Vancouver Coastal Health
Without health, life is very challenging. A country’s health system is likewise a critical piece in its culture and politics. Comparing health systems is difficult but there is general agreement that such systems should be accessible, efficient and successful in yielding good health outcomes. A recent study ranked the Netherlands, the United Kingdom and France as superior on those counts, based on objective measures of health outcomes and surveys of health care recipients and practitioners (Table 1). Canada and the United States ranked at the bottom of this group of 10 countries. Generally speaking, the cost of the health care system (as a percentage of the country’s Gross Domestic Product) is not related to its ranking.
Table 1: Rank of ten countries for health care perfomance and cost as well as for self-perceived health.
| Country | Performance | Cost | Physical Health | Mental Health |
| Netherlands | 1 | 7 | 8 | 7 |
| United Kingdom | 2 | 8 | 5 | 2 |
| France | 3 | 3 | 9 | 10 |
| Australia | 4 | 9 | 4 | 9 |
| Germany | 5 | 4 | 10 | 8 |
| Switzerland | 6 | 2 | 6 | 3 |
| New Zealand | 7 | 10 | 1 | 5 |
| Sweden | 8 | 5 | 7 | 1 |
| Canada | 9 | 6 | 2 | 6 |
| United States | 10 | 1 | 3 | 4 |
Improving a health care system requires a long term effort. For example, in Canada, key improvements would involve better access to primary care, enhanced coverage for dental and pharmacy expenses and better access to mental health care and home care. The C.D. Howe Institute found that a combination of these initiatives would be necessary to increase Canada’s ranking from a below-average performance. Though new spending and legislation are in place for several of these factors, the roll out will take time and the cost of these initiatives will be put under increasing scrutiny. Improving the performance of the American health care system is a much more daunting task, despite its gold-standard level of care for those with health insurance coverage. I believe it is fair to say that American exceptionalism implies a greater tolerance for inequality, including in health outcomes.
Table 1 also ranks these ten countries on their self-perceived physical and mental health. Here, I used, respectively, questions 2 (general health) and 21 (anxiety or sadness) of the Commonwealth Fund’s 2024 survey of older adults. On average, one third of participants reported excellent or very good health (Q. 2) and 81% reported no difficulty in dealing with anxiety or sadness in the past year (Q.21). Though the anglosphere countries (United Kingdom and their former colonies ) did not perform particularly well in objective measures of health outcomes (e.g. life expectancy, preventable deaths), their seniors are noticeably upbeat about their physical health. The UK and the US also have good rankings for mental health. This may simply be a cultural artifact -stiff upper lip and all that – but it could also reflect the quality of life in these countries. Neither the quality (performance) nor effort (cost) behind the health systems of these countries seems to be driving their self perceptions of health. That, however, is not a reason for giving up on the quest for better health for all.