Time for a checkup on the health of the average Calgarian. They can expect to live 82.3 years, and if they’re 65 today they can expect to add another 20.9 years to their lifespan. They consider themself pretty healthy and have their immunizations up to date. If they’re a senior, they’ve had their flu shot, too. They have a family doctor, though they’re more likely to go to a hospital emergency room if they want same-day health-care access.
They’re less likely to be obese than the average Albertan or Canadian (but more likely than their peers in Vancouver or Toronto). Most don’t smoke, and they’re more likely than the average Canadian to choose to exercise during their leisure time. They drink a little more than the national or provincial average but not as much as their peers in Northern Alberta. The Canadian Institute for Health Information, which tracks and releases this data, is a little concerned about upward-trending rates of hospitalization caused entirely by alcohol, but rates for Calgarians are not the highest in the province or the country, so things could be worse. And, if the average Calgarian ends up in a hospital, they’ll receive good care with which they’ll likely be satisfied. Plus, they’re unlikely to die of unexpected complications from treatment or sepsis and unlikely to be readmitted.
They’re also pretty into Calgary. They give the city a solid B, reports the Calgary Foundation in its annual Vital Signs report. They feel they know their neighbours well enough to ask them for help, believe they have an opportunity to make a difference, and consider their mental well-being and physical well-being to be quite high.
Pretty good, right? To make it even better, they live in one of the healthiest and wealthiest cities in the world. “Globally speaking, Calgary is a rather healthy city,” says William Ghali, scientific director of the O’Brien Institute for Public Health at the University of Calgary. “Why? Because of education and prosperity. Calgary is a rich city, on a national landscape, and even in the context of the economic downturn, it remains a rather prosperous city.”
But don’t throw that congratulatory party just yet. Let’s pick those numbers apart a little. First, let’s consider that there is no such person, ultimately, as the “average Calgarian.” As the Calgary Foundation’s 2016 Vital Signs report points out, “Our citizens speak over 140 languages and belong to 240 ethnic origins.” In 2011, around a quarter of Calgary’s population were new immigrants and Statistics Canada estimates new immigrants will comprise 40 per cent of Calgary’s population by 2020.
Calgary’s “average” income is well above the national average, even during an economic downturn. However, economic disparity in our city continues to increase, too, says Noel Keough, a professor with the faculty of environmental design at the University of Calgary, and a co-founder of the Sustainable Calgary Society.
Keough and Sustainable Calgary have been tracking Calgary’s social and economic health through its State of the City reports since 1998. “[Income] inequality in the city has been growing over that period of time,” Keough says. “Calgary is now noted as one of the most unequal cities in the country.”
According to a recently released study by the Chartered Professional Accountants of Canada, Calgary’s income inequality is four times higher than the Canadian average. That doesn’t mean just that the gap between Calgary’s wealthiest and poorest is large (that goes without saying). What’s more troubling, as a 2016 Statistics Canada report on Canadian income disparity highlights, is the widening gap between the uber-wealthy and the average Calgarian. The city’s richest one per cent earns 11 times as much as the city’s median earners. That’s almost double the six-to-one spread between the top one per cent and the median income Calgary reported in 1982.
This matters as a health issue because, on average, a wealthy city is a healthy city. But if the wealth isn’t evenly distributed, neither is the health. Wealth, or, to be more academic about it, socio-economic status, has a huge impact on physical and mental health and overall well-being. The research is pretty much unanimous: “The biggest determinants of poor health are lack of stable housing, lack of food security and social isolation,” says Ghali. In other words, the poorer you are, the worse your health, from daily quality of life through to your life expectancy.
“We know that the social determinants of health, such as stable housing, social capital and social support, education, access to healthy food, experiences of racism and discrimination … those sorts of things determine the health of a population far more than access to hospitals and systems of health care,” says Dr. Gabriel Fabreau. An internal medicine physician at the Peter Lougheed Hospital, co-founder of the East Calgary Health Centre and assistant professor at the U of C’s Cumming School of Medicine, Fabreau is deeply involved with Calgary’s most vulnerable populations. His major research project, CUPS Coordinated Care Team (CUPS CCT), a partnership between CUPS (Calgary Urban Project Society) and Alpha House‘s Downtown Outreach Addictions Partnership team, is focused on the health needs of Calgarians struggling with addiction and homelessness.
