Health of Canadians
Health determinants

The determinants of health encompass a range of factors that shape the health outcomes of individuals and populations. Among these, the social determinants of health play a critical role, including factors such as income, racialized status and immigrant status. These elements influence the environments in which people are born, grow up, live, work and age, and they interact in ways that can significantly affect overall health and well-being.

This report explores several population-level health indicators, including health outcomes (e.g., perceived health, chronic diseases), health behaviours (e.g., fruit and vegetable consumption, substance use) and access to health care (e.g., having a regular health care provider), all of which are profoundly impacted by these determinants of health. Since the next Census of Population will take place in May 2026, the most recent profiles for the distribution of the determinants of health across the population are based on the 2021 Census. This section summarizes the cross-cutting themes related to the selected health determinants emerging from this report.

Key findings

• Geography and rurality: In most of the Atlantic provinces, the prevalence of chronic diseases was higher, and proportionally fewer adults reported having very good or excellent perceived health and mental health or consuming fruits or vegetables five or more times per day, compared with the average across all provinces. A higher share of adults in rural areas than in population centres reported very good or excellent mental health, but chronic disease prevalence was higher in rural areas. Proportionally fewer adults in rural areas had dental insurance and had visited an oral health professional in the past year.
• Household income: A larger share of higher-income than lower-income adults reported very good or excellent perceived health and mental health; a smaller share reported having chronic diseases. Although cigarette smoking and cannabis use were less common among higher-income adults, heavy drinking was more common. Proportionally fewer lower-income Canadians had a regular health care provider, and a greater percentage had unmet needs for home care.
• Age: The prevalence of most chronic diseases examined increased with age. Unlike very good or excellent perceived health, which decreased with age, very good or excellent perceived mental health rose and was highest among those aged 65 and older. The prevalence of anxiety and mood disorders was lower among older adults than those aged 18 to 34, a larger share of whom used cannabis daily or almost daily and vaped in the past 30 days, and a smaller share of whom consumed fruits or vegetables five or more times per day. Having a regular health care provider was less common among younger adults.
• Sex at birth and gender: A smaller share of women than men reported very good or excellent perceived health and mental health and a larger share had unmet home care needs. Proportionally more men vaped in the past 30 days, smoked cigarettes daily or occasionally, were heavy drinkers and used cannabis daily or almost daily, and fewer consumed fruits or vegetables five or more times per day. A larger share of females than males reported having chronic diseases, and females were projected to have higher lung cancer incidence in 2024.
• Sexual orientation: The prevalence of mental health disorders and substance use was higher among people who reported their orientation as lesbian, gay, bisexual or another orientation that is not heterosexual (LGB+) than heterosexual people. A lower share of LGB+ people reported very good or excellent perceived health and mental health or had a regular health care provider.
• Disability: Proportionally fewer adults with a disability than those without disabilities reported very good or excellent perceived health and mental health, and more used cannabis daily or almost daily, smoked cigarettes daily or occasionally, and reported having a chronic disease and long-term COVID-19 symptoms.
• Immigrants: Immigrants had healthier substance use behaviours than non-immigrants, reporting lower alcohol consumption in the past week and a lower prevalence of heavy drinking, cigarette smoking (daily or occasionally), vaping (in the past 30 days) and cannabis use (daily or almost daily). A higher share of recent immigrants reported very good or excellent perceived health than immigrants who were admitted more than 10 years ago.
• Racialized populations: Most of the chronic diseases examined were more prevalent among non-racialized people, compared with racialized populations.
• Indigenous populations: Indigenous groups had a lower life expectancy and higher infant mortality rates than the non-Indigenous population. Arthritis, high blood pressure and asthma were the most prevalent chronic diseases among Indigenous groups, while mood and anxiety disorders were more prevalent among low-income Indigenous people. A lower share of Indigenous adults and children had a regular health care provider, and a higher share reported unmet needs.

