| PREFACE | 5 | |
| INTRODUCTION | 8 | |
| 1. | THE TRADITIONAL VIEW OF THE HEALTHFIELD | 11 |
| 2. | THE LIMITATIONS OF THE TRADITIONAL VIEW | 13 |
| 3. | MAJOR PROBLEM AREAS IN THE HEALTH FIELD | 19 |
| HEALTH STATUS OF THE POPULATION | 19 | |
| PROBLEMS IN THE ORGANIZATION AND DELIVERY OF HEALTH CARE | 26 | |
| 4. | THE HEALTH FIELD CONCEPT | 31 |
| 5. | ISSUES ARISING FROM THE USE OFTHE HEALTH FIELD CONCEPT | 35 |
| 6. | POPULATIONS AT RISK | 38 |
| 7. | CONSTITUTIONAL POWERS AND THE PRESENT FEDERALROLE | 43 |
| 8. | RESEARCH AND THE HEALTH FIELD CONCEPT | 55 |
| 9. | SCIENCE VERSUS HEALTH PROMOTION | 57 |
| 10. | CARE VERSUS CURE | 59 |
| 11. | MENTAL HEALTH | 61 |
| 12. | THE HEALTH FIELD CONCEPT AND STRATEGIES FOR THE FUTURE | 63 |
| CONCLUSION | ||
| REFERENCES | ||
| ANNEX A |
William Paley, in Natural Theology wrote:
ウィリアム・ペーリーは自然神学において、このように書き記した。
“Nightly rest and daily bread, the ordinary use of our limbs, and senses, and understandings, are gifts which admit of no comparison with any other.”1
「夜の眠りと日々のパン。四肢、意識、理性の営み。これらは、神からの贈り物のなかでも、最上のものである」1
It is these gifts which health and welfare policies seek to ensure for as many Canadians as possible.
保健と福祉政策は、可能な限り多くのカナダ人のために、これらの贈り物を確保するためにある。
Complete well-being for all may be beyond our grasp, given the human condition, but much more can be done to increase freedom from disease and disability, as well as to promote a state of well-being sufficient to perform at adequate levels of physical, mental and social activity, taking age into account.
人間の状況を考えると、すべての人にとっての完全なる快適な暮らしは、私たちの範疇ではないが、疾病や能力低下から自由であるために、また、適切な身体、精神、社会活動の水準を維持するのに充分な快適な暮らしを守るためにできることは、たくさんある。
Most Canadians by far prefer good health to illness, and a long life to a short one but, while individuals are prepared to sacrifice a certain amount of immediate pleasure in order to stay healthy, they are not prepared to forego all self-indulgence nor to tolerate all in convenience in the interest of preventing illness.
多くのカナダ人は、疾病よりも健康を、短命よりも長寿を望んでいる。個人は健康であるために、ある程度の刹那な喜びに犠牲を払う用意がある。その一方で、
病気を予防するためにわがままに先立つ用意は無く、また便利さを耐え忍ぶ準備も無い。
The behaviour of many people also reflects their individual belief that statistical probability, when it is bad, applies only to others.
多くの人々の行動は、統計的確率の分が悪ければ、他のものを選ぶ、という、個人の信条を反映している。
This belief is the comfort of soldiers at war, criminals and racing drivers, none of whom could sustain their activities did they not look on the sunny side of risk and probability.
この信条は、
It is also the solace of those whose living habits increase the likelihood of sickness, accidents and early death.
Yet, when sickness strikes, the patient expects rapid, quality care; allavailable resourcesmustbemarshalledonhisorherbehalfwithlittleregardforcost.
Theforegoingattitudes, beliefs and expectations are basic to an understanding of how the health field has developed in Canada.
They explain why Canadians are prepared to spend such a large part of the irnational income on personal health care services, while to lerating environmental and lifestyle hazards which contribute heavily to the frequency of sickness and death.
1. Paley, William, Natural Theology, R. Faulder, London, 1802, republished by Gregg International Publishers, Farnborough, England, 1970 - p. 498.
1. ウィリアム・パーリー, 自然神学, R. Faulder, London, 1802, republished by Gregg International Publishers, Farnborough, England, 1970 - p. 498.
One of the purposes of this Working Paper, nevertheless, is to show the links between different kinds of mortality and illness on the one hand and their underlying causes on the other.
Only when these links are known will it be possible to make judgments on whether certain risks are worth taking or certain sacrifices are worth making.
These judgments must be made by individuals in respect of their own living habits, by society in respect of the values it holds, and by governments in respect of both the funds they allocate to the preservation of health and the restrictions they impose on the population for whose well-being they are responsible.
Ultimately, it is to help in making those judgments that this Working Paper has been written.
The traditional or generally-accepted view of the health field is that the art or science of medicine has been the fount from which all improvements in health have flowed, and popular belief equates the level of health with the quality of medicine.
従来の、あるいは常識的な医療領域の視点では、医術あるいは医学が健康の湧き出る源泉であった。そしてそのよく知られた信仰は、健康水準と医療の品質を同一視していた。
Public health and individual care, provided by the public health physician, the medical practitioner, the nurse and the acute treatment hospital, have been widely-regarded as responsible for improvements in health status.
公衆衛生医師、開業医、看護師、急性期治療病院により提供される公衆衛生と個人治療が、健康状態の改善をもたらしているとは、広く受け入れられているところである。
Individual health care, in particular, has had a dominant position, and expenditures have generally been directed at improving its quality and accessibility.
とりわけ個人医療は支配的地位を占めており、また、一般に医療費は個人医療の品質と近接性の改善に利用されている。
The success of the Canadian personal health care system, particularly in the treatment of disease, is unquestioned, and the demand by the Canadian people for more and better personal health care continues unabated.
カナダの個人医療制度の、とりわけ疾病の治療における成功は、疑いの無いところである。そしてカナダ人はより多くの、より優れた個人医療を要求しており、それは止まるところを知らなかった。
Preventive medicine, as exemplified by immunization, has practically eliminated such scourges as smallpox, diphtheria and poliomyelitis, and advanced surgical procedures save thousands more lives annually than they did thirty years ago.
例えば予防接種といった予防医学は、天然痘、ジフテリア、小児麻痺のような疫病を [開発途上国に] 押し込めた。また、高度な外科的処置は30年前から年間数千の生命を救ってきた。
Graduates of Canadian medical colleges and of post-graduate specialty training are the equal of any in the world and Canadian hospitals have a general high level of service and equipment that matches that of any other country.
カナダの医科大学の卒業生と卒後専門医訓練の修了生は、世界においても遜色はない。またカナダの病院は、他のどの国にも敵う高度な医療と設備を提供している。
In both numbers and skills the members of the Canadian nursing profession generally provide the finest of nursing care.
カナダの看護師は、数と技能の両方において、優れた看護を提供する。
Taken as a whole, then, the amount, quality and method of financing health care in Canada, while still improvable, is one to be envied.
その結果、全体としてみると、カナダにおける医療会計の量、質、方法は、改善の余地はあるものの、羨望のまとである。
In most minds the health field and the personal medical care system are synonymous.
多くの人々は、医療領域と個人医療制度を同意義ととらえている。
This has been due in large part to the powerful image projected by medicine of its role in the control of infective and parasitic diseases, the advances in surgery, the lowered infant mortality rate and the development of new drugs.
これは、感染性疾病、外科手術の発展、低体重児死亡率、新薬開発における、医学の役割により投影された強迫観念によるところが大きい。
This image is reinforced by drug advertising, by television series with the physician as hero, and by the faith bordering on awe by which many Canadians relate to their physicians.
この強迫観念は、薬品広告、医師が英雄として活躍する遠隔映像連続放送、多くのカナダ人が医師へ抱く畏敬に縁取りされた信頼により、凝り固まっている。
The consequence of the traditional view is that most direct expenditures on health are physician-centered, including medical care, hospital care, laboratory tests and prescription drugs.
従来の視点のもたらしたものは、治療、病院治療、臨床検査、処方薬からなる直接医療費のほとんどの、医師への集中である。
When one adds dental care and the services of such other professions as optometrists and chiropractors, one finds that close to seven billion dollars a year are spent on a personal health care system which is mainly oriented to treating existing illness.
歯科治療と検眼士や脊椎指圧療法師といったその他の専門家の医療を加えると、年間$70億近くが、既存の疾病の治療を指向する個人医療制度に費やされている。
[さりげなくProblem Oriented Medicine疾病指向型医療を一蹴しているあたりに、ラロンド・レポートの時代の先取り具合が読み取れます]
There are two approaches which can be taken to assess the influence of various factors on the general level of illness.
疾病の水準に影響をもたらす要因の評価方法には、2つの手法がある
One is by analysing the past and determining the extent to which various influences have contributed, over the years, to changes in the nature and incidence of sickness and death.
1つは過去を分析し、疾病と死亡の性質と発生率の変化させる要因を決定する手法である。
A second approach is to take present statistics on illness and death and to ascertain their
underlying causes.
もう1つは、疾病と死亡についての現在の統計を考察し、根本にある原因を確かめる手法である。
The historical approach is most clearly expressed by Dr. Thomas McKeown, Professor of Social Medicine at the University of Birmingham Medical School.2
第1の手法である歴史手法は、主にトマス・マキューンにより明示された。2
Dr. McKeown traces the level of health in England and Wales back to the eighteenth century, and evaluates the effect of the several influences on the health level.