Fabreau also works with Calgary’s Mosaic Refugee Health Clinic, as does Tanvir Turin Chowdhury, research director and assistant professor with the faculty of medicine at the U of C. The Mosaic Refugee clinic is part of the Mosaic Primary Care Network, an arrangement between a group of family doctors and Alberta Health Services to provide primary-care services to patients living in the northeast, southeast and some northwest Calgary communities, which include some of Calgary’s poorer neighbourhoods and are home to a disproportionate number of Calgary’s vulnerable citizens. The refugee clinic, now considered one of the best refugee clinics in the country, supports the unique health needs of refugees. Just as importantly, it engages in ongoing dialogues with physicians and other service providers and stakeholders in the city to educate them (and learn from them) about how to best serve violently transplanted citizens who, apart from culture shock, may be suffering from a level of trauma outside the experience of an average Calgary doctor or city employee.
“Refugees are different from conventional immigrants,” says Chowdhury. “They didn’t really choose to come here. They need unique supports to become integrated, flourishing and contributing citizens of our city.”
And they can’t be expected to find those supports on their own, so part of Chowdhury’s work is creating maps of “assets” – services and resources that both clinic clients and their service providers can utilize. People can’t access services they don’t know about, and even when services exist and people know about them, they still need help connecting with them.
The same holds true for people in need of support for mental health. The Calgary Foundation’s Vital Signs 2016 report has 77 per cent of Calgarians rating their mental well-being as high, and 80 per cent giving their physical well-being a thumbs up. The spike in suicide rates that Alberta, including Calgary Zone, experienced in 2015 has receded to a level that could be considered “normal.”
Of course, what those Vital Signs numbers also reveal is that more than 20 per cent of Calgarians aren’t so sanguine about the state of their mental health.
Sadly, there’s nothing surprising about that statistic. According to the Canadian Institute for Mental Health, one in five Canadians will experience a mental-health episode a year. Callum Ross, the Advocacy Lead with the Calgary branch of CIMH, really wants to drive that point home. “That’s one in five Calgarians a year going through some tough mental-health stuff,” he says. “That’s more than 200,000 people in this city, every year, needing mental-health support.”
There are not sufficient dollars in any government’s coffers to provide support for that many struggling people. “We’ve created this situation where we’ve done a really good job of telling people to ask for help,” Ross says. “We’ve done a lot of good work around removing the stigma of mental health, especially among younger people. If they feel they need help, they ask for it.”
And then they get put on a waiting list. Getting mental-health help through Alberta Health Services can be a gruelling process, especially for someone in crisis, involving jumping through myriad bureaucratic hoops.
“When I finally managed to talk to my doctor about my depression and got a referral from her to AHS, my first contact with AHS was this horrible form letter that sounded almost threatening to me,” says one of those 23 per cent of Calgarians who does not report good mental health and spoke on the condition of anonymity. It took tremendous effort to persevere and take the next step, she says. She’s now on a waiting list to get help and, in the meantime, is left to cope with her depression without support from the system.
When the road to help from the system is long, what fills the gap is community. Friends. Family. Neighbours.
According to the Calgary Foundation, 60 per cent of Calgarians feel they know their neighbours. But that also means that 40 per cent of Calgarians don’t feel they have that connection. According to Ross, community and connection are a critical part of well-being. International studies bear them out pretty much unanimously, and not just on the mental-health front – the more connected you feel to other people, the healthier (and likely the happier) you are.
The more connected you are, the more resilient you are in the face of adversity, too, says Ross.
Now, Calgary is a damn resilient city. We even have a recent award to prove it: the Rockefeller Foundation named us one of the world’s 100 resilient cities in 2016. “One trend that has remained consistent [over the decade of our Vital Signs reports] is our city’s sense of optimism and resiliency,” says Taylor Barrie, director of communications with the Calgary Foundation.