Geography and rurality

Where a person lives can profoundly affect their health and well-being. For example, as explored in the Health outcomes section of this report, patterns of perceived health and mental health varied throughout Canada. Proportionally fewer adults living in the Atlantic provinces (except Newfoundland and Labrador) reported very good or excellent perceived health and mental health compared with the average across all provinces. The prevalence of having one or more chronic diseases was higher in the Atlantic provinces in 2023, with a larger share of people having high blood pressure, arthritis and mood disorders. In contrast, consistently from 2021 to 2023, proportionally more adults living in Quebec reported very good or excellent perceived health and mental health, and fewer reported having high blood pressure, arthritis and mood disorders.

Geography and rurality may influence diet and substance use through variations in access and availability, cultural norms, economic conditions, social environments, and policy regulations. The Health behaviours section shows that in 2023, the percentage of adults consuming fruits or vegetables five or more times per day was notably lower in the Atlantic provinces and Ontario compared with the average across all provinces, while it was higher in Quebec. The same year, vaping prevalence was higher in Alberta but lower in Ontario. In 2022, cigarette smoking and cannabis use were more prevalent across all three territories compared with the Canadian average.

A person’s location can also determine the availability of health care facilities, providers and preventive services. Limited transportation options in some regions may hinder access to medical care and result in unmet needs.^{Note 5} This report reveals disparities in health care access across Canada, including in terms of regular health care providers, home care services, dental insurance and dental visits. In 2023, a lower proportion of people living in Quebec had a regular health care provider, though a higher proportion used home care services, than the average across all provinces. Additionally, a smaller share of Quebec residents than Ontario residents reported having dental insurance and having visited a dental professional in the past year.

Population centres typically have more health care resources, while rural or remote regions may experience shortages, leading to delayed care and poorer health outcomes. Although in 2023 a greater proportion of rural residents had a regular health care provider than those in population centres, they also experienced a higher prevalence of certain chronic diseases and risk factors, including high blood pressure, heart disease, diabetes, obesity and arthritis. Additionally, a lower proportion of adults in rural areas had dental insurance or had visited a dental professional in the past year, and a higher proportion experienced edentulism (having no natural teeth), compared with those living in population centres.

Household income

The interplay between income and health is complex, as education, employment, housing and environment are all often tied to income, and changes in one area can affect others, creating a web of influences. Considerable research has shown that health status improves with each step up in income.^{Note 6} From 2021 to 2023, there was a consistent increase in the percentage of adults reporting very good or excellent perceived health as household income levels rose, as discussed in the Health outcomes section.

In addition, higher income often provides a buffer against financial stress, contributing to better mental health.^{Note 7} This report highlights that a larger percentage of adults in the highest income quintile reported very good or excellent perceived mental health compared with those in the lowest quintile in 2023.

In many cases, higher-income individuals experience a lower prevalence of chronic diseases because they have better access to health care, healthier living conditions and more resources for maintaining a healthy lifestyle. In 2023, several chronic diseases and risk factors (high blood pressure, heart disease, stroke, diabetes, obesity, arthritis, anxiety and mood disorders) were less prevalent among adults in the highest household income quintile than among those in the lowest.

Personal choices and behaviours, influenced by income and access to information, significantly affect health. Individuals with higher incomes tend to have better access to nutritious food and health information, leading to greater awareness of substance use risks and healthier lifestyle choices.^{Note 8} This is reinforced in the Health behaviours section, which shows that in 2023, proportionally more adults in the highest-income households than in the lowest-income households reported consuming fruits or vegetables five or more times per day, and fewer reported regular cigarette and cannabis use. However, this section also reveals a contrasting trend: a higher share of people in higher-income households were classified as heavy drinkers compared with those in the lowest-income households.

Low-income individuals in Canada may have less access to regular doctors because of regional disparities in health care availability, financial barriers and challenges related to health literacy.^{Note 9} Experiences of discrimination and the stress of financial instability can further discourage them from seeking consistent medical care. The Access to health care section reveals that in 2023, proportionally fewer adults in the lowest-income households had a regular health care provider compared with those in the highest income quintile. While the use of home care services was more prevalent among the lowest-income households, a larger percentage of low-income Canadians reported unmet needs for home care.

