Keywords Health & Medicine

The study shows that the 13 regions of the country where people live longest - for 79.5 years or longer - are mostly southern urban communities with populations between 46,000 and 850,000. They include Victoria, Vancouver, Winnipeg, Toronto and the Ottawa-Carleton region. But people also live long lives in some less-urbanized areas, including parts of southern Manitoba, a large swath of southwestern Saskatchewan and some rural districts of British Columbia. Dr. John Millar, CIHI vice-president for research and analysis, attributes the higher life expectancies in the cities mainly to higher educational and income levels and lower unemployment. The better access that city dwellers have to health-care services plays a smaller role, he says. "But clearly," adds Millar, "you can also have long-living populations in non-urban areas." In areas where life expectancy is lowest, he notes, "the remarkable thing is that you tend to find more of everything - higher rates for disease generally, for AIDs, for accidental death. That's partly because high stress levels in those areas seem to undermine people's immune systems and leave them more vulnerable."

The bleakest findings emerge from the North, with its heavy concentration of native peoples. All of the 12 health regions that the report includes in the lowest life-expectancy category - less than 75.7 years for both sexes - are in northern regions, and nine of them have large aboriginal populations. Among aboriginals, accidental injuries are the principal cause of death, but the report also points to high rates of cancer and respiratory diseases in Nunavut and the Nunavik region of northern Quebec, with lung cancer rates among women in Nunavut 4.7 times higher than the overall rate for Canadians.

Nunavut and Nunavik, home to most of Canada's Inuit people, also record Canada's highest suicide rates among men. Among Aboriginal Peoples generally, infant mortality rates are twice as high as in the overall Canadian population, while accidental injuries are four times more common among aboriginal infants, five times higher among pre-schoolers and three times higher for aboriginal teenagers.

On the other hand, in the regions with the highest life expectancies, mortality rates for cancer and other common diseases, as well as suicide and infant mortality rates, are predictably lower. But as Millar notes, the report points to socioeconomic factors as a major determinant of health. High life-expectancy scores, it notes, correlate with higher educational levels and lower unemployment rates. However, while acknowledging that some high-life-expectancy regions also show relatively high income levels, the report finds no consistent link between longer lives and income or housing costs across the country.

Looking further into the issue of health and income inequality, a separate study of Canadian and U.S. mortality statistics, released at the same time, concludes that higher incomes appear to be more closely linked to longer lives in the United States. One reason, the report suggests: Americans do not have access to the kind of publicly funded medical services generally available in Canada. That finding, at least, is a reminder of the surviving value of a health system that is increasingly under stress - economically and politically.

Maclean's April 10, 2000

Author MARK NICHOLS