In Focus

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Is Canada’s health system keeping pace or are we falling behind?
Studying international comparisons and trends to understand how Canada’s health systems are performing

In recent years, there has been considerable discussion about Canada’s health system performance on the international stage. Canadians believe that we have one of the best health care systems in the world. However, there has been rising concern about whether our health system is keeping pace with those of other countries.

Inspired by a recent Organisation for Economic Co-operation and Development (OECD) study that measures the burden of disease, injury and risk factors across OECD countries, we decided to focus on how Canada performs on premature mortality. Our report, Canada’s International Health System Performance Over 50 Years: Examining Potential Years of Life Lost, answers the question “Is Canada’s health system keeping pace with other top-performing countries or are we falling behind?”

What is PYLL?

To understand how Canada’s health system is performing on premature mortality, studying international comparisons and trends in potential years of life lost (PYLL) is essential. But what exactly does “potential years of life lost” mean? PYLL is defined as a measure of premature mortality that provides an estimate of the additional time a person would have lived had he or she not died before age 70. For example, a person who dies at age 50 has lost 20 years of potential life. The PYLL for a given country represents the total years of potential life lost within the population each year.

What is PYLL?  PYLL is demonstrated using 3 people. Person A dies at age 50. He loses 20 potential years of life. Person B dies at age 40. He loses 30 potential years of life. Person C dies at age 65. He loses 5 potential years of life.

What did we find?

Our analysis — which spanned a 50-year period — shows some good news for Canada. Between 1960 and 2010, Canada’s PYLL decreased from 9,113 per 100,000 population to 3,113 per 100,000 population — a 66% improvement. Despite this, however, when compared with other OECD countries, Canada has remained an average performer over time. Between 2000 and 2010, countries that traditionally had mirrored the Canadian trajectory began to accelerate to the front of the pack, relative to other OECD countries.

A lower ranking becomes increasingly evident when we compare our performance with Australia’s. While both countries shared an average performance for most of the study period, in the last decade, Australia’s performance has improved and Canada has remained in the middle of the pack. Other countries like Spain, Switzerland, Norway and Italy — whose performance at one time closely paralleled Canada’s — have also pulled ahead in recent years.

Gender had a notable effect on the results of PYLL and there is a significant difference between Canadian men and women. Canadian women are falling behind the international average, particularly for years of life lost due to lung cancer. Canadian men fare better and have consistently performed ahead of the international average since the 1990s.

Room for improvement

Deborah Cohen, one of the lead authors of the study, suggests that the results should inspire discussion around what this means for Canada.

“Our report shows that Canada has room for improvement and can learn from peer countries. Strategies within and beyond health care — such as social policy, education, health promotion and disease prevention — should be analyzed to learn how they may be applied to the Canadian context.”

By identifying where Canada lags behind the international average for premature mortality, we can better focus our efforts to improve the health of Canadians.

In addition to the full report, an interactive web-based companion product is available. This tool allows you to compare leading causes of PYLL caused by cancer, heart disease, stroke, and external causes such as falls, traffic accidents, accidental poisonings and intentional self-harm for the 18 high-income OECD countries studied.