マキューンは、イングランドとウェールズの健康水準を18世紀から追跡し、健康水準に影響をもたらす要因の影響力を評価した。
His conclusions are:
マキューンの結論は、以下の通りである。
“that, in order of importance the major contributions to improvement in health in England and Wales were from limitation of family size (a behavioural change), increase in food supplies and a healthier physical environment (environmental influences), and specific preventive and therapeutic measures”3
「イングランドとウェールズにおける健康の改善への寄与要因は、家族の少人数化（行動の変化）、食品供給の増加、健康的物理環境（環境の影響）、そして特異的予防、治療である」3
and
そして
“Past improvement has been due mainly to modification of behaviour and changes in the environment and it is to these same influences that we must look particularly for further advance”.4
「過去の健康の改善は、行動変容と環境の変化によるところが大きく、さらなる改善のために目を向けるべきは、これらの要因である」4
These conclusions, drawn from an analysis of the history of the level of health of the population, are not surprising when one recalls the progress in income security, in education and in protection from public health hazards during the past century.
旧世紀の所得保障、教育、公衆衛生の危機、そしてその改善を思い返せば、集団の健康水準の歴史的分析から導かれたこの結論は、驚くには値しない。
The second approach is to examine the nature and underlying causes of present mortality and hospital morbidity in Canada.
第2の手法は、カナダにおける現在の死亡率と病院死亡率の性質と根本にある原因を評価する方法である。
2. McKeown, Thomas, A Historical Appraisal of the Medical Task from“Medical History and Medical Care”. Oxford University Press. 1971.
2. トマス・マキューン 「医療史と医療（1971）」より医療の歴史的批判
3. McKeown, Thomas, The Major Influences on Man’s Health, unpublished paper, August, 1973.
3. トマス・マキューン、人類の健康に影響をもたらす要因（未発表、1973）
4. McKeown, Thomas, An Interpretation of the Modern Rise in Population in Europe, Population Studies, Vol. XXVII, No. 3, p. 345, November 1972.
4. トマス・マキューン、西欧における現代の人口増加の解釈（1972）
Looking first at mortality it was found that overall statistics on causes of death are dominated by deaths over age seventy.
まず、死亡率に目を向けると、死亡原因のすべての統計は70歳以上に強く出ている。
Since more than 50% of deaths in 1971 occurred beyond age seventy, the causes of death in old age have an overwhelming impact on total figures and thus obscure the relative significance of the deaths that come before their time.
1971年の死亡の50%以上が70代以上に生じており、高齢者の死亡の原因は、総計に絶大な影響を及ぼしている。つまり、高齢になる前の死亡の相対的意義は、よくわからない。
It is the early deaths that reflect adversely on the health status of Canadians, as far as mortality is concerned, and they can be properly assessed only if they are separated from overall mortality statistics.
早世はカナダ人の健康状態、死亡率に負の影響を与える。そして早世は、総死亡統計とは分けて考えなければ、適切な評価はできない。
All of the following figures reflect Canada’s experience in 1971 when there were 157,300 deaths recorded from all causes, of which 75,200 came before age seventy.
以下のすべての数字は、15万7300の死亡を記録し、7万5200が70代以前に死亡した1971年の経験を反映している。
These early deaths are the ones which were analysed.
これらの早世を分析した。
Of the 75,200 early deaths, 7,600 or roughly 10% occurred before age five.
7万5200の早世のうち、約10%である7600は5歳以前に亡くなっていた。
Of these, 1,500 were due to congenital anomalies, and 3,300 more were due to other conditions which caused death shortly after birth.
7600の早世のうち、1500は先天異常であり、3300は生後まもなくの死亡であった。
Given that the present high level of obstetrical and neo-natal service can be maintained, it is generally conceded that early prenatal care, along with the early identification of high-risk pregnancies, is the principal means by which the infant mortality rate can be further lowered.
現在の高度な産科・新生児医療が維持されうることを考えれば、ハイ・リスクな妊娠の早期同定と一緒に出生前医療が、乳児死亡率を低減させる第一の手法であることが、一般に認められる。
It is also true that economically-deprived segments of the population, including its native peoples, contribute disproportionately to the infant mortality rate in Canada.
先住民を含む経済的搾取を受ける人たちが、カナダの乳児死亡率に過度に寄与するというのも真実である。
[言い草は色々あるものよ...]
It is also true that the importance of early pre-natal care is recognized more by the relatively affluent levels of society than by the under-privileged.
早期出生前医療の重要性は、社会の恵まれない人々よりも、比較的裕福な水準の人々の方が、よりよく理解しているというのも、真実である。
Finally, it is true that universal pre-paid health care has practically eliminated any financial barrier between a pregnant woman and the prenatal care she should receive.
最後に、一般的な前払い医療は事実上、妊婦と彼女が受けるべき妊婦管理の間にあるあらゆる財政的障壁を排除する、というのも、真実である。
All these conditions lead to the conclusion that economic circumstances, health education, attitudes and facility of physical access to health care, as well as improved pre-natal care, are the principal factors to be considered in lowering the rate of infant mortality.
これらの状況は、改善された出生前医療と同様に、経済的環境、保健教育、態度、医療の物理的な入手の容易さも、乳児死亡率の低下における主な要因である、という結論を導く。
In brief, environment and self-imposed risks, including attitudes, are the main influences by which infant mortality rates can be further improved.
つまり、環境と、態度を含む自主リスクは、乳児死亡率のさらなる改善に、大きな影響をもたらす。
From age five to age thirty-five, the principal cause of death is motorvehicle accidents, the second most important cause is other accidents and the third is suicide.
5歳から35歳まで、死亡の第1要因は、自動車事故である。第2要因は、その他の事故であり、第3要因は自殺である。
These three, taken together, account for 6,200 of the 9,700 deaths for the group aged five to thirty-five.
これらの3つで、5-35歳の死亡9700のうちの6200が説明される。
Since all these causes of death are mainly due to human factors, including carelessness, impaired driving, despair and self-imposed risks, it is evident that changes in these factors are needed if the rates of death are to be lowered.
これらの死亡要因は主に、不注意や飲酒運転、失望、自主リスクからなる、人的要因であるため、死亡率を低下させるには、これらの要因を変化させることが必要である。
At age thirty-five, coronary-artery disease first appears as a significant (over 5%) cause of death.
35歳では、冠動脈疾病が、死因（の5%）として浮上する。
By age forty it becomes the principal cause and holds this position in increasing ascendancy through all subsequent age groups.
40歳まででは、冠動脈疾病は第一の死因となり、続くすべての世代において優位な位置を占めている。
For the age group thirty-five to seventy, diseases of the cardio-vascular system accounted for 25,700 deaths out of a total of 58,000.
35歳から70歳では、心臓血管疾病は、5万8000のうちの2万5700を占める。
While the causes of circulatory diseases are various, there is little doubt that obesity, smoking, stress, lack of exercise and high-fat diets, in combination, make adominant contribution.
循環器疾病の要因はさまざまであるが、肥満、喫煙、ストレス、運動不足、高脂肪の食事、そしてその組み合わせが、主な寄与要因であることに、疑いは無い。
All of these are due to environmental conditions and self-imposed risks.
これらのすべては、環境と自主的な不確実性による。
At age fifty, these condmost important cause of death in menis cancer of the larynx, trachea, bronchus or lung.
50歳では、咽頭、気管、気管支、肺のがんによる死が、重要な要因となる。
These accounted for 3,600 deaths, male and female, between forty and seventy.
40歳から70歳の間の男女の死亡の3600に値する。
Bronchitis, emphysema and asthma,in this age group, accounted for another 1,400 deaths.
この年代における気管支炎、肺気腫、喘息は、1400の死をもたらす。
For these 5,000 deaths, cigarette smoking is a major contributing factor.
あわせて5000の死の主な寄与要因は、喫煙である。
Once more the root cause is found in a self-imposed risk.
その根本的な原因は、自主リスクにある。
[root cause、underlying cause、cause of causeは、1998年以降はdeterminantsという概念として統合されています]
In order to ascertain and measure the principal causes of early death, calculations have been made of the years of potential life lost by each cause, measured against a life expectancy of seventy and eliminating causes of infant mortality.
早世の第一原因を解明し評価するために、それぞれの原因の、乳児死亡率の影響を排除した、70代の平均余命に対する潜在的生命喪失年数を計算した。
Years lost due to early death for the five main causes, by this definition, were as follows for 1971:
この定義に従うと、1971年に5つの原因の早世により失われた寿命は、以下の通りである。
| Cause 原因 | Total Years Lost 失われた寿命 |
| Motor Vehicle Accidents 交通事故 | 213,000 |
| Ischaemic Heart Disease 虚血性心疾病 | 193,000 |
| All Other Accidents その他の事故 | 179,000 |
| Respiratory Diseases and Lung Cancer 呼吸器疾病と肺ガン | 140,000 |
| Suicide 自殺 | 69,000 |
It will be noted that self-imposed risks and the environment are the principal or important underlying factors in each of the five major causes of death between age one and age seventy, and one can only conclude that, unless the environment is changed and these lf-imposed risks are reduced, the death rates will not be significantly improved.
自主的なリスクと環境は、1歳から70歳までの5大死亡原因それぞれの根本的原因である。環境が変わらなければ、そして自主的なリスクが削減されなければ、死亡率は改善しない。
Mortality rates are not the only indicators of health, so a similar analysis was made of hospital morbidity, i.e. those illnesses which required hospitalization.
発生率は健康の指標である。そして、似たような分析は病院発生率、すなわち入院の必要な疾病にもなされる。
For analytical purposes, morbidity can be classified under three headings:
分析的目的のために、発生率は3つの頭突きに分類される。
1. hospital morbidity, defined as sickness requiring hospitalization
1. 病院発生率。入院の必要な疾病として定義される。
2. non-hospital morbidity for which treatment was given but outside the hospital
2. 非病院発生率。病院の外で治療される。
3. untreated morbidity, sickness which was self-treated or self-limiting, or undetected morbidity.
