Canada

The Health in the Americas+¹ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.

Environmental and social determinants of health

In 2000 the total population of Canada was 30 683 313 inhabitants; by 2023 this figure had risen to 38 781 291, representing a 26.4% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 19.5% of the total population, an increase of 7.1 percentage points compared to the year 2000. In 2023, there were 101.2 women per 100 men and 126.9 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 65.0% of the total population of the country in 2023 (25 226 854 people). When we add these figures to the potentially passive population (5 974 344 under 15 years of age and 7 580 094 over 65 years of age), the result is a dependency ratio of 53.7 potentially passive people per 100 potentially active people. This ratio was 46.3 in 2000.

Life expectancy at birth in 2023 was 83.0 years, higher than the average for the Region of the Americas and 3.8 years higher that in 2000.

Figure 1. Population pyramids of Canada, years 2000 and 2023

Between 2001 and 2016, the average number of years of schooling in Canada increased by 8.5%, reaching an average of 13.7 years in the latest year for which information is available. The unemployment rate in 2022 was 5.2%. Disaggregated by sex, the rate was 5.0% for women and 5.4% for men. In addition, 0.2% of the population was below the national poverty line in 2017, defined as the percentage of the population with an income of less than US$ 1.90 per day; this is below the regional average of 3%. 

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 5.2% (from a score of 0.89 to a score of 0.936); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2021

In 2021, public expenditure on health accounted for 8.71% of gross domestic product (GDP) (Figure 3) and 19.02% of total public expenditure, while out-of-pocket spending on health accounted for 12.6% of total health expenditure.

Figure 3. Public expenditure on health as a percentage of gross domestic product in the Region of the Americas, 2020

Digital coverage

In 2021, 92.8% of the population had an internet connection, representing a considerable increase from 2000, when 51.3% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2019, infant mortality in Canada decreased from 5.3 to 4.4 deaths per 1000 live births, a decrease of 17.0% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 5.6% to 6.6% between 2000 and 2019.

Regarding the immunization strategy, measles vaccination coverage was 92.0% in 2022, a decrease of 3 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 11.0 deaths per 100 000 live births, a reduction of 18.4% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 1.5 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 63.8% decrease, from 17.5 live births per 1000 women aged 15 to 19 years in 2000 to 6.3 in 2023. Between 2007 and 2017, there was no variation in the percentage of prenatal care, which remained at 99%. In 2020, 98.0% of births were attended by skilled birth personnel.

Figure 4. Infant mortality per 1000 live births, 1995–2020

Figure 5. Maternal mortality per 100 000 live births, 2000–2020

Communicable diseases

In 2020, there were 4.7 new cases of tuberculosis per 100 000 population in Canada. In parallel, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.1 in 2019 (0.1 in women and 0.2 in men).

In 2019, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 5.7 per 100 000 population. The age-adjusted mortality rate for HIV was 0.3 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 77,8% in Canada.

There were no cases of human rabies in the country in 2022.

Noncommunicable diseases and risk factors

In 2021, there were 5 new cases of tuberculosis per 100 000 population in Canada. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.1 (0.1 in women and 0.2 in men).

In 2020, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 4.3 per 100 000 population. The age-adjusted mortality rate for HIV was 0.3 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 77.8%. There were no cases of human rabies in the country in 2020.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Canada was 125.6 deaths per 100 000 population, a decrease of 29.4% from a rate of 178 in 2000. Among potentially avoidable premature mortality, the rate for preventable causes was 80.9 per 100 000 population in 2019, which is 41% lower than the regional average rate; and the rate for treatable causes was 44.7 per 100 000 population, below the regional average of 89.6.

The overall age-adjusted mortality rate was 3.5 per 1000 population in 2019, a decrease of 25.7% compared to 2000 (4.7 deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 18.6 per 100 000 population (20.7 per 100 000 in men and 16.6 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 301.5 per 100 000 population (354.9 per 100 000 in men and 254.7 per 100 000 in women). The rate of age-adjusted mortality from external causes was 26.8 per 100 000 population (37.3 per 100 000 in men and 16.6 per 100 000 in women), including road traffic accidents (4.6 per 100 000 population), homicides (1.6 per 100 000 population), and suicides (10.3 per 100 000 population). In 2000, the percentage distribution of causes was 87.9% for noncommunicable diseases, 4.9% for communicable diseases, and 7.2% for external causes; in 2019, the percentages were 86.9%, 5.3%, and 7.7%, respectively (Figure 6).

