Canada has a single-payer health care system in which virtually all medical care is government-paid. Consumers have no copayments, no deductibles and no medical cost sharing.

Canada spends about 10% of GDP on health care, compared with about 17% in the United States. Canadians live about 80.7 years; Americans about 78.2. About 16% of Canadian men are obese, compared with 28% of American men.1

Why is Canada's obesity level lower - and life expectancy longer - than America's?

We'll answer this question by focusing on one key difference between Canada and America: zoning and land use patterns.2 These factors have a major impact on a population's health.

Canadian cities are generally more densely populated than American cities, with less surrounding suburban sprawl. Canadian metropolitan population densities are about 50% higher than in America, and Canadian metropolitan job densities are about 60% higher.

These factors led Alain Desroches of the Public Health Agency of Canada to conclude:

The denser, mixed-used development in Canadian cities leads to average trip distances only half as long in Canada, and thus more walkable than the longer trips Americans make. Canada also has higher transit user rates per capita than the U.S., accounting for walking between trips.

Can this really affect Canada's obesity levels, health status and longevity?

Let's assume that a "typical" Canadian walks five minutes from home to public transportation, then five minutes from public transportation to work, back and forth each work day. Let's also assume that the typical Canadian walks an additional 20 minutes for shopping, socializing or other routine trips (due to the local availability in high density, mixed use areas) five times per week.

At three miles per hour - a moderate walking pace - this "typical" Canadian walks about 500 more miles a year than a "typical" American.

At 100 calories per mile, our typical American would need to consume about 50,000 fewer calories per year than this Canadian just to maintain the same weight level.

This is especially difficult given the relative availability of high-calorie food in the U.S. Let's use McDonald's franchises as an indicator: McDonald's has one franchise for every 36,000 Canadians versus one franchise for every 26,000 Americans.3

Canadian land use and zoning patterns - denser urbanization than America - encourage more walking and exercise in normal daily life. Canadian social investments support this. Exercise acts as preventive medicine. As a result, Canadians are less obese and live longer than Americans, while spending less on health care.

Interestingly, European countries have even denser urban areas with more mixed use zoning than Canada, due largely to their historical development. Europeans walk and cycle even more per capita than Canadians, and thus far more than Americans.

For example, 60% of all journeys made by Dutch people over age 60 are by bicycle. Dutch obesity rates for middle-aged people are about 10%.4 The obesity rate for middle-aged Americans: almost 30%.

The key idea: European countries have even denser urbanization than Canada, requiring even more walking in daily life. This helps explain how they can spend less on health care than us, but live longer. EBA

Fradin is the president of HealthInsuranceCE, a provider of continuing education courses for health insurance brokers. He is also the author of Moral Hazard in American Healthcare (2007) and Healthcare Problems and Solutions (2008).

This month's column is related to "Insurance Solutions to Healthcare Problems," approved for CE in most states. EBA readers get a 15% discount on it through April 30, 2010. To access your discount, visit HealthInsuranceCE.com and use code "EBA-Mar" (Florida brokers use "EBA-MarFL").

Footnotes

1. Longevity estimate from Economist Pocket World in Figures, 2008; male obesity estimate from Economist Pocket World in Figures, 2007.

2. This discussion comes from John Pucher and Ralph Buechler, "Why Canadians Cycle More Than Americans," Transportation Policy 13 (2006) 265-279. All quotes and references in this section come from this article unless otherwise indicated.

3. Population figures Googled January 2008; McDonald's franchise figures from http://www.entrepreneur.com.

4. London Times, 2/18/08.