3. 無治療発生率。自己医療や自然治癒する疾病。検出不能な発生率。
[self-limitingは治療をしないでも長期的には症状が落ち着いたり収まる性質のあるという形容詞。「自己限定的」と訳されるが、ここでは分かりやすく「自然治癒」としています]
The only available morbidity statistics in Canada, i.e. those who required hospitalization, were examined.
カナダで利用可能な発生率の統計は、入院で必要となる人々の統計のみである。
For this analysis, hospitalization due to uncomplicated deliveries of babies was set aside on the premise that this is not sickness so much as a normal part of life.
この分析では、新生児の複雑ではない出産のため入院は、人生の一部であり疾病ではないため、除外した。
Diseases of the cardio-vascular system were by far the principal cause of hospitalization as measured by the number of hospital days, accounting for 7,600,000 hospital days out of a total of 38,600,000 in 1970, in acute general hospitals.
心臓血管系の疾病は、入院日数評価すると、入院の第一の原因である。1970年の緊急総合病院の合計3860万日のうち760万日を占める。
Fractures, head injuries, burns and all other causes arising from accidents and violence accounted for 3,100,000 hospital days.
事故や暴力による骨折、頭部受傷、火傷、その他の原因は、310万日である。
For these causes of hospitalization, individual behaviour and carelessness are the principal or important underlying factors.
これらの入院の原因のため、個人の行動と不注意は、第一あるいは重要な根本にある原因である。
Mental illness accounted for 2,200,000 hospital days in acute general hospitals but it also accounted for 21,200,000 patient days in psychiatric institutions in 1970.
精神疾病は1970年の緊急総合病院の入院の220万日を占めているが、精神疾病の施設ではその他に2120万日の入院がある。
The effect of self-imposed risks on these and other kinds of sickness, as well as on mortality figures, is reflected in the following grisly litany of the more destructive lifestyle habits and their consequences:
以下の破壊的な生活様式の身の毛もよだつ連祷とその帰結は、自主リスクの疾病や発生率に影響をもたらす。
(a) alcohol addiction: leading to cirrhosis of the liver, encephalopathy and malnutrition,
(a) アルコール依存: 肝硬変や脳障害、栄養失調をもたらす
(b) social excess of alcohol: leading to motor vehicle accidents and obesity,
(b) 社会的な過剰摂酒: 交通事故と肥満をもたらす
(c) cigarette smoking: causing chronic bronchitis, emphysema and cancer of the lung, and aggravating coronary-artery disease,
(c) 喫煙: 慢性気管支炎、肺気腫、肺ガン、冠状動脈疾病の悪化をもたらす
(d) abuse of pharmaceuticals: leading to drug dependence and drug reactions,
(d) 医薬品の乱用: 薬物依存と薬物反応をもたらす
(e) addiction to psychotropic drugs: leading to suicide, homicide, malnutrition and accidents,
(e) 向精神薬への依存: 自殺、殺人、栄養失調、事故をもたらす
(f) social use of psychotropic drugs: leading to social withdrawal and acute anxiety attacks.
(f) 向精神薬の社会的利用: 社会からの脱退、急性不安発作をもたらす
(a) over-eating: leading to obesity and its consequences,
(a) 過食: 肥満とその帰結をもたらす
(b) high-fat intake: possibly contributing to atherosclerosis and coronary-artery disease,
(b) 脂肪の過剰摂取: 粥状動脈硬化と冠動脈疾病に寄与するかもしれない
(c) high carbohydrate intake: contributing to dental caries,
(c) 炭水化物の過剰摂取: 齲蝕に寄与する
(d) fad diets: leading to malnutrition,
(d) 気まぐれダイエット: 栄養失調をもたらす
(e) lack of exercise: aggravating coronary-artery disease, leading to obesity and causing lack of physical fitness,
(e) 運動不足: 冠動脈疾病を悪化させ、肥満をもたらし、体力低下をもたらす
(f) malnutrition: leading to numerous health problems,
(f) 栄養失調: 数多くの疾病をもたらす
(g) lack of recreation and lack of relief from work and other pressures: associated with stress diseases such as hypertension, coronary-artery disease and peptic ulcers.
(g) 保養不足、労働とその他の圧力からの慰安不足: 高血圧、冠状動脈疾病、胃潰瘍といった重圧性疾病との関連
Turning to the physical and social environment, about which the individual can do little or nothing, it is generally assumed that all known public health measures have been put into effect across our land, and that we are protected through governmental action against public health hazards.
個人がほとんど関わることのできない、物理的社会的環境に目を向けると、あまねく知られる公衆衛生的施策は、カナダの大地全体に影響をもたらしており、公衆衛生の危機に対する政府の措置を通じて、我々は守られていると、一般はそう決めかかっている。
On closer examination it will be found that the application of known public health measures is both imperfect and uneven.
より綿密に調べると、公衆衛生的施策の適応は、不完全で公平ではないと気づかされるだろう。
The contamination of drinking water, as illustrated by the analyses carried out by Pollution Probe in Western Quebec and Eastern Ontario, is far more widespread than one would have thought in this day and age.
ケベック州西部とオンタリオ州東部の汚染調査の実施により示された飲料水の汚染は、現在ではより拡大している。
Sewage from a substantial proportion of Canada’s population is still poured out raw into Canada’s rivers and lakes.
カナダの人口の充分な割合からの汚水は、河川湖畔にそのまま注いでいる。
Many large centres still do not fluoridate drinking water, in spite of the low cost and the preponderance of scientific opinion in favour of fluoridation.
水道水フッ化物添加に賛成する科学的意見の優勢やその費用の安さにもかかわらず、多くの浄水場は水道水添加水を配水していない。
So contaminated are some Canadian lakes and streams that many public beaches have had to be closed down because of their threat to health.
カナダの湖と河川のいくつかは汚染されており、多くの公共海水浴場は健康被害を避けるために閉鎖されている。
The total effect of air pollution on the health of Canadians has not been ascertained with any precision but links have been established between air pollution and sickness.
大気汚染がカナダ人の健康に与える影響は、いかなる精度においても解明されていない。しかし、大気汚染と疾病の関連は確立されている。
[関連性は示されているが、因果関係は示されていない、ということだろうか]
Direct cause-and-effect relationships are now being proved and measured.
原因と結果の直接的な関連は、現在検証、評価中である。
Urbanization, and all its effects on physical and mental health, has not been assessed in any comprehensive way.
都市化とその身体的精神的健康への影響は、いかなる包括的方法によっても評価されていない。
Crowding, high-rise living, and the dearth of intensive-use recreational areas in cities are all contributors to sickness in Canada.
過密人口、高層建築、都市部での集中保養地域の不足は、すべてカナダにおける疾病への寄与要因である。
Working conditions, including the deadening effect of repetitive production line tasks on the human spirit, take their toll in terms of physical and mental illness.
反復する工程線の仕事が人の霊魂を衰弱させる影響を含めた労働環境は、身体的精神的疾病の点から、損害をもたらすである。
Workmen’s Compensation Benefits alone cost 400 million dollars yearly.
労働者補償給付は、年間4億ドルである。
One of the most important but least understood environmental problems is the effect of rapid social change on the mental and physical health of Canadians.
最も重要で、あまり理解されていない環境の課題の1つは、急速な社会の変化がカナダ人の精神的身体的健康におよぼす影響である。
Some of the social change is due to technological innovation, such as the introduction of television, but significant disorientation and alienation arise as well from the crumbling of previous social values and their replacement by others whose long-term effect is still unknown.
社会の変化のいくつかは、遠隔映像の導入といった技術的革新のためである。長期的影響の解明されていない従来の社会の価値の崩壊とその置き換えから、深刻な方向感覚の喪失と疎外感が生じている。
When a society increasingly pursues private pleasure by sacrificing its obligations to the common good, it invites stresses whose effect on health can be disastrous.
社会がますますその公益への義務を放棄して個人の愉しみを追求するとき、社会はまた健康へ破壊的影響をもたらす重圧を招く。
Finally, on the subject of the environment, the number of economically-deprived Canadians is still high, resulting in a lack of adequate housing and insufficient or inadequate clothing.
結局、環境に関して、経済的に困窮しているカナダ人の数はまだまだ多く、結果として、適切な住居、そして不十分であれな衣類さえも不足している。
All the foregoing environmental conditions create risks which are a far greater threat to health than any present inadequacy of the health care system.
前述の環境状況は、いかなる現行の医療制度における欠点よりも、健康にはるかなる脅威であるリスクをもたらす。
When the full impact of environmental and lifestyle has been assessed, and the foregoing is necessarily but a partial statement of their effect, there can be no doubt that the traditional view of equating the level of health in Canada with the availability of physicians and hospitals is inadequate.
環境と生活様式のすべての影響が評価され、前述が必然的にそれらの影響の一部となれば、カナダの健康水準と医師や病院の入手可能性を同一とする従来の視点が不適切であることは、明らかであろう。
Marvellous though health care services are in Canada in comparison with many other countries, there is little doubt that future improvements in the level of health of Canadians lie mainly in improving the environment, moderating self-imposed risks and adding to our knowledge of human biology.
他の国と比較してカナダの医療は素晴らしいが、カナダ人の健康水準の将来の改善は、主に環境の改善、自主リスクの変容、そして人間生物学の知見の増加にあることに、疑いは無い。
The major problem areas in the health field fall generally into two separate categories: 1) the health status of the population and 2) the problems involved in the actual organization and delivery of health care.
医療領域の主な課題は、2つの区分に分けられる。1) 集団の健康状況 2) 現実の医療組織と医療提供の課題、である。
Three main indicators of the health status of the population are (a) life expectancy and mortality rates, (b) causes of death and (c) morbidity.
集団の健康状況の3つの指標は (a) 平均余命と死亡率 (b) 死因 (c) 発生率、である。
Life expectancy at birth has increased significantly between 1941 and 1971, from 63.0 years to 69.4, for males and from 66.3 to 76.5 for females.