Figure 6. Proportional mortality in Canada, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 11.9 per 100 000 men; lung cancer, 30.9 per 100 000; and colorectal cancer, 14.6 per 100 000. In women, these values were 15.4 deaths per 100 000 for breast cancer, 24.4 per 100 000 for lung cancer, and 10.2 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In Canada in 2020, there were a total of 497 978 cases of COVID-19, representing 13,048 per million population. In 2021, there were 1 516 911 identified cases, equivalent to 39 745 per million population. In 2022, there were 2 201 252 identified cases, equivalent to 1172.25 per million population. In 2020, there were 14,272 deaths directly caused by COVID-19 in people diagnosed with the disease, or 374.0 per million population; in 2021, 15 615 deaths were reported, or 409 per million. In 2022, 14 853 deaths directly caused by COVID-19 in people diagnosed with the disease, or 289 per million population. In 2020, Canada ranked 18th in the Region of the Americas in terms of the number of deaths from COVID-19, and 17th in 2022, with a cumulative 1 172 25 deaths per million population over the considered years (Figure 7).

According to estimates by the World Health Organization, there was a total of 16 984 excess deaths in 2020, or 45 per 100 000 population;² a total of 5 210 deaths were estimated in 2021, for an excess mortality rate of 14 per 100 000.

As of 1 June 2022, at least one dose of COVID-19 vaccine had been given to 84.92% of the country’s population. As of 1 June 2022 (latest available data), 82% of the population had completed the vaccination schedule. The vaccination campaign began on 20 December 2020, and seven types of COVID-19 vaccine have been used to date.³

Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023

Health risks from climate change

Climate change is negatively influencing the health of Canadians by driving the spread of infectious diseases, such as Lyme disease, while climate-related natural disasters and extreme weather events are increasing risks of injury or death and adversely affecting the wellness of Canadians.

Certain communities in Canada, including indigenous, racialized, and other marginalized individuals, as well as older adults and those with disabilities, face disproportionate climate change risks. To demonstrate, during the "heat dome" event in British Columbia in the summer of 2021, older adults faced a disproportionate impact. Specifically, of the 569 heat-related deaths recorded by the British Columbia Coroners Service, 69% were people aged 70 years or older.⁴ In addition, a growing body of international evidence points to chronic, long-term exposure to air pollution as a leading risk factor for the emergence of dementia, including Alzheimer's disease, most common in older adults. Canada is currently developing its first National Adaptation Strategy focused on bringing forward plans and collaborative actions to support climate change adaptation across the country.

Prospects

Measures to achieve universal health coverage

Canadian health care is mostly publicly financed and administered, with the federal government working closely with the provinces and territories, which have responsibility for healthcare delivery. Collectively, national standards are maintained through the Canada Health Act.⁵ The Act facilitates "reasonable access to health services without financial or other barriers," and represents an adoption of the global move toward universal health coverage. Canadian health care includes promotive, preventive, curative, rehabilitative, and palliative services, and recognizes that a strong primary healthcare system is essential to achieve universal health coverage. To ensure the long-term strength of the health system, the federal government is continuing its collaborative work with provinces and territories, focusing on five critical areas: (1) reducing healthcare backlogs and growing the health workforce; (2) easier access to a family health provider or team for all Canadians; (3) helping Canadians age with dignity closer to home and improving long-term care and home care services; (4) improving mental health and access to substance use services; and (5) modernizing health data and digital health.

