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andré picard's second opinion

Life expectancy in Canada rivals that of almost any country in the world. A girl born today can expect to live, on average, to 82 and a boy to a more modest 76.9, according to Statistics Canada.

But life expectancy is a crude measure that tells a superficial story, so there have been many attempts to drill down into the data.

There are, for example, wide regional variations. In Canada, there is a West-to-East-to-North health gradient: Those who are healthiest and live longest are on the Pacific Coast, and the numbers get gradually worse as you move across the nation to the Atlantic region. Then, when you look to the North, the numbers take a precipitous drop. In the territories, life expectancy is similar to that in low- and middle-income countries.

Just as there are regional variations, there are differences across the lifespan. Those who die early tend to skew data on average life expectancy.

This has given rise to the popular measure of life expectancy at 65. On her 65th birthday, a Canadian woman can expect to live 21 more years on average, and a man almost 18.

Increasingly, those years are lived in good health. But a significant number of seniors have chronic health conditions.

So Statistics Canada decided to calculate disability-free life expectancy (DFLE) as a way of looking beyond mortality to the preceding morbidity.

DFLE is estimated at 68.6 years in Canada, compared to a life expectancy of 78.3. That means most people can expect to live almost a decade with a significant physical or mental disability before they die.

This is a measure, obviously, that should be of great interest to those who fashion health and social services.

So, too, should the most complex and intriguing measure to date, something called health-adjusted life expectancy (HALE) - an attempt to measure not only the quantity of life, but the quality of life .

Essentially, what Statistics Canada has done is take the Health Utility Index (a scoring system that looks at factors such as pain and mobility) and used it to weight the years lived in good health higher than years lived in poor health.

It is well established that there are many contributors to poor health. In addition to genetics (which play a relatively small role), socio-economic status and, to a lesser extent, lifestyle choices have a tremendous impact.

Those socio-economic determinants include education, housing, physical environment and, above all, income. Put bluntly, poverty makes people unhealthy and poverty kills.

While this may seem self-evident, a group of researchers at Statistics Canada has managed to calculate the impact of poverty (or, as they say, "income disparities") on life expectancy.

The findings, published in the journal Health Reports, are eye-opening.

Only 51.2 per cent of Canadian men in the lowest income group (the bottom 10 per cent) can expect to live to age 75. By comparison, 74.6 per cent of high-income earners (the top 10 per cent) can expect to see 75.

That is a startling 23.4-point difference - not good odds.

For women, the comparative figures are 69.4 per cent of poor women living to 75, compared with 84.4 per cent of wealthy women. A smaller, but still significant, 15-point gap.

Put another way, at age 25 a poor man can expect to live an additional 48.6 years. A wealthy man can expect 56 years - a 7.4-year gap.

A poor 25-year-old woman can be expected to live 56.5 more years, compared with 61 years for a wealthy woman of the same age. That gap is 4.5 years.

Those are the raw numbers based on conventional life expectancy.

When Statistics Canada applied the HALE measure, it found that those gaps between poor and rich were even more considerable.

Being wealthy translated into 11.4 more years of healthy living for men and 9.7 for women.

When they crunched the numbers further, the statisticians found that even if you compare the health-adjusted life expectancy of the highest-income earners with those of the average person, the difference was still 5.9 years for men and 4.2 years for women.

To put those numbers in context, consider that cancer, the No. 1 killer in Canada, reduces health-adjusted life expectancy by 2.8 years for men and 2.5 years for women.

There are a lot of numbers to digest here, but the bottom line is this: People's income (or lack thereof) has about twice the impact on their health as cancer does.

That is a humbling bit of data.

It also raises the question: Why is tackling poverty not a health priority?

Patching and mending is all well and good, and our sickness-care system does a good job of it.

But the data tell us that the most powerful tool we have in our health-care armamentarium is income redistribution.

The most powerful drug we have - money - is pretty plentiful in Canada. But it is not being prescribed to everyone who would benefit.

Yesterday, the group Campaign 2000 released its 2009 Report Card on Child and Family Poverty in Canada. It showed that 637,000 children are still living in low-income families - two decades after federal politicians vowed to eradicate child poverty.

One can only despair that, in a country with one of the highest life expectancies in the world, these children are being deprived of almost a decade of life from the get-go, and we seem largely indifferent.

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