Grant: Operating Grant

It is not widely known that death rates for many diseases have fallen dramatically in the last 40 years. Canada is doing well but improvements have been outpaced by some other countries (e.g. Australia). The causes of the decline in death rates include both public health (less smoking, less pollution, safer roads) and health care factors (better treatment for many diseases, some screening programs, and improved control of risk factors for heart disease). The separation of public health and health care is artificial and we contend that they should both be viewed as part of the same health system. In view of the importance of premature mortality, you might expect that it would be used as a critical success measure by those monitoring the performance of our health system. Currently, it's not - but we would like to change that. A very detailed file has been created in Ontario that links all the deaths (with causes) for the past 25 years to details about those individuals, including prior health care treatments, economic status, and whether they belong to vulnerable groups in the community. In some cases, we have information from detailed health surveys completed by them. All the data are anonymously linked and held in one secure place. We will carry out detailed analyses of this large file to identify possible reasons for variations in death rates, especially any gaps among vulnerable groups. We have recruited a committee of the most senior health policy makers in Ontario, who will be advised by a panel of leading international experts on mortality. We will present the results of these analyses to health policy makers and ask them to propose some solutions.