Challenges related to population health

The Canadian population is aging, and the pace of this aging is predicted to continue. In 1980, the proportion of the Canadian population aged 65 and older was 9.4 percent. This proportion had increased to an estimated 18.0% by 2020, and is predicted to rise to 27.3% by 2060.⁶ Canadians continue to face health challenges, particularly related to an aging demographic, noncommunicable diseases. and mental health, along with emerging concerns related to communicable disease, antibiotic resistant infection, and climate-related health impacts. These challenges have been exacerbated by the ongoing COVID-19 pandemic. Cardiovascular disease, and cancers in 2019 were the top two causes of death and disability in Canada, collectively accounting for one-third of all healthy life lost.⁷ Over 3.4 million Canadians are living with diabetes, and more than 200 000 people are newly diagnosed each year. Indigenous peoples in Canada experience higher prevalence rates of many chronic diseases compared to the general Canadian population, and a particular concern is the excess and increasing levels of type 2 diabetes among First Nations children. Opioid and other substance overdoses are increasing; there were over 7 000 apparent opioid toxicity deaths in 2021 – about 21 deaths per day, up from 8 per day in 2016 and 12 per day in 2018.⁸ Solutions to each of these challenges require multisectoral cooperation as part of a resilient, agile, and sustainable health system.

COVID-19 pandemic response

Canada experienced seven distinct COVID-19 outbreak surges between April 2020 and May 2022, with many of the 44 000 confirmed deaths by August 2022 concentrated in these outbreak periods. COVID-19 has dramatically changed the paradigm of public health threat detection in Canada. Since 2020, Canada has made investments in public health surveillance, vaccination, public health measures, research, and other COVID-19 response components. Canada's response continues to demand an unprecedented level of public health surveillance, analysis, reporting, and advice.

Canada's plans to strengthen surveillance and public health guidance in the next 2–3 years include: improved recruitment and retention of subject-matter experts, including ongoing professional development and training; strengthened genomic sequencing and genomic surveillance; improved data collection and dissemination among Canada's federal, provincial, territorial, and municipal governments; implementation of new or enhanced information management and information technology systems; better integration of epidemiological, immunization, and laboratory data to support public health threat assessment; and identification of gaps in public health knowledge. In January 2022, Canada's Minister of Health announced the creation of the Centre for Research on Pandemic Preparedness and Health Emergencies, with an ongoing investment of Can$ 18.5 million per year.⁹ This research center aims to be a leader in preventing, preparing for, responding to, and recovering from existing and future pandemics and public health emergencies. It collaborates with other federal departments and agencies, as well as stakeholders domestically and internationally.

Measures to reduce inequalities in health

There is a national commitment to reducing health inequalities and three broad strategies have been identified to address the social, environmental, and economic determinants of health: (1) strengthening the evidence base to inform decision-making, (2) supporting community-based interventions, and (3) multisectoral collaborations beyond the health sector. A strong health-inequalities evidence base is anchored by the Pan-Canadian Health Inequalities Reporting Initiative, which provides online data tools and information products on health inequalities.¹⁰ The Canadian Institutes of Health Research Strategic Plan (2021–2031) focuses on making research inclusive, collaborative, transparent, culturally safe, and focused on real world impact, with the aim of positioning Canada as a global leader in the science of achieving health equity.¹¹ Specifically, the plan has five priorities, each with an equity focus, and these include accelerating the self-determination of indigenous peoples in health research; pursuing health equity through research; and integrating evidence in health decisions. There is national support for community-based interventions to advance health equity. For example, the Intersectoral Action Fund supports communities to build local capacity for collaborative action on the social determinants of health and health inequities. The Promoting Health Equity: Mental Health of Black Canadians Fund supports community-based programs in mental health promotion to address the underlying determinants of health for black communities. The Healthy Canadians and Communities Fund invests in initiatives that address common risk factors (e.g., physical inactivity, unhealthy eating, tobacco use) with the aim of improving health and reducing health inequalities among priority populations at greater risk of major chronic diseases (diabetes, cardiovascular disease, and cancer). Canada is committed to working in partnership with indigenous peoples to co-develop indigenous health legislation to foster health systems that will respect and ensure the safety and well-being of indigenous people. This includes addressing the social determinants of health and advancing self-determination, in alignment with the United Nations Declaration on the Rights of Indigenous Peoples.

The sources of the interagency indicators used in this profile can be found in this table.

For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.