are similar, men tend to rate their health more positively than women do. The paradox is that despite reporting more favourably on most health indicators, men are more likely than women to die at earlier ages (see life expectancy).
The health status of individuals, and the population as a whole, is the end result of many factors. Genetics aside (for which we have no indicator) our health is a direct consequence of behaviours such as diet, alcohol consumption, smoking, and exercise. Characteristics of the environment in which we live and work also influence our health – access to affordable housing, education, and employment for example as well as exposures to toxins such as second-hand smoke. In addition, the health of Canadians is inexorably tied to our country's demographic composition. As the proportion of seniors in the population increases, so too does the prevalence of many chronic conditions. While these place a burden on individuals, families, and the health care system, they are often a consequence of longevity which is itself a positive indicator of the health status of Canadians.
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2. Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior 1997; 38(1): 21-37.
3. Last JM, ed. A Dictionary of Epidemiology, 4th ed. New York: Oxford University Press, 2001.4. Breivik H. World Health Organization supports global effort to relieve chronic pain.
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