Health SystemsNorthern Canada
Defining the Canadian North
Indigenous communities have long defined the northern regions according to their cultural connections and land claims. For example, the Inuit refer to their traditional homeland as Inuit Nunangat, which spans across two territories, two provinces, and beyond. Determining geographically or administratively what constitutes “the North” in Canada has been contested for decades. While geographical attributes such as the tree line and continuous permafrost are important, such markers are not helpful in discussions of inter-regional health disparities, as health statistics are usually aggregated by political and administrative divisions.
Yukon, NWT and Nunavut are considered the “territorial North”, while the “provincial North” encompasses northern sub-regions of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Québec, and Newfoundland and Labrador. The two “Norths” share many characteristics but are also distinct, especially in their constitutional status within the Canadian federation, which affects how public services – including healthcare – are organized, financed, and delivered.
Selection of Northern Regions
Each of Canada’s three northern territories can be considered a “region”, while in the provinces, regions are defined by different government bodies for program administration and strategic planning purposes, such as in economic development. For healthcare, the existence of regional health authorities (RHAs) and equivalent provide ready-made “health regions”. Beginning in the 2000s, Statistics Canada (Statcan) began presenting health data by “Health Regions”. Full documentation, maps, and legislation relevant to the health regions are available from Statcan.
Our 18 northern health regions are based on 2018 boundaries defined by Statcan, as well as their inclusion in one of Statcan’s four “peer groups”, which identify sociodemographic characteristics deemed to be determinants of population health status but intentionally not based on health outcome indicators. With boundary changes over the years, the regions themselves and their peer group classification has been revised periodically.
Health System Performance Framework
Our framework for monitoring and assessing health system performance was developed by the Canadian Institute for Health Information (CIHI). It provides a unifying pan-Canadian perspective that acknowledges the specific health strategies of the provinces and territories. The framework comprises four interrelated quadrants:
- social determinants of health
- health system inputs and characteristics
- health system outputs
- health system outcomes
Within each quadrant are performance dimensions, applicable to political, cultural, demographic, and economic contexts.
Indicators are based on broad groupings of disease conditions or reasons for hospitalizations. A complete list of selected indicators with their definitions, units, and sources, is available on the observatory website. For each indicator, we provided single-year values from 2010 to the most recently available year as well as the mean value for the five-year period of 2010-14. For census-based indicators, we computed the mean of the 2011 and 2016 censuses. Earlier trend data were not consistently available due to boundary changes over time. The list of indicators will be expanded in the future, and new data will be added as they become available from Statcan and CIHI.
The north is not all the same: comparing health system performance in 18 northern regions of Canada, International Journal of Circumpolar Health
Health System Performance in Yukon Compared to Northern Canada, NAO Rapid Review