生誕時の平均平均は1941から1971年の間に、男性で63.0年から69.4年に、女性で66.3歳から76.5歳に改善した。
The main reason is the significant drop in infant mortality, from 61 deaths per 1,000 births in 1941 to 17.5 deaths per 1,000 births in 1971.
この主な理由は、乳児死亡率の大幅な下降である。1941年の出生1000あたりの死亡61は1971年には出生1000あたりの死亡17.5へと改善した。
Once a male has survived beyond childhood, however, there has been very little improvement in the number of remaining years he can expect to live.
しかし、幼児期を生き延びた男性の余命には、改善はほとんどない。
A twenty-year old male in 1941 could expect to live to 69.6 years of age, while in 1971 this had only increased to 71.8.
1941年の20歳男性の余命は69.6年であったが、1971年では71.8年という具合である。
For twenty-year old females the improvement has been more significant, from 71.8 in 1941 to 78.3 in 1971.
20歳女性では、1941年の余命は71.8年であったが、1971年では78.3歳と大きく延びている。
These figures reflect a widening gap between male and female life expectancy, whose gravity is underlined when one looks at specific statistics.
これらの数字は、男性と女性の平均余命の格差の拡大にあらわれている。具体的な統計を見れば、その重みは強調される。
In 1971 twice as many men as women died between the ages of fifteen and seventy.
1971年には50歳から70歳の間では、男性は女性の2倍、死んでいる。
The actual figures are 43,450 male deaths and 22,150 female deaths in this age group.
数字としては、この年代の男性は4万3450人が女性は2万2150人が、死んでいる。
In simple terms, death overtook two men for every woman in these prime years of life.
単純に言えば、これらの年代に、死は男性2人と女性1人を迎え入れる。
In 1931, women, on the average, could expect to live two years longer than men.
1931年、平均して女性は男性より2年長く生きていた。
In 1971 this difference had grown to seven years.
1971年、この差は7年に広がっている。
Turning to comparisons with other countries, there are only three nations in the world, Sweden, Norway and The Netherlands, which have a greater life expectancy for females than Canada, and the difference between Canada and the best nation is only one year.
他の国と比較すると、世界の3つの国、スウェーデン、ノルウェー、ネザーランドでは、カナダより女性の平均余命が長い。カナダとそれらの国の差は1年である。
For male life expectancy, there are six countries, Sweden, Norway, The Netherlands, Denmark, Switzerland and Greece, which outperform Canada and the gap between Canada and the best
nation is two and a half years.
男性の平均余命では、6つの国、スウェーデン、ノルウェー、ネザーランド、デンマーク、スイス、ギリシアが、カナダより優れている。カナダとそれらの国の差は2.5年である。
Another analysis was made of years lost due to early death between the ages of one and seventy, using relativity at age seventy.
また、1歳から70歳までの早世のために失われた年数を70歳と比較して、分析した。
By this definition the following comparison was obtained:
この定義により、以下の比較を得た。
| Years Lost 喪失年数 | Years Lost 喪失年数 | |
| Cause 原因 | Male 男性 | Female 女性 |
| Motor Vehicle Accidents 交通事故 | 154,000 15万4,000 | 59,000 5万9,000 |
| Ischaemic Heart Disease 虚血性心疾病 | 157,000 15万7,000 | 36,000 3万6,000 |
| All Other Accidents その他の事故 | 136,000 13万6,000 | 43,000 4万3,000 |
| Respiratory Disease and Lung Cancer 呼吸器疾病と肺ガン | 90,000 9万0,000 | 50,000 5万0,000 |
| Suicide 自殺 | 51,000 5万1,000 | 18,000 1万8,000 |
| TOTAL 合計 | 588,000 58万8,000 | 206,000 20万6,000 |
For these five main causes of early death, as defined, males lost almost three years of potential life for every year lost by females.
早世の5大要因で、男性は女性と比べて、約3倍潜在的余命を失っている。
Turning next to the actual number of deaths by cause and sex, one finds that between the ages of thirty-five and seventy there were 18,400 men who died of diseases of the cardio-vascular system compared to only 7,300 women.
次に、原因と性別の死の数字を見ると、35歳と70歳の間に男性1万8400、女性7300が心臓血管系疾病により死んでいる。
For each sex at all ages, major differences in numbers of deaths were also found in the following selected categories for 1971.*
1971年の選択した以下の区分では、すべての年代の性別で、死亡数の大きな違いがみられる。*
* More complete mortality statistics are shown in the ensuing table.
* より完全な死亡統計は次の表で示す。
| Deaths 死亡 | Deaths 死亡 | |
| Cause 原因 | Male 男性 | Female 女性 |
| 1. SPECIFIC ACCIDENTS 1. 特定の事故 | ||
| (a) Automobile Accidents (a) 自動車事故 | 4,100 | 1,600 |
| (b) Other Transport Accidents (b) その他の交通事故 | 500 | 70 |
| (c) Industrial Accidents (c) 労働災害 | 700 | 55 |
| (d) Accidental Drownings (d) 不慮の溺死 | 600 | 150 |
| 2. LUNGCANCER 2. 肺ガン | 4,600 | 800 |
| 3. BRONCHITIS, EMPHYSEMA AND ASTHMA 3. 気管支炎、肺気腫、喘息 | 2,800 | 700 |
| 4. SUICIDE 4. 自殺 | 1,900 | 700 |
| 5. CIRRHOSIS OF THE LIVER 5. 肝硬変 | 1,300 | 650 |
From the foregoing analysis, there is nodoubt that Canada has a male mortality problem of great significance.
前述の分析から、カナダは男性の死亡率に大きな課題があることに、疑いは無い。
As already noted, life expectancy is much influenced by changes in the infant mortality rate and most of the improvement in Canadian life expectancy can be attributed to a reduction in the infant mortality rate from 102.0 deaths per 1,000 live births in 1921 to 17.5 in 1971.
既に述べたように、平均余命は乳児死亡率の変化の影響を大きく受ける。そしてカナダ人の平均余命の大きな改善は、1921年の出生1000あたり死亡102.0が1971年の死亡17.5になったという、乳児死亡率の改善によるところが大きい。
While Canada’s performance has been outstanding, it still falls well be low that of Sweden with a rate of 11.0 per 1,000 live births.
カナダの現状は際立っているが、スウェーデンの出生1000あたり死亡11には及ばない。
What offers hope for improvement is the difference in infant mortality rates between certain socio-geographic segments of the Canadian population.
改善の手がかりとなるのは、カナダの人口の特定の社会地理的区分の間の乳児死亡率の差である。
By attacking the problem among high-risk populations, improvements can still be made.
ハイ・リスクな集団の課題に取り組みによる、改善の余地がある。
At the same time one must keep the importance of infant deaths in perspective.
また、乳児死亡の重要性を忘れてはいけない。
Of 157,300 deaths in 1971, only 6,400 occurred before age one and of these many are due to congenital anomalies about which little can bed one after a baby is born.
1971年の15万7300の死亡のうち、6400が1歳未満で生じており、その多くが先天異常によるものである。
The graphic at Annex A provides a vivid picture of the major causes of death for each sex and age group in 1971.
付録Aのグラフは、1971年の6歳ごとの死亡原因をヴィヴィッドに描き出している。
It highlights the fact that the importance of each cause of death varies according to sex and age group.
グラフは、それぞれの死因の重要性が、年齢層により変化するという事実を強調している。
Noticeable immediately is the tremendous importance of motor vehicle accidents and all other accidents, which account for large percentages of death in young males between the ages of five and forty and infemales between five and thirty.
5から40歳の男性と5から30歳の死亡の大部分を占める自動車事故と交通事故の途方も無い重要性は、目を引く。
Suicide is an important cause of death in males and females as young as fifteen years.
自殺は15の男性と女性の重要な死因である。
Coronary-artery disease becomes and remains the major cause of death in males from age forty on, and in females from age fifty on.
冠動脈疾病は、男性では40歳、女性では50歳から主要な死因となる。
Cancer strikes at most ages, but at a much earlier age among women.
癌は、たいていの年代を直撃しており、女性では、より早い年代から直撃する。
Deaths due to respiratory diseases and lung cancer are important in men over fifty years.
循環器疾病と肺ガンによる死亡は、50歳以上の男性で、重要である。
Cirrhosis of the liver appears as a major cause of death in males between the ages of forty and fifty.
肝硬変は40代50代の男性として登場する。
An overall view of the major causes of death at all ages, with predominant ages for each, is as follows:
あらゆる年代の主要な死因とそれぞれの年代の特徴の全体図は以下の通りである。
| Major Causes of Mortality (1971) 主要な死因 | No. of Deaths 死亡数 | % of All Deaths | Predominant Ages 死亡年代 |
| Ischaemic heart disease 虚血性心疾病 | 48,975 | 31.1% | 40 and over |
| Cerebrovascular disease 脳血管疾病 | 16,067 | 10.2% | Age 65 and over |
| Respiratory diseases and lung cancer 呼吸器疾病と肺がん | 15,677 | 10.0% | Under 1 year |
| Motor Vehicle and all other accidents 交通事故 | 12,031 | 7.6% | All ages |
| Cancer of the gastro-intestinal tract 胃腸管ガン | 7,947 | 5.1% | 50 and over |
| Cancer of the breast, uterus and ovary 乳がん、子宮がん、卵巣がん | 4,816 | 3.1% | 40 and over |
| Diseases specific to the newborn 新生児に特異的な疾病 | 3,299 | 2.1% | Under 1 week |
| Suicide 自殺 | 2,559 | 1.6% | 15 to 65 |
| Congenital anomalies 先天異常 | 1,967 | 1.3% | Under 1 year |
| TOTAL 合計 | 113,338 | 72.1% | |
| ALL DEATHS 総死亡 | 157,272 | 100.0% | |
It will be noted that the major causes of death are now chronic illnesses and accidents, with relatively few due to infectious diseases.
