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Wednesday, June 2, 2004

Joint Canada/United States Survey of Health


Most Canadians and Americans report being in good to excellent health, according to a new survey of health that compares health status and access to health care services between the two nations. However, Canadians with the lowest incomes were less likely to be in fair or poor health and less likely to have reported severe mobility limitations than their American counterparts.

Overall, the vast majority in both countries-88% of Canadians and 85% of Americans-reported that they were in good, very good or excellent health in 2003.

However, the health status of Americans was slightly more polarized. More Americans reported being at either end of the health status spectrum, that is, they were more inclined to report either excellent health, or fair or poor health.

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This was particularly true among women, a fact which may be associated with the higher rate of severe mobility limitation and obesity among American women compared with Canadian women. There were relatively few differences between men.

About 13% of Americans reported that they had experienced an unmet health care need in the year prior to the survey, compared with 11% of Canadians. The difference is attributable to a much higher rate among uninsured Americans, 40% of whom reported an unmet need. There was no difference, however, in the proportion who reported unmet health care needs between Canadians and Americans with health care insurance (10%). The top reasons for unmet health care needs differed in the two countries. Waiting too long was most often reported in Canada, while costs were reported in the United States.

Another difference between the two countries was related to health disparities between individuals in various income groups. According to the survey, almost one-third (31%) of Americans in the lowest income group reported fair or poor health, compared with only 23% among their Canadian counterparts. Significant differences were also noted with regard to severe mobility limitations and risk factors such as smoking and obesity.

Note to readers

This release is based on a report providing first results from the Joint Canada/United States Survey of Health (JCUSH), a unique population health survey conducted jointly by Statistics Canada and the US National Center for Health Statistics of the US Centers for Disease Control and Prevention between November 2002 and June 2003.

The JCUSH represents the first attempt to collect comprehensive information regarding health status and access to health care services using a single survey and a standard approach across countries.

Because it was conducted in the same manner in both countries, it provides a degree of comparability never before possible. As a result, meaningful comparisons can be made between Canada and the United States regarding a number of indicators of health status and access to health care services.

The target population included residents of both countries aged 18 or older living in private dwellings.

With the exception of income, missing data (e.g., responses such as "I don't know," "not stated" and "refusal") have been excluded from the analysis.

At the other end of the income spectrum, there were no systematic differences in the reporting of fair and poor health or severe mobility impairment among the most affluent households on either side of the border.

On the whole, Americans were more likely to be "very satisfied" with their health care services, while Canadians were more likely to be "somewhat satisfied," even when compared with insured Americans.

About 42% of Americans reported that the quality of their health care services in general was excellent, compared with 39% of Canadians. However, Canadians were more likely to report that the quality was only "fair." These differences remained when Canadians were compared with insured Americans.

Uninsured Americans, however, were less likely than Canadians to report that the quality of their health care services was excellent, and more likely to report that it was fair or poor.

Health status levels: overall similarities between the two countries, but less polarized among Canadians

The majority of individuals in both countries reported that they were in good, very good or excellent health. About 88% of Canadians classified themselves in these categories, compared with 85% of Americans.

Americans were slightly more likely to report "excellent" health than Canadians. This was mainly the result of the 15% of Americans aged 65 and older who reported excellent health, almost twice the proportion of only 8% of Canadians in the same age group.

More American women were at either end of the health status spectrum. About 25% of American women reported they were in excellent health, compared with 23% of Canadian women. Similarly, about 11% of American women reported fair health, as opposed to 8% of Canadian women. There were no differences between males in the two countries.

In terms of specific risk factors, a slightly higher proportion of Canadians were current daily smokers, while a significantly higher proportion of Americans were obese.

Overall, 19% of Canadians were current daily smokers compared with 17% of Americans. The difference was partly the result of the higher rate among seniors aged 65 and older in Canada, 10% of whom were daily smokers, compared with only 7% in the United States.

About 21% of Americans were obese, compared with only 15% of Canadians. The gap was primarily because of differences between American and Canadian women. One in five American women was obese, compared with about one in eight Canadian women.

Health disparities between richest and poorest in both countries

In both countries, individuals with the lowest incomes reported poorer health and higher rates of severe mobility limitations, as well as higher levels of smoking and obesity compared with those in higher income groups.

Looking across countries as well as across incomes, low-income Americans were more likely to be in fair or poor health, and to have severe mobility limitations than low-income Canadians. Just under one-third (31%) of low-income Americans reported that their health was fair or poor, compared with 23% of low-income Canadians. On the other hand, there were no differences in fair or poor health among higher income groups between the two countries.

With respect to obesity, differences were most notable in the lowest income group where 27% of Americans were considered obese, compared with 18% of Canadians.

Canadians more likely to have a regular medical doctor

Canadians have universal access to publicly funded health care services, including physician and hospital services. In the United States, the majority of citizens require private insurance to cover the cost of these services. Public insurance is provided for the poor (Medicaid), and for those aged 65 and over (Medicare).

The data collected in this survey show that about 11% of Americans did not have health insurance.

The majority of both Canadians and Americans reported having a regular medical doctor, but overall, the proportion was higher among Canadians (85% vs. 80%).

The proportion of Canadians who had a regular medical doctor was similar to the rate among insured Americans.

Also, a similar proportion of Canadians and Americans reported contacting any medical doctor in the 12 months prior to the survey. Uninsured Americans were less likely to have contacted any medical doctor.

Unmet health care needs: long waits in Canada and costs in the US

Unmet health care needs provide a measure of access to health care services that focusses on individuals' experiences accessing care. Individuals were asked whether there was a time in the 12 months prior to the survey that they felt they needed health care services, but did not receive them.

Overall, 13% of Americans reported an unmet health care need, slightly more than the 11% of Canadians who did. The difference was much higher when Canadians were compared with uninsured Americans. There was no significant difference in unmet health care needs between Canadians and insured Americans.

Respondents were asked about the reasons for having an unmet health care need. Of the Canadians who had experienced one, about a third reported long waiting times for care as the primary barrier. But more than half of Americans (53%) with an unmet need cited cost. Cost was the primary barrier cited in the United States regardless of insurance status.

In both countries, individuals with lower incomes experienced higher levels of unmet needs than those with higher incomes. However, 27% of Americans in the lowest income group reported an unmet health care, compared with only 17% among low-income Canadians.

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There was no difference in the rate of unmet health care needs among those with higher incomes in both countries. The gap in unmet health care needs between the highest and lowest income group was significantly higher in the United States than Canada.

Definitions, data sources and methods: survey number 5020.

The report Joint Canada/United States Survey of Health, 2002-03 (82M0022XIE, free) is now available online. From the Our products and services page, under Browse our Internet publications, choose Free, then Health.

For more information regarding access to the JCUSH data, contact Mario Bédard (613-951-8933; fax: 613-951-4198;, Health Statistics Division. To enquire about the concepts, methods or data quality of this release, contact Claudia Sanmartin (613-951-6059; fax: 613-951-3959; or Jean-Marie Berthelot (613-951-3760; fax: 613-951-3959;, Health Analysis and Measurement Group.

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Date Modified: 2004-06-02 Important Notices