But, again, that resilience, and the better health it brings, isn’t equitably distributed. Barrie is blunt: “The gap between rich and poor is ever-widening and poverty reduction remains a big issue in our community.”
It’s important to note that the gap between the rich and poor in Calgary isn’t just related to the neighbourhood one can afford to live in or what kind of car one drives. It’s related, directly, to how long one lives. University of Calgary studies on longevity in Calgary communities have identified a difference of 10 years in life expectancy between Calgary’s lowest-income and highest-income communities. (It could be worse: in Winnipeg, the difference between life expectancy in its troubled city core communities and affluent suburbs is a whopping 18 years.)
ILLUSTRATION BY CELIA KRAMPIEN
Community design also has a significant bearing on health. Gavin McCormack, a population and public health researcher, and associate professor in the Cumming School of Medicine at the U of C is among the researchers who study the relationship between urban design and physical activity. “Our research shows that regardless of your socio-economic status, living in a walkable neighbourhood is good for your health,” McCormack says. “Where you live and the environment in which you live have an impact on physical activity, and also it can have an impact on outcomes such as the amount of time you spend watching TV or using screens in your leisure time” (and, yes, also on your weight).
Plug socio-economic status into that equation, though, and something scary happens: the health of people in poor neighbourhoods with low walkability is much worse than the health of people in affluent neighbourhoods with low walkability. “It’s a double whammy in a sense,” says McCormack.
Implications for policy makers and neighbourhood developers are clear: if you want healthy citizens, build walkable neighbourhoods. But the most walkable neighbourhood is no good to you if you can’t afford to live there, and affordable housing remains a troubling issue in Calgary.
“The way it is right now, housing is almost entirely within the private market and that suits most people quite well,” says Lindsay McLaren, associate professor at the Department of Community Health Sciences at the U of C, as well as chair in Applied Public Health with Canadian Institutes of Health Research, the Public Health Agency of Canada and Alberta Innovates Health Solutions. “And then, there’s a very, very tiny social-housing sector that sort of helps some people.
“Then, there’s that group of people in the middle who are precariously housed.”
This “precariously housed” group of Calgarians (sometimes described as employed but struggling), spends a disproportionate percentage of their income on housing. Providing them with housing security, says McLaren, is a complex task that requires the support of all three levels of government: municipal, provincial and federal. In November 2016, Prime Minister Justin Trudeau announced consultations on a national housing strategy, something McLaren notes Canada hasn’t had since 1993. McLaren is hopeful Calgary will see progress on this front. “The City of Calgary has an affordable housing strategy and there is potential here for alignment with the other levels of government,” she says.
Food security – and we’re not talking about reliable access to food banks for the most vulnerable – is as important to health as housing security. Keough and McCormack’s research illustrates that proximity to “utilitarian destinations,” such as grocery stores, correlates with people’s health. In other words, the harder it is to get to your local Safeway, Co-op, or Superstore to get fruit and veg and the easier it is to swing by McDonald’s or call for pizza delivery, the worse you’ll eat – and the worse your health.
But there’s more to the relationship between health and food than just proximity. You can live really close to grocery stores and eat only junk food. Charlene Elliott studies food marketing, packaging and policy in Canada, with a specific focus on children’s health, and is involved in several projects related to Health Canada that are designed to help Canadians make better food choices. A key focus of that endeavour is improving food literacy across generations.
“Healthy cities need to have a food-literate population,” Elliott says. “That means people who are able to critically understand packaging and marketing and nutrition claims, and differentiate between facts and advertising.”
“Food literacy” research is pretty nascent, but it’s already shown that food literacy is closely correlated with socio-economic status, that key social determinant of health.
ILLUSTRATION BY CELIA KRAMPIEN
When you start talking about health, everything is connected.
The Canadian Institution for Health Information (CIHI) does not collect data on art, but the Calgary Foundation does, and Calgarians consistently give the city a “B” grade on its art performance. The average Calgarian’s relationship with art is, well, average. They like, for the most part, knowing that it’s there. They’d just rather not pay for it or fund it through tax dollars. But art is one of the critical ways that people in a city foster meaningful connections with each other, says Marc Scholes, the former executive director of continuing education and enterprise at the Alberta College of Art + Design.