主な死因は慢性疾病と事故であり、感染性疾病は比較的少ない。
This is a drastic change from the situation around the turn of the century when the major causes of death were primarily, or related to, infectious diseases such as influenza, pneumonia, tuberculosis, gastro-enteritis, chronic nephritis and diptheria.
これは、主な死因がインフルエンザ、肺炎、結核、胃腸炎、慢性腎炎、ジフテリア、あるいはその関連であった世紀からの大きな転換である。
These diseases have largely been brought under control, and the only ones which remain major problems of mortality are influenza and pneumonia, and certain diseases of early infancy.
これらの疾病は、沈静化されており、主な死因として残っているのは、インフルエンザと肺炎そして乳児の特定の疾病のみである。
Whereas the major problems of the past were acute illnesses, which have a fairly abrupt onset and a finite duration, the major problems now are chronic illnesses, which have a gradual onset and an indefinite duration (see Chapter 10), and accidents.
過去の主な疾病は、突如始まり有限期間をもって終了する、急性疾病であったが、現在の疾病は、緩やかにはじまり無期限に続く（10章参照）、慢性疾病と事故である。
With regard to the incidence and causes of illness, the available information is more limited and less reliable than it is on mortality.
疾病の発生率と原因に関する資料は、死亡率の資料よりも少ない。
In order to have key indicators of health, it would be necessary to have a measure of ill-health in the population, including the whole range of disabilities from the severe conditions that often require hospitalization and medical treatment to the minor ailments and mild chronic conditions.
健康のカギとなる指標を把握するために、入院と治療の必要な重篤な状態から、軽い病気と穏やかな慢性疾病まで、あらゆる範囲の能力低下を含む集団における疾病の評価は欠かせない。
However, the only Canadian data that are current relate to illness treated in hospitals, and to certain contagious diseases which must be reported by physicians to public health authorities.
しかし、カナダの資料は、病院で治療された疾病と医師から公衆衛生機関に報告される特定の伝染性疾病のみである。
Looking at acute treatment hospital morbidity, measured by the number of hospital days, one finds that diseases of the cardio-vascular system, injuries due to accidents, respiratory diseases and mental illness, in that order, are the four principal causes of hospitalization, accounting for some 45% of all hospital days.
在院日数により評価された急性治療の病院発生率を見ると、心臓血管系の疾病、事故による怪我、呼吸器疾病、精神疾病の順に、入院の4大原因であり、すべての入院の約45%を占めている。
By another measure, the number of hospital admissions, diseases of the respiratory system come first, followed by child-birth, diseases of the digestive system, diseases of the genito-urinary system, diseases of the cardio-vascular system and accidents.
入院人数で評価すると、呼吸器疾病が1番であり、続いて乳児死亡、消化器疾病、泌尿器疾病、心臓血管系疾病、事故となる。
The difference between the two rankings is due to the fact that one measures the number of hospital days while the other measures the number of admissions.
2つの序列の違いは、一方は在院日数を評価しており、他方は入院人数を評価している、ということにある。
Since hospital stays, on the average, are longest for cardio-vascular disease and accidents, these are more prominent in the ranking by hospital days.
心臓血管疾病と事故の平均入院期間は長さのため、それらは在院日数で並べると目につきやすい。
Hospital morbidity, like mortality, is of limited use in assessing the general level of health of the population because it reflects only the severe cases, i.e. those requiring hospitalization.
病院発生率は死亡率に似て、集団の健康水準の評価には使いにくい。なぜなら、病院発生率は、入院の必要な重症症例のみを反映しているからである。
Furthermore, if one makes year-to-year comparisons, it is necessary to take into account factors other than the rate of sickness, such as the effect of prepayment of hospital and medical care and of more sophisticated diagnostic techniques. .
また、年ごとの比較をするなら、発生率ではなく、医療費の前納や洗練された診断技術の影響といったそのほかの要因を考慮しなければいけない。
These factors are difficult to measure at present.
これらの要因は、目下、評価が困難である。
What is really needed is a measure of the prevalence of ill-health in the population, counting not only mortality and hospital morbidity, but illness treated by health professionals outside hospital, illnesses which are self-treated or self-limiting, undetected morbidity, and a count of the chronically disabled.
本当に必要なのは、集団における疾病の有病割合、死亡率や病院発生率の集計、そして病院外で医師により治療された病気、自己医療、自然治癒、検出されない発生率、慢性的能力低下として扱われた病気の集計である。
[self-limitingは「治療をしないでも長期的には症状が落ち着いたり収まる性質のある」という形容詞なのですが、自然治癒としています]
Only when this comprehensive view is obtained will it be possible to ascertain the level of health and to identify year-to-year changes.
この包括的評価がされた時にのみ、健康水準の解明と年ごとの変化の確認は可能となる。
Conceptual and technical problems need to be resolved before this comprehensive view is obtained, and substantial funds would have to be made available for surveys of the population and for the establishment of useful data series.
この包括的評価を得るには、概念的技術的課題の解決を解決し、また集団の調査と有用な資料を作成するための潤沢な資金を用意しなければいけない。
To operate most effectively in regulating dangerous products there is a need for accurate, comprehensive knowledge of the causes of accidents and for the identification of the products, if any, involved.
危険な製品の規制において最も効果的なのは、正確で包括的な事故原因の知見と、もしあるなら関連する製品の検証である。
This points to the need for a broadly-based, well-designed statistical system for reporting accidents.
この視点から、事故報告のための、多くの賛同を得た、良好な設計の統計体系が必要である。
One of the ironies of obtaining and analysing health data is that it is so difficult to act upon the conclusions reached.
健康資料の入手と分析における皮肉の1つに、到達した結論に基づき行動することが難しい、ということがある。
Taking coronary-artery disease as an example, one finds that it is the major killer and the major cause of hospital days.
冠状動脈疾病を例に挙げれば、それは主要な死因であり在院日数の大きな要因である。
Contributing factors are well known and include genetic inheritance, the relative absence of estrogenic hormones in men, smoking, obesity, high-fat diets, high serum cholesterol, lack of exercise and stress as well as such morbid conditions as atherosclerosis, diabetes and high blood pressure.
寄与要因はよく知られいる。遺伝子、男性のエストロゲン・ホルモンの相対的な不足、喫煙、肥満、高脂肪摂食、血清コレステロール、運動不足、重圧そして粥状動脈硬化（症）や糖尿病、高血圧といった病的状態である。
Yet, when one looks for programs aimed at reducing the prevalence of coronary-artery disease through an abatement of known contributing factors, one finds that they are weak or non-existent.
しかし、既知の寄与要因の軽減により冠状動脈疾病の有病割合を減少することを目的とした計画をみると、脆弱であるか、存在しないかのどちらかであることが分かる。
Deaths and injuries due to automobile accidents could probably be reduced by 50% if everyone wore seat-belts, and if stricter measures were taken to reduce the number of impaired drivers.
自動車事故による死亡や外傷は、座席帯を締める、あるいは飲酒運転の数を減らす厳しい対策により、50%に減らしうる。
In spite of this knowledge the rate of seat-belt wearing stays at about 10% and alcohol continues to be a factor in half the traffic accidents.
このような知見にも関わらず、座席帯装着割合が約10%にとどまっており、飲酒は交通事故の半数の要因である。
Cigarette smoking contributes heavily to respiratory disease and lung cancer.
喫煙は、循環器疾病と肺ガンに大きく寄与している。
Educational campaigns have succeeded in reducing the number of smokers in the twenty years-and-over bracket from fifty-eight per hundred to fifty per hundred but the recruitment of new smokers among teenagers has increased alarmingly, especially among teen-age girls.
教育活動は20歳以上の喫煙者の人数を100人あたり58人から50人に削減させているが、10代の新たなる喫煙者、とりわけ少女の喫煙が憂慮すべき増大を示している。
Some 40% of all alcoholic beverages in Canada are purchased by but 7% of the drinking population, the alcohol abusers.
カナダのすべてのアルコール飲料の40%は、飲酒人口の7%であるアルコール依存症患者により、消費されている。
At December 31, 1969, there were sixty-seven children under the age of fifteen with a diagnosis of alcoholism in Canadian mental hospitals.
1969年12月31日に、カナダの精神病院でアルコール依存症と診断された15歳以下の小児は67人いた。
One-quarter of all first male admissions to psychiatric hospitals are due to alcoholism, and the heavy contribution of alcohol abuse to motor vehicle accidents, poisonings, accidental fire deaths, cirrhosis of the liver and falls has been ascertained.
男性の精神病院への最初の入院の4分の1は、アルコール依存症によるものであり、アルコール依存の自動車事故、中毒、不慮の火事による死亡、肝硬変、転落への寄与が明らかとなっている。
Absenteeism due to alcohol abuse costs a million dollars a day to Canadian industry5.
アルコール依存症による無断欠勤はカナダの産業に1日100万$の損害を与えている。5
Yet the control and treatment of alcohol abuse in Canada is fragmented and weak.
しかしカナダにおけるアルコール依存症の管理と治療は、断片的で脆弱である。
5. Collins, R., Drinking on the Job, Imperial Oil Review, 1973, No. 2.
5. Collins, R., 職と飲酒, Imperial Oil Review, 1973, No. 2.
The lack of physical fitness of the Canadian population has been measured and one criterion, the capacity to use oxygen efficiently, indicates that Canadians are not as fit as citizens of some European countries.
カナダ人の運動不足が評価され、その基準の1つである、酸素効率を利用する吸収力は、カナダ人は欧州の人々ほど達者ではないことが示唆している。
[capacity to use oxygen efficientlyは専門語か?]
