Imagine a nation once admired worldwide for its citizens' well-being, now lagging behind, struggling to keep pace with others. That's the stark reality facing Canada, and it begs the question: Is something fundamentally broken in our society? This isn't just about statistics; it's about the quality and length of our lives.
To the Editor,
Let's play a thought experiment. Suppose you heard that the United States was steadily losing ground in life expectancy rankings compared to other wealthy nations. Would you be surprised? Many would point to factors like inadequate governance, a widening gap between the rich and poor, a lack of concern for those struggling with housing and food insecurity, the decline of unionized jobs offering stable employment, and a healthcare system riddled with problems. Most Canadians might shake their heads, relieved to be living in a country perceived as more equitable and compassionate.
Indeed, the U.S. doesn't fare well in the "Life Expectancy Olympics," currently ranking 31st out of 37 OECD (Organization for Economic Cooperation and Development) countries. Back in 1990, they held a slightly better position at 20th. That's a concerning drop of eleven places over just a few decades.
But here's where it gets controversial... What if I told you that Canada has experienced an even steeper decline? In 1990, Canada proudly held 5th place in life expectancy globally. By 2023, however, we've plummeted to 17th. That's a drop of twelve ranking positions, surpassing even the US decline. And this is the part most people miss: the underlying causes for Canada's slide are strikingly similar to those we often criticize in the U.S. - growing income and wealth inequality, indifference to citizens facing housing and food insecurity, a scarcity of unionized jobs providing fair wages and benefits, and a healthcare system increasingly strained and inaccessible.
While Canada may still be considered a desirable place to live, the hard truth is that you are statistically likely to live fewer years here compared to countries like Switzerland, Japan, Spain, Israel, Italy, Korea, Luxembourg, Sweden, Norway, Australia, France, Ireland, Belgium, Portugal, Iceland, New Zealand, Slovenia, Austria, the Netherlands, Denmark, or Greece. It's important to note that while Canadian life expectancy in 2023 (81.7 years) is higher than it was in 1990 (77.5 years), it has stagnated or even slightly declined in recent years, failing to keep pace with the gains made in other developed nations. For those interested in delving deeper into the data, OECD statistics on life expectancy are readily available online. (https://www.oecd.org/en/data/indicators/life-expectancy-at-birth.html)
Life expectancy serves as a powerful barometer of the overall living and working conditions within a country. These conditions, encompassing factors like access to quality healthcare, nutritious food, safe housing, and meaningful employment, are so intricately linked to health outcomes that they've become known as the "social determinants of health." The evidence strongly suggests that these social determinants of health are eroding in Canada, both in terms of their quality and their equitable distribution across the population. And this isn't because Canada has become impoverished. In fact, in terms of Gross Domestic Product (GDP), or the sheer size of our economy, Canada has never been wealthier.
Increasingly, Canadians are becoming aware of these contradictions as we grapple with converging crises: an income crisis, a food crisis, a housing crisis, an employment crisis, and a healthcare crisis, all intertwining to create a complex "polycrisis." The alarming statistics on food insecurity (affecting 17% of all Canadians), poverty (impacting 14% based on commonly used international measures), precarious work arrangements (affecting over 33% of the workforce), and the fact that half of Canadians are just $200 or less away from being unable to pay their bills, coupled with the growing privatization of our supposedly universal, not-for-profit healthcare system, all point to a profound systemic problem in how our economic and political systems distribute resources.
But here's the million-dollar question: Are the solutions being proposed by our leaders actually addressing the root causes of this polycrisis? Policies like promoting new industrial development, building more oil pipelines, and investing billions in warplanes and warships may stimulate economic activity in certain sectors, but are they truly tackling the underlying issues of inequality, insecurity, and inadequate social support that are driving down life expectancy? Similarly, scapegoating immigration and advocating for restrictive immigration policies might appeal to certain segments of the population, but they fail to address the fundamental flaws in our economic and social structures.
Ultimately, solving this polycrisis requires Canadians to engage in critical self-reflection and ask some tough questions: In whose interests is our economy truly operating? Why do the profits of wealthy corporations and the incomes of wealthy individuals continue to soar while the wages of most Canadians struggle to keep pace with inflation? And, perhaps most importantly, what kind of economic system will genuinely meet the needs of the vast majority of Canadians, ensuring a healthy, prosperous, and fulfilling life for all? Because clearly, the current system is falling short.
What are your thoughts? Do you agree that Canada is facing a crisis of declining social determinants of health? What solutions would you propose to address these challenges? Share your perspectives in the comments below.
Dennis Raphael and Toba Bryant
Dennis Raphael is a professor of health policy and management at York University in Toronto. Toba Bryant is an associate professor of health sciences at Ontario Tech University in Oshawa.