Scholes is the producer of “An Art-Enabled Life,” a collaboration between ACAD and the Calgary Board of Education, funded by the Calgary Foundation with support from the Calgary Arts Development Authority, which aims to open up people’s understanding of the huge capacity the arts have to enrich our lives. “We come together in a city for a lot of reasons and most of them are economic,” Scholes says. “But once we’re in the city, we realize we need to connect. We need meaningful connections with each other and that’s what the arts do. We know there’s more to being a human being than meeting our material needs.”
We also know that there’s more to health than absence of disease, but that makes defining and improving the health of a city a truly Herculean task.
The good news, though, especially for the fiscally conservative, is that throwing more money at the health-care system is not the way to build a healthier city. Calgary and Alberta already have one of the highest-costing health-care systems in the country. The average cost for a hospital stay in Canada in 2015 was $6,098. In Alberta it was $8,007. In Calgary, it was $8,233. Both numbers have also been trending upward and at a faster pace than the Canadian average.
“One of the broadest and most difficult problems we face is the ongoing overreliance on emergency departments for our population at large,” Fabreau says. “This is completely unsustainable. We really need to be building coordinated models of care that work upstream and improve patient care and outpatient services so that we can reduce the burden on our hospitals.”
The solution isn’t to increase health spending, it’s to increase health literacy. Health literacy goes hand-in-hand with education and improving socio-economic status. Make your people wealthier, more educated and less vulnerable and they will use the services you offer in a smarter, more cost-effective manner.
While making people wealthier – or at least less poor – during an economic downturn may seem impossible, making them less vulnerable starts with getting them more connected to both each other and to all the services our city offers. “A healthy city for me is a city that meets the needs of its people, and not just economic needs and safety needs,” says Scholes. “It’s an emotionally connected city that fosters relationships between communities and across age groups. It’s a city in which everyone has the means to become the best people we can become.”
Such a city doesn’t just happen. Nor is it engineered overnight. And it does require work, and financial investment by municipal, provincial and federal governments, as well as support and advocacy from organizations such as the Calgary Foundation and Sustainable Calgary. And buy-in from citizens who value each other’s well-being.
We got this, Calgary. Right?
Prescription to Improve Your Health
Get a family doctor. Now. News of a doctor shortage in Calgary is outdated. We have plenty, and they’re easy to find through calgaryareadocs.com. Use your family doctor’s office, and not the emergency department, as the default go-to for managing your health. Emergency hospital care is for emergencies, not for getting a prescription for your cough. Not sure whether it’s an emergency? Call Healthlink at 8-1-1.
Get some friends. Not on Facebook – in real life. The studies are unanimous: connected people are happier and healthier. Don’t know your neighbours? Knock on their doors and meet them. Hate your neighbours? Go on meetup.com and type your city and hobby into its search engine. Go to your next community association meeting. Call a friend you haven’t seen for a while and make plans to go for coffee.
Get out and go for a walk. You do not need skis or a gym membership to get active. Walk around your neighbourhood. Walk to the bus stop, the LRT, the grocery store. Walk to your friend’s house. Trouble motivating yourself to get out? Get a dog. Research shows dog owners walk more, no matter how unwalkable their neighbourhood is.
Eat good food. It doesn’t have to be expensive. It’s as simple as buying more fruit and veggies and not buying three-for-the-price-of-one bags of Doritos. Truly strapped for cash? Check out the Community Kitchen Program of Calgary’s Good Food Box program (ckpcalgary.ca) and the offerings at the Alex Community Food Centre (thealexcfc.ca).
Be the change you want to see in your city. Concerned about the health of your neighbours? Cook them a meal. Invite them out for a walk. Help them find a family doctor. Want the city to be a more welcoming place for newcomers? Volunteer with one of the many organizations that work on this – Calgary Catholic Immigration Society (ccisab.ca) is a good start, regardless of your religion. Got food security on your mind? Check out the Alex Community Food Centre or foodsecurityalberta.org.