A study in 1972 showed that 76% of Canada’s population over age thirteen spend less than one hour a week participating in a sport, and that 79% have less than one hour per week in other physical activity such as walking.
1972年の研究は、13歳以上のカナダの人口の76%は週に1時間も運動をしておらず、79%は散歩といった身体活動もしていないことを、示している。
This same survey shows that 84% of the population over age thirteen watches four or more hours a week of television.
同じ調査は、13歳以上の人口の84%は週に4時間以上、遠隔映像受信機を眺めていることを示している。
Some 36% watch in excess of fifteen hours a week.
36%あまりは、週に15時間以上、受信機に吸い込まれている。
This pattern of living, dominated by sedentary living, explains why so few Canadians are fit.
この座わりがちな生活の傾向は、 なぜほとんどのカナダ人が運動をしないのかを説明している。
Accurate statistics on the incidence of gonorrhea and syphilis are hard to come by but those that are reported indicate that venereal disease is again reaching epidemic proportions.
淋病と梅毒の発生率の正確な統計は、入手しにくい。しかし報告された統計は、性病が再び地域的流行となっていることを示している。
[エンデミックは局地的流行、エピデミックは地域的流行、パンデミックは世界的流行です]
Efforts to combat this health problem are at best of uneven effectiveness.
この疾病との戦いの効果には、むらがある。
The common dental diseases of caries, periodontal disease and malocclusion are not dramatic but in terms of numbers of people affected they constitute one of the greatest public health problems in Canada.
代表的歯科疾病である齲蝕、歯周疾病、不正咬合は、劇的ではないが、冒された人々の数の点からは、カナダの最も大きな公衆衛生的疾病の1つである。
Almost 60% of Canadians appear to receive little or no dental care, and yet few dentists are in a position to accept more patients.
カナダ人の約60%は歯科医療をほとんど、あるいは全く受けられず、また多くの患者を受けいられる歯科医師は、ほとんどいない。
A greater number of dental auxiliaries is needed, to relieve dentists of the more routine procedures.
多くの常法から歯科医師を解放するために、多くの歯科補助士が必要である。
It is estimated that about half the burden of illness is psychological in origin and this proportion is growing.
元来、疾病の重荷の約半分は、精神的なものであり、その割合は拡大してきていると推測される。
An indication of the seriousness of the problem can be seen from the following facts:
疾病の重症度の指標は、以下の要因からなる。
one-third of all hospital beds and hospital days are for mental care patients;
すべての病院寝床と在院日数の3分の1は、精神疾病の患者である。
three out of 1,000 Canadians are hospitalized in psychiatric institutions at any given time;
いかなる瞬間においても、カナダ人の0.3%は、精神医学の施設に入院している。
between 5% and 10% of school children suffer from mental or learning disorders;
学童の5-10%は、精神障害あるいは学習障害に苦しんでいる。
there is a significant increase in alcoholism and drug addiction, homicide and suicide, crime, anxiety neuroses and depressive psychoses.
アルコール依存と薬物依存、殺人と自殺、犯罪、不安神経症と鬱症のおびただしい増加がある。
And yet mental health, as opposed to physical health, has been a neglected area for years; unfortunately there is still a social stigma attached to mental illness.
しかしながら、身体保健に対して精神保健は、久しく軽視されてきている。不幸なことに、精神疾病にともなう社会的不名誉は、今なお根強い。
When one looks at the foregoing major health problems of Canada and their underlying causes it is obvious that we are failing to act on the information we already have.
このようなカナダの主要な疾病とその根本にある原因に目を向けると、私たちはでたらめに行動している、ということが明らかとなる。
[underlying causesを常套句となったのは、いつ頃からなのだろうか?]
The health care system, for all its facilities and for all the numbers, training and dedication of its health professionals, still tends to regard the human body as a biological machine which can be kept in running order by removing or replacing defective parts, or by clearing its clogged lines.
医療制度は、人間の身体を、故障部分があれば破棄したり置き換えれば、あるいは塞がりを掃除すれば動き続ける生物学的機械と見なす傾向にある。
The medical solution to health problems, while an extremely important aspect of health, is only one of many aspects revealed by an examination of the underlying causes of sickness and death.
疾病の医学的解決は、重要ではあるが、疾病と死亡の根本にある原因の調査による解明された多くの側面の1つに過ぎない。
If government is, at least in part, a mirror of the people’s collective will, then the people collectively must accept the blame for any causes of sickness arising from the deterioration that has taken place in the environment.
もし政府が人々全体の意思の鏡であるなら、人々は共同で、環境の劣化から生じる疾病の原因の責任を認めなければいけない。
In addition to the health care system and the people collectively, individual blame must be accepted by many for the deleterious effect on health of their respective lifestyles.
医療制度と人々全体に加えて、個人の責任はそれぞれの生活様式の健康への悪影響の多くを受け入れなければいけない。
Sedentary living, smoking, over-eating, driving while impaired by alcohol, drug abuse and failure to wear seat-belts are among the many contributors to physical or mental illness for which the individual must accept some responsibility and for which he should seek correction.
座りがちな生活、喫煙、過食、飲酒運転、薬物依存、座席帯着用の失敗は、個人が責任を負わなければいけない、そして個人が訂正を模索しなくてはいけない身体と精神の疾病の主要な寄与要因である。
Finally, the medical research community, with its emphasis on human biology, must continue to evaluate the direction of its research in terms of the country’s major health problems and of the gaps in knowledge that need to be closed if those problems are to be solved.
最後に、人間の生物学を強調する医学研究界は、国の主要な疾病とそれらの疾病が解決できるのであれば、その知見における埋められるべき隙間に関する研究を評価し続けなければいけない。
Balancing the need to respect the independence of the researcher with the need to relate research to health problems is a question of continuing debate; it is true, however, that the research community could pursue with more vigour the application of new knowledge in the environment, lifestyle and health care sectors.
研究の独立性と疾病研究の両立はいかにあるべきか。これは、今なお続く議論である。しかし研究界は環境、生活様式、医療部門の新たなる知見の応用に消極的である、というのは確かである。
[なんか、凄いこと主張してるな]
This section on Canada’s health status dwells necessarily on the problems which still face the country and because of this tends to project a picture that is gloomier than is actually the case.
カナダの健康状態についての本説は、カナダの直面している疾病を力説するために、実際の状況より悪い状況を映し出す。
By comparison both with its past history and with other countries, Canada has much to be proud of, and thankful for.
現在のカナダは、過去や他の国と比較して、大いに誇れるし、多いに感謝されている。
This is no less true in the health field than it is in other areas of social progress.
これはその他の社会発展の領域と比べた医療領域においても、真実である。
With the introduction of universal pre-paid medical and hospital care, Canadian provinces, with federal financial assistance, have substantially eliminated the spectre of catastrophic medical and hospital bills.
普遍的前納医療の導入にともない、カナダの州は、連邦財政援助とともに、壊滅的な医療請求の不安を一掃した。
Various measures are also in effect to help pay for other services, including special assistance to the needy.
さまざまな施策は、貧困階層への特別な援助からなる、その他の医療のための支払いの助けている。
There are three overall indicators of the level of health services: the ratio of various health professions to the total population, the ratio of treatment facilities to the population, and the extent of pre-paid coverage.
医療水準指標は、3つある。さまざまな医療専門家と人口の比、医療施設と人口の比、前納対象の範囲である。
The following table shows how Canada compares with other countries in some of these respects.
以下の表はカナダとその他の国の比較である。
The actual years for which statistics are shown vary slightly according to the availability of the most recent figures.
統計の年度は、利用できる近年の数字である。
[ラロンド・レポートの公開は1981年です]
| Country | % Covered by Medical and Hospital Insurance | No. of Hosp. Beds per 10,000 Population | No. of Physicians per 10,000 Population | No. of Nurses per 10,000 Population | |
| Australia | 79% (Hosp.) 75% (Med.) | 117.4 | 11.8 | 66.6 | |
| Canada | Almost 100% | 102.3 | 15.7 | 57.3 | |
| Denmark | 96.7% | 89.4 | 14.5 | 53.4 | |
| Sweden | Almost 100% | 145.8 | 12.4 | 43.7 | |
| United Kingdom | Almost 100% | 111.4 | 12.5 | 35.1 | |
| United States | 85% (Hosp.) 65% (Reg. Med.) 35% (Maj. Med.) | 82.7 | 15.3 | 49.2 | |
In hospital and medical insurance coverage Canada equals the best of the five countries chosen for comparison; it leads in respect of physicians, is in the middle rank in respect of hospital beds, and is second only to Australia in nurses.
医療保険範囲においてカナダは比較した5つの国の最良の国と台頭である。医師に関してはトップであり、病床に関しては中程、看護師に関してはオーストラリアに次いで2位である。
Since the countries chosen are among those with the best health care services in the world, there is no doubt that, by the four measures used in the table, Canada is among the world leaders.
Canada’s national health expenditures, including personal health care,*
in 1971, were as follows:
| As % of G.N.P. | As % of Personal Income | Per Capita Annual Expenditures | |
| Canada | 7.1 | 9.0 | 306.11 |
These figures reflect total health expenditures. For that part which com- prised personal health care only, the per capita cost in Canada was $271.72, or about $1100 for a family of four. This is a substantial sum by any measure, even if most of the costs were met by insurance.
* Personal health care consists of services received by individuals and provided by
hospitals, physicians, nurses, dentists, pharmacists, etc.
Inspiteof thegreat strides made inrecent years, there area numberof difficult problemsfacingthosewithresponsibilitiesforprovidinghealthcare services:
1. Theannual rateofcostescalationhasbeenbetween12%and16%, whichisfarinexcessoftheeconomicgrowthofthecountry;ifunchecked, healthcarecostswillsoonbebeyondthecapacityofsocietytofinancethem.