Age

Age significantly affects health in various ways, influencing both physical and mental well-being. Physically, as people age, certain functions of their bodies naturally begin to decline, making them more vulnerable to chronic health issues. Throughout the Health outcomes section, this report shows that in 2023, the prevalence of certain chronic diseases, such as high blood pressure, heart disease, stroke, diabetes, arthritis and cancer, increased with age. However, older adults also exhibit greater emotional resilience and life satisfaction because of their life experiences and coping skills.^{Note 10} This report finds that, unlike perceived health, which declined with age, perceived mental health increased with age; the share of people reporting very good or excellent mental health was highest among those aged 65 and older.

During adolescence and young adulthood, individuals are more prone to taking risks and may adopt unhealthy habits like smoking and poor eating, often because of peer pressure and social norms.^{Note 11} This report reveals that in 2023, vaping and cannabis use were more prevalent among younger adults aged 18 to 34 compared with older age groups. Fruit and vegetable consumption also varied by age, with proportionally fewer 18- to 34-year-olds consuming them five or more times per day, as shown in the Health behaviours section.

Young people may consider health services inaccessible because of inconvenient locations and hours, and fear of confidentiality issues may make them hesitant to seek help.^{Note 12} This report finds that a lower proportion of Canadians aged 18 to 34 than those aged 65 and older reported having a regular health care provider in 2023. Further details can be found in the Access to health care section.

Sex at birth and gender

This report examines health outcomes, health behaviours, substance use and access to care by sex at birth and gender, recognizing that both are crucial for identifying health disparities linked to biological and sociocultural factors.^{Note 13Note 14} Understanding these distinctions allows for a more comprehensive approach to health research and interventions. Life expectancy, infectious diseases, chronic diseases and mortality are presented in this report by sex, reflecting biological differences. Meanwhile, health behaviours, substance use, access to care, and perceived health and mental health are presented by gender, highlighting the influence of gender roles and expectations.

The Health outcomes section highlights notable trends showing that proportionally fewer women than men reported very good or excellent perceived health and mental health. In 2023, the most pronounced gender differences were observed among those aged 35 to 39 and 18 to 34. Across all age groups, a higher percentage of women consumed fruits or vegetables five or more times per day. A larger share of men than women reported regular vaping, cigarette smoking, drinking and cannabis use in 2023, as explored in the Health behaviours section. The Access to health care section shows that proportionally more women than men reported having a regular health care provider and using home care services, yet more women than men also reported unmet health care and home care needs.

In 2023, the prevalence of having one or more chronic diseases was higher overall among females than males, with heart disease and diabetes more common among males and arthritis more prevalent among females. These sex differences widened with age. In addition, overweight was more common among males, particularly those aged 35 to 49. The projected age-standardized incidence and mortality rates for all cancers combined were higher for males, although lung cancer rates have recently begun to converge. While lung cancer mortality remained higher among males, females were projected to have a higher incidence rate in 2024. Colorectal cancer incidence and mortality rates have been steadily decreasing for both sexes. Lastly, proportionally fewer females reported that their long-term COVID-19 symptoms had resolved. Among those whose symptoms had resolved, females experienced symptoms for a longer average duration compared with males. Details are further explained in the Health outcomes section.

Sexual orientation

LGB+ individuals often have a higher prevalence of anxiety, depression and suicidal ideation, which may be associated with experiences of societal stigma, discrimination and isolation.^{Note 15} The Health outcomes section of this report finds that in 2023, the prevalence of self-reported diagnosed anxiety disorders was twice as high among gay or lesbian adults and more than three times as high among bisexual or pansexual adults, compared with heterosexual adults. Across all age groups (except for those aged 60 and older), anxiety was more prevalent among LGB+ adults than their heterosexual counterparts. In 2023, a lower percentage of LGB+ men and women reported very good or excellent perceived mental health, compared with their heterosexual counterparts.

In 2023, perceived health was lower among LGB+ adults aged 18 to 34, compared with their heterosexual counterparts. However, most of the chronic diseases examined were either similar or lower in prevalence among LGB+ adults than heterosexual adults.

The Health behaviours section reveals that in 2023, proportionally more LGB+ women than heterosexual women reported heavy drinking, while no differences were found among men. Additionally, cigarette smoking and vaping were found to be more prevalent among LGB+ women and among LGB+ people aged 18 to 34, who reported these behaviours in higher proportions than their heterosexual counterparts. Furthermore, a greater percentage of LGB+ people reported daily (or almost daily) cannabis use in 2023, compared with heterosexual adults, particularly among LGB+ young adults aged 18 to 34.

