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Hertzman, Clyde & Siddiqi, Arjumand A. (2008). Tortoises 1, Hares 0: How Comparative Health Trends between Canada and the United States Support a Long-Term View of Policy and Health. Healthcare Policy, 4(2), 16-24. PMCID: PMC2645214


Fifty years ago, Canadian and US life expectancies were roughly equal. Now, however, Canadians are, on average, healthier than Americans. To discover the reasons behind this trend, the authors compared Canada and the United States on a range of determinants of health based on data from 1950 to the present. Their analysis yielded three conclusions: (1) greater economic well-being and spending on healthcare did not yield better health outcomes; (2) public provision and income redistribution trump economic success where population health is concerned; and (3) the gradual development of public provision represents the build-up of social infrastructure that has long-lasting effects on health status. The authors contend that in the context of thinking about population health, the historical, dynamic approach casts a clearer light on trends than does the cross-sectional approach.

Reference Type

Journal Article

Year Published


Journal Title

Healthcare Policy


Hertzman, Clyde
Siddiqi, Arjumand A.