2. Thepasttwentyyearshaveseenanemphasisontheconstructionof hospitalsandnotenoughonotherneededhealthcarefacilities.Asaresult, Canadanowfindsitself withanexcessof expensiveacutecarebeds, coupledwithashortageofalternativetreatment,convalescentandcusto- dialcarefacilitiesandincreasingpressureonhospitalemergencyservices.
3. Medical servicesarenot yet equallyaccessibletoall segmentsof the populationbecausehealthmanpowertendstoconcentrateincitiesandis notattractedtorural orisolatedlocations.
4. Dental services arenot equallyaccessibletoall segments of the population, mainlybecauseof thecost tothepatient of dental care, a shortageofdental professionals,aswell asamaldistributionofavailable dental manpower.
5. Presentorganizationalarrangementsforprovidinghealthcareservices couldbeimprovedtomoresatisfactorilymeettheneedsofthepopulation.
6. Overtheyears, alargeproportionof Canada’sneedsforphysicians hasbeenmet bytheimmigrationof personnel fromforeigncountries. Overthedecade1961-1971, theaverageannual numberof immigrant physicianswas914.Duringthesamedecade,anaverageof919students graduatedeachyear fromCanadianmedical schools. This reflects a problemofdependencyonothercountriesforphysiciansupply.
7.Certainsectorsofthepopulationhavespecial healthproblems,dueto anumberoffactorssuchasmodeoflivingandisolation;theyrequiresup- plementaryserviceswhichmustbeprovidedathigherthanaveragecost.
8. Thereisalackof auniformandintegratedsystemformaintaining healthrecordsofindividuals;essentialdataarescatteredinmanylocations: inphysician’soffices,hospital records,clinics,etc.
9. Healthmanpower planningis difficult becauseof interprovincial mobility,immigrationandemigration.
10. Presentcost-sharingarrangementsbetweenthefederalandprovincial governmentstendtoencouragetheuseofphysiciansandacutetreatment hospitals,evenforserviceswhichcouldbeadequatelyprovidedthrough lesscostlymeans.
11. Improved ambulatory health centres, with round-the-clock, compre- hensive out-patient care are needed in order that accessibility of care will not be dependent on the individual availability of physicians.
12. Regional health authorities with the power to plan and manage the health care requirements of a given geographical area are needed.
The foregoing problems in the provision of health care services are principally the concern of provincial governments, who are charged with ensuring that adequate health care is available at a cost that can be afforded.
Some of the problems of providing and financing health care within reasonable limits arise from attempts to meet conflicting goals.
On the one hand, it is a goal to make physician services equally accessible to everyone; on the other hand, it is also a goal to permit physicians to practise where they wish. The result is that physicians are maldistributed among provinces and between urban and rural areas. At the two extremes, British Columbia, in 1971, had one physician for every 603 citizens while Prince Edward Island had one physician for 1,143 citizens. Ontario had one to 616 in 1971 and calculated that by the end of 1973 it had one physician for less than 600 citizens, in spite of the fact that there is no evidence to suggest that the standard of health care is improved when the ratio of 1 to 600-650 is exceeded.
A second set of conflicting goals consists of trying to control costs while removing all incentives to patients, physicians and hospitals to do so. The existence of a generous supply of hospital beds and of increasing numbers of physicians makes it easy for patients to seek care even for minor conditions and for physicians to hospitalize more patients, particularly when there are no financial barriers. Thus the goal of ready access to health care services, both physical and financial, conflicts with the goal of controlling costs.
A third set of conflicting goals consists of providing a balanced supply of the various medical specialties while permitting physicians to select their fields of special training. The shortage of physicians specializing in rehabilitation medicine and in the care of the aged is evidence that mechanisms are needed to reconcile these two goals.
Fourth, health care administrators would like to see services provided by staff trained only to the level of skill needed for the task performed. However, the present licensing patterns for health professionals as well as the fee-for- service system, coupled with the principle that the physician or dentist alone bears responsibility for his patient, encourages the practice of physicians and dentists carrying out tasks which could be done by others, as well or better, and often at a lower cost. In the Canadian North the role of the nurse has been expanded along these lines with great success. Similarly, the Government of Saskatchewan has successfully implemented a dental care system for school children in which a major part of the work is done by dental health professionals other than dentists, according to protocols established by dentists and under their overall supervision.
Finally, there is the paradox of everyone agreeing to the importance of research and prevention yet continuing to increase disproportionately the amount of money spent on treating existing illness. Public demand for treat- ment services assures these services of financial resources. No such public demand exists for research and preventive measures. As a consequence, resources allocated for research, teaching and prevention are generally insufficient.
It would appear that steps need to be taken to reconcile the foregoing, and other conflicting goals and principles, while retaining all that is necessary to properly reward health manpower, control costs and ensure accessibility to quality service.
A basic problem in analysing the health field has been the absence of an agreed conceptual framework for sub-dividing it into its principal elements.
医療領域の分析における基本的な課題は、医療領域を大まかな要素にグループ分けするのための合意された概念的枠組みがない、ということろにある。
Without such a framework, it has been difficult to communicate properly or to break up the field into manageable segments which are amenable to analysis and evaluation.
そのような枠組みなしには、適切に医療領域の概念を共有・議論し、医療領域を分析や評価をしやすい区分に分けることが困難である。
It was felt keenly that there was a need to organize the thousands of pieces into an orderly pattern that was both intellectually acceptable and sufficiently simple to permit a quick location, in the pattern, of almost any idea, problem or activity related to health: a sort of map of the health territory.
数千の要素を、知的にも受容でき、健康に関するあらゆる思いつきや課題、活動を簡単に割り振りできる、十分に単純な、ある1つの整った型 - つまり医療領域をあらわす地図のようなもの - で体系化する必要があるように感じられた。
Such a Health Field Concept6 was developed during the preparation of this paper and it envisages that the health field can be broken up into four broad elements: HUMAN BIOLOGY, ENVIRONMENT, LIFESTYLE and HEALTH CARE ORGANIZATION.
本雑文の執筆中に医療領域の概念が整理された。6この医療領域の概念は、4つの大まかな要素（生物学的領域、環境、生活様式、医療の構成）を想定している。
These four elements were identified through an examination of the causes and underlying factors of sickness and death in Canada, and from an assessment of the parts the elements play in affecting the level of health in Canada.
これらの4つの要素は、カナダにおける疾病と死亡の原因と根本にある原因の調査、そしてカナダにおける健康水準に影響を与える要素の評価を通じて決定された。
The HUMAN BIOLOGY element includes all those aspects of health, both physical and mental, which are developed within the human body as a consequence of the basic biology of man and the organic make-up of the individual.
生物学的要素は、人間の基本的生物学と個人の器官の構成の結果である、身体と精神の両面の健康からなる。
This element includes the genetic inheritance of the individual, the processes of maturation and aging, and the many complex internal systems in the body, such as skeletal, nervous, muscular, cardio-vascular, endocrine, digestive and so on.
これは、個人の遺伝的形質、成熟と加齢の進行、骨、神経、筋、心血管、内分泌、消化といった、身体の複雑な内部体系からなる。
The human body being such a complicated organism, the health implications of human biology are numerous, varied and serious, and the things that can go wrong with it are legion.
人間の身体は複雑な器官からなり、人間の生物学の健康への影響は、数多く、さまざまで、重大である。また健康への影響とともに調子の悪くなることも、数多くある。
This element contributes to all kinds of ill health and mortality, including many chronic diseases (such as arthritis, diabetes, athero-sclerosis, cancer) and others (genetic disorders, congenital malformation, mental retardation).
生物学的要素は、多くの慢性疾病（関節炎、糖尿病、アテローム性動脈硬化、癌）そしてその他（遺伝性障害、先天性形成不全、知的障害）からなるあらゆる疾病や死亡率に関係している。
Health problems originating from human biology are causing untold miseries and costing billions of dollars in treatment services.
生物学的要素に由来する疾病は、表現のできない苦痛と数十億ドルの治療費という損害をもたらす。
6. Laframboise, Hubert L., Health Policy. Breaking It Down Into More Manageable Segments. Journal of the Canadian Medical Association, February 3, 1973.
6. フーベルト・ラフラムボイス 保健政策: より管理しやすい区分への分割 (1973)
The ENVIRONMENT category includes all those matters related to health which are external to the human body and over which the individual has little or no control.
環境要因は、人間の身体の外部にあり、個人ではほとんど、あるいは全く管理できない健康に関連するすべてである。
Individuals cannot, by themselves, ensure that foods, drugs, cosmetics, devices, water supply, etc. are safe and uncontaminated; that the health hazards of air, water and noise pollution are controlled; that the spread of communicable diseases is prevented; that effective garbage and sewage disposal is carried out; and that the social environment, including the rapid changes in it, do not have harmful effects on health.
個人は、自分自身では、食品、薬品、美容、道具、水道などが安全で汚染されていないということを、確認できない。空気汚染、汚水、騒音といった健康被害が管理されているということを、確認できない。感染性疾病の蔓延が予防されているということを、確認できない。廃棄物と汚水の効果的な処理が実行されているということを、確認できない。急速に変化する社会環境が健康に危害がないということを、確認できない。
The LIFESTYLE category, in the Health Field Concept, consists of the aggregation of decisions by individuals which affect their health and over which they more or less have control.
医療領域における生活様式は、健康に影響を与え、またある程度管理できる、個人の判断の集合からなる。
The importance of the LIFESTYLE category has already been elaborated on in the section on The Limitations of the Traditional View.
生活様式の重要性は、従来の医療領域の限界の節（p13-9）にて詳述した通りである。
Personal decisions and habits that are bad, from a health point of view, create self-imposed risks.