Some LGB+ Canadians have reported negative experiences with the health care system related to their sexuality, and, as a result, avoid or delay seeking care.^{Note 16} This report finds that proportionally fewer LGB+ adults had a regular health care provider compared with heterosexual Canadians in 2023. Further details are available in the Access to health care section.

Disability

Disability can limit employment opportunities, leading to financial stress and reduced access to health resources. People with disabilities may also experience social isolation because of mobility challenges or societal attitudes, which can negatively affect mental and emotional health.^{Note 17Note 18}

According to the Health outcomes section of this report, in 2023, proportionally fewer individuals with a self-reported disability had very good or excellent perceived health and mental health, compared with those without disabilities. Additionally, a greater share of adults with a disability had at least one chronic condition, with a higher prevalence of high blood pressure, heart disease, stroke, diabetes, obesity, arthritis and mood disorders. Furthermore, a larger percentage of adults with a disability had a regular health care provider and experienced long-term symptoms of COVID-19 than those without disabilities.

This report reveals that while alcohol consumption in the past week and heavy drinking were less prevalent among those with a disability in 2023, higher proportions of people with a disability reported cigarette smoking and cannabis use, compared with those without disabilities. This is further explored in the Health behaviours section.

Immigrant status

Many immigrants initially enjoy better health than native-born populations, a phenomenon known as the “healthy immigrant” effect, though this advantage tends to diminish over time.^{Note 19Note 20} This report highlights key aspects of this effect in the Health outcomes section. For instance, from 2021 to 2023, a greater share of immigrants reported very good or excellent perceived mental health compared with non-immigrants. However, it was found that proportionally fewer established immigrants, who were admitted to Canada more than 10 years ago, reported very good or excellent mental health compared with their more recent counterparts. Nonetheless, the percentage of established immigrants reporting very good or excellent mental health was still greater than that of non-immigrants.

Over time, the prevalence of chronic diseases may increase among immigrants, influenced in part by aging, lifestyle changes and environmental stressors in their new country. This report reveals that while, in general, proportionally fewer immigrants than non-immigrants reported having at least one chronic disease in 2023, a larger percentage of those who were admitted to Canada more than 10 years ago reported having a chronic disease, compared with more recent arrivals. Notably, heart disease, obesity, arthritis, anxiety and mood disorders were less prevalent among immigrants than non-immigrants in 2023, yet these conditions were more common for established immigrants than for recent immigrants. While the prevalence of diabetes and obesity was higher among immigrants overall in 2023, thos ewho were admitted more than 10 years ago had a higher prevalence of both, compared with recent immigrants. Additionally, a greater percentage of immigrants, both recent and established, were classified as overweight, compared with non-immigrants.

Many immigrants carry dietary habits from their home countries that can differ markedly from those in their new surroundings, influencing their nutrition and leading to either healthier or less healthy eating patterns. The Health behaviours section shows that a lower proportion of immigrants than non-immigrants consumed fruits or vegetables five or more times per day, with the lowest proportion among recent immigrants, rather than established immigrants.

The Health behaviours section highlights that immigrants had healthier substance use behaviours, reporting lower alcohol consumption in the week before the survey and a lower prevalence of heavy drinking, cigarette smoking (daily or occasional), vaping (in the past 30 days) and cannabis use (daily or almost daily), compared with non-immigrants. The prevalence of vaping was higher among immigrants who were admitted to Canada in the last 10 years, whereas the prevalence of cannabis use was higher among immigrants who were admitted to Canada more than 10 years ago. However, there were no differences in the prevalence of heavy drinking and cigarette smoking based on the time since immigration.

The Access to health care section indicates that from 2021 to 2023, the percentage of non-immigrants with a regular health care provider decreased, while there was no change among immigrants. However, when examined by time since immigration, the percentage with a provider was unchanged for established immigrants but increased for recent immigrants.

Although home care service use did not differ by immigrant status in 2023, a higher proportion of immigrants reported unmet needs for home care, particularly among those who have been in Canada longer, compared with more recent immigrants.

