In a stark revelation about global health trends, Canada's standing in international life expectancy rankings has plummeted dramatically over the past three decades, according to a recent opinion piece published in the Calgary Herald. Once ranking fifth among wealthy nations in 1990, Canada now sits at 22nd in 2023 among 37 Organization for Economic Co-operation and Development (OECD) countries, marking a 17-point decline. This shift, highlighted by health policy experts Dennis Raphael and Toba Bryant, raises questions about the underlying social and economic factors affecting the nation's well-being.
The article, titled 'Opinion: Is a nation falling from 5th to 22nd in life expectancy rankings a sign of something wrong?', draws on OECD statistics to illustrate Canada's trajectory. In 1990, the average Canadian life expectancy stood at 77.5 years, improving to 81.7 years by 2023. However, the authors note that this absolute figure has actually declined in three of the past four years, failing to keep pace with gains in other developed nations. Countries now surpassing Canada include Switzerland, Japan, Spain, Israel, Italy, South Korea, Luxembourg, Sweden, Norway, Australia, France, Ireland, Belgium, Portugal, Iceland, New Zealand, Slovenia, Austria, the Netherlands, Denmark, and Greece.
Raphael, a professor of health policy and management at York University in Toronto, and Bryant, an associate professor of health sciences at Ontario Tech University in Oshawa, attribute this decline not to overall economic downturns but to deteriorating 'social determinants of health.' These encompass living and working conditions that profoundly influence health outcomes. 'Life expectancy is a good indicator of the living and working conditions within a nation,' the authors write. 'These conditions are so strongly related to health that they have come to be known as “social determinants of health.” And all evidence is that these social determinants of health in Canada are declining in quality and in their equitable distribution.'
Despite Canada's gross domestic product reaching record highs, indicating unprecedented wealth, the opinion piece points to widening disparities. Growing income and wealth inequality, indifference to housing and food insecurity, a scarcity of unionized jobs, and a health-care system in crisis are cited as key culprits. The authors reference specific figures: 17 percent of Canadians experience food insecurity, 14 percent live in poverty according to international measures, more than 33 percent face work precarity, and half of the population is just $200 away from being unable to pay bills.
This is not because Canada has grown poorer. In terms of gross domestic product (GDP) or the size of its economy, Canada has never been wealthier.
The piece contrasts Canada's situation with that of the United States, which has also seen its ranking slip—from 20th in 1990 to 31st in 2023—but by a lesser margin of 11 points. The authors suggest similar root causes plague both nations, challenging the common perception among Canadians that their country is insulated from American-style woes. 'You might attribute this to the country’s poor governance, which has led to growing income and wealth inequality, indifference to citizens suffering from housing and food insecurity, a lack of unionized jobs and a health-care system in crisis,' they write of the U.S. 'You would shake your head and thank the stars that you live in Canada.'
Yet, the experts argue, Canada is grappling with the same issues. The opinion highlights a converging 'polycrisis' of income, food, housing, employment, and health-care challenges. Privatization trends in the universal, not-for-profit health-care system are flagged as particularly concerning, eroding access for many. Raphael and Bryant emphasize that these problems are interrelated, amplifying their impact on public health.
The OECD data, accessible on the organization's website, provides the backbone for these claims. Established in 1961, the OECD comprises 38 member countries focused on economic development and policy coordination. Its health statistics, compiled from national reports and international surveys, are widely regarded as a benchmark for comparing well-being across affluent societies. Canada's drop in rankings underscores a broader trend: while absolute life expectancy has risen since 1990, relative performance has eroded as peers like Japan and Switzerland have advanced further, with Japanese life expectancy exceeding 84 years in recent reports.
In discussing potential solutions, the authors critique approaches from political figures. They reference Prime Minister Mark Carney's proposals for new industrial development, expanded oil pipelines, and substantial investments in military hardware, including billions for warplanes and warships. According to Raphael and Bryant, such measures fall short of addressing the polycrisis. 'Prime Minister Mark Carney’s solutions of new industrial development, more oil pipelines and billions of dollars in purchases of warplanes and warships are not going to solve the polycrisis,' they state. 'Blaming immigration levels and limiting immigration are not going to solve it.'
Instead, the experts call for a fundamental reevaluation of economic priorities. 'What will solve the polycrisis is Canadians beginning to ask these questions — In whose interests is the economy operating? Why do profits of wealthy corporations and the incomes of wealthy individuals continue to grow as wages of most Canadians fail to keep up with inflation? And what kind of economic system will meet the needs of most Canadians?' the article poses. 'Because, clearly, the current economic system is not doing so.'
This perspective aligns with ongoing national debates in Canada. Recent polls, such as those from Nanos Research in late 2023, indicate widespread concern over affordability, with 62 percent of respondents citing cost of living as the top issue. Housing prices in major cities like Toronto and Vancouver have surged, with average home costs exceeding $1 million in Toronto as of 2023, according to the Canadian Real Estate Association. Food bank usage has hit record levels, with Food Banks Canada reporting over two million visits monthly in 2022-2023.
Health-care strains are evident too. Wait times for non-emergency procedures average 25 weeks, per the Fraser Institute's 2023 report, compared to under 10 weeks in countries like Germany. Unionization rates have stagnated; Statistics Canada data shows only about 30 percent of workers in unions as of 2022, down from peaks in the 1980s. These metrics paint a picture of systemic pressures that the opinion piece links directly to life expectancy trends.
While the Calgary Herald article is an opinion column, it draws on verifiable OECD figures, lending weight to its analysis. Other experts have echoed similar concerns. Dr. Trevor Hancock, a public health professor at the University of Victoria, has previously noted in interviews that social inequalities are 'killing Canadians prematurely,' citing data from the World Health Organization. Conversely, some economists, like those at the C.D. Howe Institute, argue that Canada's universal health care buffers against worse outcomes seen in the U.S., though they acknowledge access bottlenecks.
The implications extend beyond statistics. Life expectancy rankings influence policy discussions, from federal budgets to provincial health reforms. In 2023, the Canadian government allocated an additional $196 billion over 10 years to health care through bilateral deals with provinces, aiming to reduce wait times and bolster primary care. Yet, critics like Raphael and Bryant contend that without tackling inequality, such investments may yield limited results.
Looking ahead, the authors urge a shift toward equitable resource distribution. As Canada navigates post-pandemic recovery and global economic shifts, the life expectancy data serves as a cautionary metric. With OECD nations reconvening for health policy forums in Paris later this year, Canada's position could prompt renewed international scrutiny. For now, the drop from fifth to 22nd stands as a sobering reminder of the gaps between economic growth and lived realities for many Canadians.
In Toronto and Oshawa, where the article's authors teach, students and researchers are already engaging with these themes. Raphael's work at York University focuses on health inequities, while Bryant's at Ontario Tech explores social factors in disease. Their collaboration underscores a growing academic push for policy changes that prioritize social determinants, potentially shaping future debates in Ottawa and beyond.