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Canadians are living longer and are generally in better health than previous generations. However, a number of challenges in the health sector remain, including the reform of our health care system.

Recent surveys indicate that most Canadians believe that they are in very good to excellent health. Life expectancy, as well as health-adjusted life expectancy, has increased, the infant death rate has dropped, many infectious diseases have been practically eliminated, and medical techniques have continued to evolve.

However, although Canadians are healthier today than in the past, a number of problems persist. Heart disease, cancer, mental health problems, HIV/AIDS, asthma, obesity and diabetes are some of the health conditions that continue to affect many Canadians. Moreover, new infectious disease strains, such as severe acute respiratory syndrome (SARS), the West Nile virus and infection from C. difficile bacteria, are being monitored because they pose an ongoing threat to public health.

Disparities in health

Chart: Life expectancy at birth, by sexThere are marked disparities in health status among Canada's population groups. Certain groups such as Aboriginal people are generally in poorer health than the rest of the population.

People who lead a healthy lifestyle-that is, those who are active, eat well, drink alcohol in moderation and do not smoke-are less likely to have health problems. Better socio-economic conditions, such as higher income and higher education, also contribute to a better state of overall health.

Many Canadians have health limitations that interfere with their daily activities. In 2001, 3.6 million people living in a household-particularly the elderly-confirmed that health problems limited their activities in some way. The types of disabilities most frequently reported by people aged 15 and over are mobility or dexterity problems, pain-related disability and hearing or vision impairments. Among the elderly, mobility and memory problems are the most frequently reported disabilities.

Access to specialized health care services―such as visits to specialists, non-emergency surgeries and diagnostic tests, as well as access to first contact services―can be a challenge for a number of Canadians, according to the 2003 Health Services Access Survey. In 2003, more than 2.9 million Canadians visited a medical specialist to be assessed for a new illness or condition, and about 21% (just over 600,000 people) reported experiencing a difficulty with access. And 13% of those who accessed non-emergency surgery (about 200,000 people) reported that they had experienced difficulties. The majority of those experiencing difficulties reported that the main barrier was too long a wait for care.

A changing health care system

Chart: Population with disabilities, by province, 2001In Canada, the federal, provincial and territorial governments share responsibility for the health care system. The system, which gives all Canadians access to health care, has undergone many changes since universal health care was implemented in 1968.

Hospitals experienced big changes in the 1990s. While hospitals had 25% fewer beds in 1997/1998 than in 1984/1985, trips to emergency rooms and clinics rose 9%. In addition, use of outpatient services was three times higher in 1997/1998 than in 1984/1985. More patients were also being treated in day surgery.

While there was a decrease in institutional care, community-based care increased. From 1996 to 2002, the proportion of elderly people who received community care for a long-term health condition went from 26% to 32% among women and from 17% to 21% among men.

Health care professionals in Canada include a wide range of regulated and unregulated caregivers. The first category includes physicians, nursing staff, physiotherapists, occupational therapists and dentists. Family members, friends and community volunteers make up the second category. In 2000, more than 1.5 million Canadians worked in health and social services.

Nursing is the top health care occupation. In 2000, most of Canada's 232,000 registered nurses worked in hospitals, and more and more are working in community health. However, Canada's nursing staff is aging and fewer young people are entering the profession.

Physicians are the second largest group of regulated health care professionals. In 2000, more than 57,800 physicians worked in clinical and non-clinical practices in Canada, an increase of 5.3% since 1996. During this period, the increase in the number of specialists was higher than in the number of family physicians. Like nurses, physicians are a group that has been aging faster than some other professions.

Despite the increased number of physicians, more than 3.6 million Canadians, or 14% of the population did not have a family physician in 2003. Of these, more than 1.2 million people were unable to find one and the other 2.4 million had not looked for one.

More money for health

In 2003, Canada spent roughly $121.4 billion on health care, or an average of $3,839 per person. Ten percent of our gross domestic product was dedicated to health care spending, a level first reached in 1992.

Chart: People reporting alternative health care consultations in previous year, 2003Public funds are the primary source of funding for health care. In 2001, 71% of total health care expenses in Canada were paid for from the public purse. The rest of the funding comes from the private sector, which generally funds services such as dental care, vision care, chiropractic care and medication.

Expenses incurred by hospitals are the top category of health expenditure, which totalled 30% in 2003. Retail drug sales is the second most costly category, followed by physician services.