Healthy Canadians in 2010?

John S. Millar

CMAJ 2000;162(13):1823-4

The roadmap initiative will attempt to answer 2 questions: How healthy is the Canadian population? and How well is the health care system performing? The health indicators to support this process were selected at a national consensus conference held in May 1999¹ and are clustered in 4 domains: health status, nonmedical determinants of health, performance of the health care system, and characteristics of the community and health care system. The indicators are under development, and some examples are provided in Table 1. Through the roadmap initiative, the data to support the health indicators will be made available to allow comparisons at the regional level across the country as well as at the provincial and national levels. The intent is to provide the public with a regular update on overall health status, to support continual quality-improvement efforts for both health care providers and institutions, and to inform the development of healthy public policies.

It is hoped that the health data will be comprehensive; however, some areas may prove difficult to support within the timelines of the project. For example, although the importance of the physical environment for health is well established, there are no contemporary comparable data available on air quality, water quality or toxic exposures. Moreover, in health care most of the available databases are related to acute care. Indicators and data standards are being developed in mental health and addiction, home care, long-term care, drug utilization and primary health care; however, it is not anticipated that there will be comparable data available for these sectors across the country within the timelines of this project. The production of useful data to support indicators in these sectors will require the cooperation and resources at all levels of government.

For these data to be useful at the regional level, they will need to be augmented wherever possible with additional information available locally or provincially. For example, some provinces have conducted their own patient satisfaction studies and have arranged for increased sampling in the National Population Health Survey, which provide rich sources of information not available on a comparable basis across the country but extremely useful locally. Because these data are insufficient by themselves to provide a complete understanding of the health of the community, they will need to be augmented with qualitative assessments of health, the determinants of health, and the performance and management of the health care system.

The data currently available to support the health indicators in the 4 domains of the roadmap initiative have been calculated and standardized for 63 health regions across Canada. These data have been made available to the regional health authorities and have also been the basis of a recent report from the Canadian Institute for Health Information² and a companion special issue of Health Reports from Statistics Canada.³ There are also a number of other agencies issuing reports on aspects of health.^4,5

One important yet difficult question has been raised: although it is useful to have selected the appropriate indicators and to have these supported by data, what is the right number? In some provinces numerical targets (what should be achieved, given local conditions and resources) have been set for some of the indicators, and in other areas there has been a request for benchmarks (what could be achieved, given available evidence or best practices within the country or internationally). To provide benchmarks for all or some of these indicators would be an important but non-trivial undertaking. It would require bringing together experts in many fields and reaching consensus on the best interpretations of available evidence. It would be unreasonable to repeat this process in each jurisdiction across Canada; instead, we need a pan-Canadian process for developing health benchmarks. A similar approach was recently undertaken in the United States, and in January a report was released ("Healthy People 2010"⁶) that contains the national goals for a wide range of health indicators. It is time for a similar process in Canada — Health Canadians 2010.

Competing interests: None declared.

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Correspondence to: Dr. John S. Millar, Canadian Institute for Health Information, 200­377 Dalhousie St., Ottawa ON K1N 9N8; fax 613 241-8120; jmillar@cihi.ca

1. National Consensus Conference on Population Health Indicators final report. Ottawa: Canadian Institute for Health Information; 1999. Available: www.cihi.ca/wedo/phidoc.htm
2. Health care in Canada 2000: a first annual report. Ottawa: Canadian Institute for Health Information; 2000. Available: www.cihi.ca/Roadmap/Health_Rep/healthreport2000/toc.htm
3. How healthy are Canadians? [special issue] Health Rep 1999;11(3).
4. Federal/Provincial/Territorial Advisory Committee on Population Health. Toward a healthy future: second report on the health of Canadians. 1999 Sept
5. Hospital report '99. Toronto: Ontario Hospital Association and University of Toronto; 1999.
6. Healthy people 2010. Washington: US Department of Health and Human Services; 2000 Jan 25 Available: www.health.gov/healthypeople/Default.htm

© 2000 Canadian Medical Association or its licensors