健康という点からは良くない判断や習慣は、自主リスクにつながる。
When those risks result in illness or death, the victim’s lifestyle can be said to have contributed to, or caused, his own illness or death.
これらの暴露が疾病や死亡をもたらす時、被害者の生活様式が、その疾病や死亡に寄与している、あるいは疾病や死亡を引き起こしていると、いえる。
The fourth category in the Concept is HEALTH CARE ORGANIZATION, which consists of the quantity, quality, arrangement, nature and relationships of people and resources in the provision of health care.
4つ目の要素は、医療の構成である。これは医療提供における量、質、配置、性質、人々と資源の関係からなる。
It includes medical practice, nursing, hospitals, nursing homes, medical drugs, public and community health care services, ambulances, dental treatment and other health services such as optometry, chiropractics and podiatry.
医業、看護、病院、養護施設、医薬品、公共医療、地域医療、救急車、歯科治療、（視力検定、カイロプラクティック、足治療といった）その他の医療からなる。
This fourth element is what is generally defined as the health care system.
この要素は、通常、医療制度として定義される。
Until now most of society’s efforts to improve health, and the bulk of direct health expenditures, have been focused on the HEALTH CARE ORGANIZATION.
現在のところ、健康づくりのための社会の努力のほとんど、そして直接医療費の大部分は、医療の構成に焦点が絞られてきている。
Yet, when we identify the present main causes of sickness and death in Canada, we find that they are rooted in the other three elements of the Concept: HUMAN BIOLOGY, ENVIRONMENT and LIFESTYLE.
しかし、カナダにおける疾病と死亡の主たる原因を確認した今、それらは他の3つの要素、生物学的要素と環境、生活様式に根ざしていることは明らかである。
It is apparent, therefore, that vast sums are being spent treating diseases that could have been prevented in the first place.
それゆえ、予防されうる疾病の治療に巨額が費やされているのは、明らかである。
Greater attention to the first three conceptual elements is needed if we are to continue to reduce disability and early death.
もし身体障害と早世の減少を続けたいのであれば、3つの要素に注目することが、必要である。
The HEALTH FIELD CONCEPT has many characteristics which make it a powerful tool for analysing health problems, determining the health needs of Canadians and choosing the means by which those needs can be met.
医療領域の概念には、疾病の分析、カナダ人の医療のニーズの決定、ニーズを満たす方法の選択において強力な武器となる、多くの特徴がある。
One of the evident consequences of the Health Field Concept has been to raise HUMAN BIOLOGY, ENVIRONMENT and LIFESTYLE to a level of categorical importance equal to that of HEALTH CARE ORGANIZATION.
医療領域の概念から導かれる結論の1つは、生物学的要素、環境要因、生活様式は、医療の構成と同等に重要である、ということである。
This, in itself, is a radical step in view of the clear pre-eminence that HEALTH CARE ORGANIZATION has had in past concepts of the health field.
医療の構成は過去の医療領域の概念において傑出していたことを振り返ると、このあらたなる医療領域の概念は、本質的に、過激である。
A second attribute of the Concept is that it is comprehensive.
新たなる医療領域の概念の第2の結論は、それが包括的である、ということである。
Any health problem can be traced to one, or a combination of the four elements.
あらゆる疾病は、4つの領域のいずれか、あるいは2つ以上の影響を受けている。
This comprehensiveness is important because it ensures that all aspects of health will be given due consideration and that all who contribute to health, individually and collectively, patient, physician, scientist and government, are aware of their roles and their influence on the level of health.
この包括性は重要である。というのも、新たなる医療領域の概念は、健康のすべての側面が熟考され、医療に携わる患者、医師、科学者、政府のすべての人が、その役割と影響を承知していることを、保証するからである。
A third feature is that the Concept permits a system of analysis by which any question can be examined under the four elements in order to assess their relative significance and interaction.
3つめの特徴は、新たなる医療領域の概念により、分析の体系が可能となることである。この分析の体系によって、あらゆる議論は、4つの領域の下、それらの相対的重要性や相互作用を評価するために、考察される。
For example, the underlying causes of death from traffic accidents can be found to be due mainly to risks taken by individuals, with lesser importance given to the design of cars and roads, and to the availability of emergency treatment; human biology has little or no significance in this area.
例えば、交通事故による死亡の根本にある原因は、主に個人にあり、車両と道路の設計、緊急治療の入手可能性の重要性は低いことがわかる。交通事故による死亡には、生物学的要素はほとんど、あるいは全く影響しない。
In order of importance, therefore, LIFESTYLE, ENVIRONMENT and HEALTH CARE ORGANIZATION contribute to traffic deaths in the proportions of something like 75%, 20% and 5% respectively.
交通事故に寄与している割合は、生活様式が75%、環境が20%、医療の構成が5%である。
This analysis permits program planners to focus their attention on the most important contributing factors.
この分析により、最も重要な要因に焦点を絞る計画の立案が可能となる。
Similar assessments of the relative importance of contributing factors can be made for many other health problems.
他の疾病についても、寄与要因の相対的な重要性を評価することができる。
A fourth feature of the Concept is that it permits a further sub-division of factors.
新たなる医療領域の概念の第4の特徴は、要因の細分化が可能なことである。
Again for traffic deaths in the Lifestyle category, the risks taken by individuals can be classed under impaired driving, carelessness, failure to wear seat-belts and speeding.
交通事故の例では、生活様式の要素のなかで、個人の不確実性は、飲酒運転、不注意、座席帯装着の失敗、高速走行に分類される。
In many ways the Concept thus provides a road map which shows the most direct links between health problems, and their underlying causes, and the relative importance of various contributing factors.
新たなる医療領域の概念は、疾病とその根本にある原因、そしてさまざまな寄与要因の相対的重要性が直接に関連していることを示す、さまざまな道筋をもたらす。
Finally, the Health Field Concept provides a new perspective on health, a perspective which frees creative minds for there cognition and exploration of hit her to neglected fields.
第5に、医療領域の概念は、健康の新たなる展望をもたらす。その展望は、彼女がおざなりにしていた領域の認識と探求にむけて、創造的精神を解放する。
The importance on their own health of the behaviour and habits of individual Canadians is an example of the kind of conclusion that is obtain able by using the Health Field Concept as ananalytical tool.
カナダ人一人一人の行動や習慣の、健康における重要性は、分析手段としての医療領域の概念の利用により得られる結論の一例である。
The foregoing formulation of two broad objectives, five main strategies and seventy-four proposals constitutes a conceptual framework within which health issues can be analysed in their full perspective and health policy can be developed over the coming years.
Since all of the propositions do not have equal weight, and since authority for their pursuit is widely dispersed among governments, professions and organizations, the Working Paper does not attempt to pre-judge jurisdictional and financial issues nor to set priorities for other levels of government.
Limitations on the availability of funds will require that expanded initiatives be carefully paced in relation to the ability of the economy to absorb them without adding to existing levels of taxation.
With the Health Field Concept and this Working Paper, however, there will be a much clearer picture of the options available.
In the end - by individuals, by society and by governments - choices must be made.
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1973.
4. McKeown, Thomas, An Interpretation of the Modern Rise in Population in Europe,
Population Studies, Vol. XXVII, No. 3, p. 345, November 1972.
5. Collins, R., Drinking on the Job, Imperial Oil Review, 1973, No. 2.
6. Laframboise, Hubert L., Health Policy. Breaking It Down Into More Manageable
Segments. Journal of the Canadian Medical Association, February 3, 1973.
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Psychiatry, Vol. 28, Jan. 1973, pp. 116-119.
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The enclosed chart gives a broad overview of the prevailing causes of death* for each sex and age group in Canada (1971).
It demonstrates the importance of the contribution of our lifestyle to mortality up to middle age, for example
motor vehicle accidents, cirrhosis of the liver, heart disease, etc.
It also emphasizes the different mortality patterns and rates for males and females.
The causes included are responsible for at least 5%** of the deaths within each sex and age group, thus one cause may be important only relative to certain age and sex groups, such as leukemia among young children.
The 13 first causegroups used in this chart represent two thirds of the total deaths after the age of 5.
PITFALLS TO AVOID
As indicated in note 2 on the chart, the areas of the circles are proportionate only to the absolute number of deaths, therefore one is unable to determine if the mortality rate of one group is greater than another by simple comparison between two circles.
The mortality rate, expressed in “per thousand”, for each age and sex group is obtained by dividing the number of deaths (d) by the corresponding population (p).
Shown hereunder are 3 examples of pitfalls resulting fromignorance of this fact:
a) The number of deaths among males aged 30 to 34 (1,090) is less than that of the preceding age group, 25-29 (1,176) although themortality rate among males aged from 30 to 34 (1,090/660,9=1.65 per thousand) exceed that of the 25-29 group (1,176/800.7=1.47 per thousand)
b) In the same way, deaths among women over 80 are more numerous than those among men of the same age group (23,285 and 21,016), nevertheless the mortality rate in women is less than that of the men from the same age group ( =116 per thousand, =150 per thousand)
c) The fact that suicide disappears from the chart after age 45 for females and age 50 for males is not due to a decrease in incidence but merely to a decrease in importance compared to other causes.
*Taken from “Vital statistics, 84-201, 1971” published by Statistics Canada, using the International Intermediate “A” List of 150 cause-groups.
**The arbitrary criterion of 5% has been selected so as to limit the causes to a manageable number. It must be noted that some causes of death listed are identical to those of the classification used (motor vehicle accidents:AE138, BreastCancer:A54...)whereas others correspond to groupings representing a more comprehensive entity (other accidents: AE 139-146, respiratory diseases: A 89-96, gastro-intestinal cancer: A 46-49, and cancer of the uterus and ovary: A 55, 56, 58D).