Chronic Diseases in Canada

Canada Report presented to the CARMEN Directing Board Meeting

San Juan, Puerto RicoJune 30, 2003

2

The Burden of Chronic Disease in Canada

Individuals and families16,000,000 live with chronic illnessChronic disease accounts for 87% of disability

High risk groupsIncreased prevalence in vulnerable communities (e.g. Aboriginals) and in socio-economically disadvantaged groups.

EconomyDirect health care costs: 67% of total direct costs are expended on chronic diseasesIndirect costs: 60% of total indirect costs ($52B), e.g, loss of productivity and foregone income

All these numbers will increaseAging, increased prevalence of some risk factors, e.g. obesity

3

First, some good news….

4

Age-Standardized Mortality Rates for Cardiovascular Diseases, Canadian Males

and Females, 1950-1999

0

100

200

300

400

500

600

700

800

De

ath

s/1

00

,00

0

Males Females

Source: Health Canada, 2003. Age-standardized to the 1991 Canadian population.

5

20-Year Trends in SmokingCurrent smokers by age, Canada, 1981-

2001

6

The not so good news…

7

Age-standardized mortality rates, by neighbourhood income quintile, urban

Canada, 1971 to 1996

Source: Statistics Canada, Catalogue 82-003. Supplement to Health Reports, volume 13, 2002, p. 57.

8

Age-standardized mortality rates, by neighbourhood income quintile, urban

Canada, 1971 to 1996

Source: Statistics Canada, Catalogue 82-003. Supplement to Health Reports, volume 13, 2002, p. 57.

9

Cardiovascular deaths in women is projected to increase

Growing Burden of Heart & Stroke, 2003

10

Cancer Progress Report, 2003

Burden of cancer in Canada is expected to double over the next 20 years

11

Diabetes deaths projected to increase…

Diabetes in Canada, Second Edition, 2003

Number of diabetes deaths (1950-1995) and projections to year 2016, by gender — Canada

12

13

A Rich History in Health Promotion

14

Canadian Investment in Health Promotion and Prevention to date…

Health promotion and disease prevention strategies mainly focused on:

Single Diseases

Single Risk Factors

Specific Population Groups

15

Towards a Common Risk Factor Approach

16

National Disease / Risk Factor Strategies

Partnership models Good foundation for integrated

chronic disease policies / programs

17

Canadian Strategy for Tobacco Control

Governance- Multisectoral Partnerships

Multi-pronged Strategy- Access- Advertising and Promotion- Packaging and Labelling- Product Regulations- Taxes- Smuggling- Enforcement and Education

Sustained over 15 years

18

Canadian Diabetes Strategy

A partnership model– Diabetes Council of Canada

A comprehensive approach– Social marketing

– Community programs– National Diabetes Surveillance

System– Addresses needs of vulnerable

populations – Aboriginal Diabetes Initiative

19

Canadian Cancer Control Strategy

Governance – a thorough and inclusive process

- Canadian Council for Cancer Control

Priorities for Action- Standards and Guidelines- Primary Prevention- Rebalancing Focus- Human Resources Planning- Research

20

National Action Plan for Children

Intersectoral and inclusive partnership

Multi-pronged approach

- Centres of Excellence for Children’s Well-Being

- Aboriginal Head Start

- Community Action Program for Children

- Canada Prenatal Nutrition Program

- Fetal Alcohol Syndrome/Fetal Alcohol Effects Initiative

21

Canadian Heart Health Initiative

Backbone of CARMEN/CINDI

Platform for community-based comprehensive programs

311 projects in 10 provinces, 35 community level programs

Development of tools and methodologies

Process evaluation Dissemination – research

Partnership and linkage model

International, national, provincial and community Public, private, and voluntary sector

…

22

Many achievements to date…

But still… Fragmentation and duplication of prevention and

resources across strategies

Lack of coherence and consistency of prevention messages and approaches

Lack of integrated evaluation framework

Lost opportunities to maximize prevention efforts and … achieve the “preventive dose”

23

Towards an integrated approach to chronic disease prevention

24

Current Opportunities NGOs moving towards cross-cutting

partnerships Chronic Disease Prevention Alliance of Canada

…

Coalition of Health Professions for Preventive Practice

Research agencies CIHR Institute of Population and Public Health

25

Current Opportunities

Provinces & Territories

Several provinces and territories have made significant strides in strategies and alliances

Alberta Nova Scotia British Columbia Québec

…

26

Current Opportunities

Parliamentary committees and Special commissions Kirby

Proposed national funding for chronic disease prevention

Supports a multi-stakeholder governance model for implementation of a national chronic disease prevention strategy

Romanow Strengthening the role of prevention in primary care focus on tobacco, obesity, physical activity…

27

Current Opportunities - Centre for Chronic Disease Prevention and Control

Knowledge Generation and Dissemination Sharing best practices for policy and community interventions

Policy Development and Analysis

Surveillance Expertise Integrated national chronic disease surveillance systems

International Links CINDI – CARMEN WHO – Collaborating Centre on NCD Policy WHO – Collaborating Centre on Surveillance of Cardiovascular

Diseases CDC - USA

28

Current Opportunities: Integrated Pan-Canadian Healthy Living Strategy

Pan-Canadian, comprehensive, collaborative initiative in partnership with national, P/T, and NGO/NVO stakeholders

Main goal is to reduce risks associated with diabetes, cancer, respiratory, and cardiovascular diseases

29

Current Opportunities: Integrated Pan-Canadian Healthy Living Strategy

Initial areas of emphasis on nutrition, physical activity and their relation to healthy weights

Pan-Canadian consultations held in Winter 2003, followed by National Healthy Living Symposium on June 16-17, 2003

Agreement on framework for action and presentation to F/P/T Ministers of Health for endorsement and potential funding in Fall 2003.

30

Key steps towards an integrated approach to chronic disease

prevention

Ensuring a high order of collaboration and strategic management for chronic disease prevention: Partnerships, coalition development

CDPAC…

Strengthening the capacity for a more integrated disease prevention approach: NGO professional groups and academia Public health infrastructure in Canada

… renewed concern and interest

31

Ensuring an effective information base to guide integrated prevention and control action

Knowledge synthesis and dissemination:

A systematic approach to building, consolidating, and disseminating research evidence to inform policy and action on chronic disease prevention and control

National Best Practice Consortium for Integrated Chronic Disease Prevention and Health Promotion

Integrated and Enhanced Surveillance for chronic disease: Integrate a range of existing and new data collection activities into a comprehensive

national surveillance and monitoring system Expand current surveillance systems to capture information on determinants, risk

factors, and also interventions FPT Task Group on Surveillance Systems for Chronic Disease Risk Factors

Research: Focus on translation / implementing research

CIHR research funding

Demonstration model for integrated chronic disease prevention as part of WHO CINDI/CARMEN

New demonstration site in Alberta