Health Equity in Canada by the Numbers
July 17, 2023
Scientific breakthroughs are fuelling life-changing new treatments, but without health equity we can’t call it a true victory. Before we get to the facts and figures, here are some definitions to bring the big picture concepts into focus.
Health equity
Health equity occurs when each individual has the opportunity to reach their fullest health potential.1 In practice, this means reducing unnecessary, unjust, and avoidable differences in access to healthcare.
Health inequity
The flip side of health equity, health inequity refers to systemic differences in the health status and distribution of resources among different populations.2 Arising from the social conditions in which people are born and live, these inequities can be reduced with equity-oriented policies and initiatives from governments, academia and industry. Health inequities may also play out across diseases – for example, when certain diseases receive disproportionately low funding.3
Equity vs. equality
Equity means fairness, which does not mean giving everyone the same thing – but rather giving individuals and groups what they need to level the playing field.4 Translated to the healthcare realm, it means removing systemic differences in access so that no population group experiences extra barriers to health.
On the world stage and in Canada
79.7%: Proportion of Caucasian enrollees in US clinical trials reporting ethnic distribution over the 2000-2020 time span,5 exceeding the estimated percentage of Caucasians (72.4%) in the US population.
86%: Proportion of Caucasian enrollees in combined US/Canadian clinical trials for cancer drugs between 2010 and 2016,6 once again exceeding the 72.4% population benchmark.
> 450: Ethnic or cultural origins reported in the 2021 Canadian census.7
22%: Percentage of Canada’s population reported to be born abroad in the 2016 Canadian census.8 As of 2010, Canada had the highest proportion of immigrants among G8 countries, ahead of Germany (13%) and the US (12.9%).8
What contributes to inequities in health
100+: The number of public prescription drug plans in Canada, along with the country’s 100,000+ private plans.9 This means that a resident in one province may not have access to the same medications as someone living in the province next door – or may face higher copays or bureaucratic hurdles to gain access.
20%: Proportion of Canadians living in rural communities.10 For Indigenous peoples, the figure rises to 50%.11 This requires people to travel long distances for care – which takes time and money – and can have a detrimental affect on health and quality of life.12
80%: Proportion of Indigenous Peoples in Canada who will develop type 2 diabetes in their lifetime.13 The condition has reached epidemic levels in some communities, with socioeconomic disadvantages such as inadequate housing, food insecurity, unsanitary water, and unequitable healthcare access amplifying the inequity.
Every 22 minutes: That’s how often a woman dies of a heart attack in Canada, and most of those deaths are preventable.14 In relation to men, women have smaller hearts and different heart attack symptoms – but their treatment doesn’t always account for these differences.
46.3% to 64.2%: Proportion of Black participants in a Canadian survey reporting racial discrimination in various contexts including health services.15
36%: Proportion of Canadians with rare diseases who report they are unable to access prescribed medicines for their condition.16
Closing the gap
$198 billion: Government of Canada investment in healthcare announced in February 2023, with “access to high-quality family health services [for everyone] when they need them” as one of 4 goals.17
$1.5B: $1.5 billion over 3 years pledged by the Government of Canada to implement the Rare Disease Drug Strategy endorsed in 2019.18
2022: Year that Health Canada made a formal commitment, in alignment with the federal government’s Sex- and Gender-Based Analysis Plus Action Plan, to improve the capacity to collect the disaggregated data needed to assess, monitor and report on the diversity within clinical trial populations.19
6: Number of health equity research grants recently awarded by the Canadian Cancer Society across 6 provinces.20 With grant figures totalling $1.6M, this funding program supports projects that seek to advance cancer-related health equity, such as addressing inequities in prostate cancer care for Black patients and cancer outcomes for Métis communities in rural Manitoba.
References
Health equity. Public Health Ontario. https://www.publichealthontario.ca/en/health-topics/health-equity#
Health inequities and their causes. World Health Organization 2022. https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes
Coronado AC et al. Discrepancies between Canadian cancer research funding and site-specific cancer burden: a spotlight on ten disease sites. Curr Oncol 2018; 25:338.
Illustrating equality vs. equity. Interaction Institute for Social Change. https://interactioninstitute.org/illustrating-equality-vs-equity/
Turner BE et al. Race/ethnicity reporting and representation in US clinical trials: A cohort study. Lancet Regional Health–Americas 2022;11:100252.
Dickmann LJ, Schutzman JL. Racial and ethnic composition of cancer clinical drug trials: how diverse are we? Oncologist 2018;23:246.
Ethnocultural and religious diversity – 2021 Census promotional material. Statistics Canada 2022. https://www.statcan.gc.ca/en/census/census-engagement/community-supporter/ethnocultural-and-religious-diversity
Immigrant diasporas in Canada. The Canadian encyclopedia 2022. https://www.thecanadianencyclopedia.ca/en/article/immigrant-diasporas-in-canada
A prescription for Canada: achieving pharmacare for all. Government of Canada 2019. https://www.canada.ca/content/dam/hc-sc/images/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report/final-report.pdf
Veley A. Why do rural communities and remote communities have poor access to physical therapy? Curovate 2021. https://curovate.com/blog/why-do-rural-communities-and-remote-communities-have-poor-access-to-physical-therapy/#footnote2
Why do Indigenous Peoples in Canada have high rates of chronic diseases? Pathways Indigenous Health Collaborations. https://www.indigenoushealthpathways.ca/about-pathways/history
Roumeliotis I, Witmer B. Every 22 minutes a Canadian woman dies of a heart attack. Most of those deaths are preventable. CBC News, Sept. 24, 2022. https://www.cbc.ca/news/health/womens-heart-health-advocacy-1.6593599
Cénat JM et al. Prevalence and Effects of Daily and Major Experiences of Racial Discrimination and Microaggressions among Black Individuals in Canada. Journal of Interpersonal Violence 2021;37.
Canadians with rare diseases do not get timely diagnosis and care – with funding and the plan in place, it’s time for political leadership. Canadian Organization for Rare Disorders 2023. https://www.raredisorders.ca/rare-disease-day-2023/
Improving Healthcare. Government of Canada. https://www.canada.ca/en/health-canada/services/priorities.html
Canadian Organization for Rare Disorders welcomes federal funding for rare drug plan to accelerate access to diagnostics and treatments. Newswire. March 22, 2023. https://www.newswire.ca/news-releases/canadian-organization-for-rare-disorders-welcomes-federal-funding-for-rare-drug-plan-to-accelerate-access-to-diagnostics-and-treatments-805622202.html
Health Canada to monitor the inclusion of disaggregated data in clinical evidence. Government of Canada. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/monitor-inclusion-disaggregated-data-clinical-evidence-notice.html
Results of the September 2022 health equity research grants competition. Canadian Cancer Society 2023. https://cancer.ca/en/research/for-researchers/funding-results/health-equity22