Racialized groups

The relationship between racialized identity and health is influenced by a blend of systemic, socioeconomic, cultural and environmental factors. These elements interact to create disparities in health outcomes among different racialized and ethnic groups.^{Note 21} This report examines health and health-related outcomes for adults aged 18 and older in the 10 largest racialized groups in Canada: South Asian, Chinese, Black, Filipino, Arab, Latin American, Southeast Asian, West Asian, Korean and Japanese.

While racialized groups often face unique stressors such as discrimination and social isolation that can adversely impact their health,^{Note 21Note 22Note 23} results in the Health outcomes section indicate that a higher percentage of several racialized groups—specifically South Asian, Filipino, Latin American and Japanese individuals—reported very good or excellent perceived health, compared with the non-racialized population. Additionally, higher shares of Filipino, Black, Latin American and South Asian people reported very good or excellent perceived mental health, compared with the non-racialized population. Notably, in 2023, most people in each of the 10 largest racialized groups rated their perceived health and mental health as very good or excellent, in proportions similar to or higher than those of their non-racialized counterparts.

High blood pressure, heart disease, obesity, anxiety and mood disorders were more prevalent among the non-racialized population than among most racialized groups in 2023. Moreover, arthritis was less common among all racialized groups compared with the non-racialized population from 2021 to 2023. However, a higher proportion of South Asian and Black Canadians were classified as overweight compared with their non-racialized counterparts in 2023. Additionally, South Asian people had a greater prevalence of diabetes, while Chinese, Latin American, Japanese, Korean and West Asian adults reported lower diabetes prevalence relative to the non-racialized population. COVID-19 reinfection was most common among Black Canadians, compared with other racialized groups.

As presented in the Health behaviours section, while some racialized groups reported consuming fruits or vegetables five or more times per day in proportions comparable to the non-racialized population in 2023, lower shares of South Asian, Chinese and West Asian people did so. In addition, heavy drinking and cigarette smoking were more common among non-racialized adults, compared with most racialized groups. Vaping was less prevalent among Chinese, South Asian, Latin American, Black and Southeast Asian individuals, while it was more common among Arab adults, compared with non-racialized people. Furthermore, daily or almost daily cannabis use was notably less common among the South Asian, Chinese, Black, Filipino and Latin American groups compared with the non-racialized population in 2023.

Racialized and ethnic groups often face barriers to accessing health care, including economic challenges, lack of insurance and systemic discrimination within the health care system. Data revealed that in 2023, lower shares of Arab, Black, Korean, Latin American and Chinese adults had a regular health care provider compared with their non-racialized counterparts, while a greater proportion of Filipino adults had one. In addition, home care use was notably less common among Southeast Asian, Filipino, Latin American and Chinese adults relative to the non-racialized population. Smaller proportions of Chinese and Filipino adults reported unmet needs for home care, compared with the non-racialized population. Further details can be explored in the Access to health care section.

Indigenous populations

Indigenous groups across Canada experience health disparities that can be attributed to various social determinants of health. These determinants include systemic issues that impact everyday realities, such as access to suitable health care, high-quality education, affordable food and adequate housing.^{Note 24Note 25} Exposed to various inequities in the social determinants of health, Indigenous groups experience a disproportionate risk of poor health compared with non-Indigenous groups.^{Note 26Note 27}

Findings from the 2022 Indigenous Peoples Survey, a national survey on the social and economic conditions of First Nations people living off reserve, Métis and Inuit, reveal disparities in health indicators among Indigenous populations in Canada. As explored in the Health outcomes section, life expectancy at birth is notably lower among these populations, and infant mortality rates are higher. Chronic diseases are prevalent, especially arthritis, high blood pressure and asthma, with sex differences observed. Mental health issues are also widespread across Indigenous groups, with over one-quarter of Indigenous adults reporting anxiety or mood disorders, often exacerbated by low-income conditions. Access to health care remains a critical challenge, with many Indigenous individuals reporting unmet health care needs. Furthermore, Indigenous children experience poorer health outcomes, with high rates of respiratory infections and dental issues, often linked to inadequate social determinants of health. The COVID-19 pandemic disproportionately affected these communities, with mortality rates higher than in non-Indigenous populations,^{Note 28} emphasizing ongoing health inequities that need to be addressed.