Comprehensive School Health in Canada: Benefits, Costs and Barriers.

1. Annual Meeting of the Ontario Society of Nutrition Professionals in Public Health June 3, 2011 Ottawa Dr. Paul Veugelers Comprehensive School Health in Canada: Benefits, Costs and Barriers.

2. What is the Challenge? • Lifestyles have changed dramatically • Health behaviors • Physical environment • Where people live sets the context for behaviors that influence health • Society is car-centered and full of fast food outlets • Social and cultural environment • Sets the context for health behaviors • Increase in income inequalities • Consumer access and choices

3. What is the Challenge? • Increasing rates of chronic diseases • Affects 89% of all Canadians • One in three children will develop type 2 diabetes • Children will no longer outlive their parents • Increasing costs in Canada • Chronic disease costs $183 billion annually – compared to WHO annual budget of approximately $4.5 billion • Most chronic disease is preventable by adopting healthy lifestyles • 91% of diabetes • 90% of cardiovascular disease • 70% of cancer

4. What is the Challenge? Grade 5 students in Alberta (2008)

5. Why School-based Health Promotion? • Habits developed at an early age can lead to lifelong behavioral patterns • There are benefits to learning and social development • Schools are places where: • Children spend most of their wakening hours • Children are educated • Parents and staff can be influenced • Environments can be changed

6. School-based Programs Work • Research • 50% of the 32 school-based intervention studies showed changes towards healthier body weights • Comprehensive School Health • An internationally recognized framework for supporting improvements in students’ educational outcomes while addressing school health in a planned, integrated and holistic way • Increasingly implemented in Canada

7. A ‘Best Practice’Annapolis Valley Health Promoting Schools project • What they do: • Healthy lunches only • No junk policy • Daily physical activities • Access to gym • Health & nutrition • curriculum • Parent involvement • Community involvement What we saw: • 59% less overweight • 72% less obesity • Better diets • More physical activity • Less screen time

8. A ‘Best Practice’Annapolis Valley Health Promoting Schools project

9. From ‘Best Practice’ to ‘Next Practice’

10. What is APPLE Schools? • The Alberta Program Promoting active Living and healthy Eating in Schools provides: • A trained facilitator in each school to facilitate the implementation of Comprehensive school Health • Annual research to determine nutrition and physical activity • Annual reports to schools compared to provincial averages (2008, 2010, 2012) • Support for developing action plans based on school research results

11. What is an APPLE School? Video www.appleschools.ca

12. Comprehensive School Health Veugelers et al IJPO 2008 Ahamed, Naylor et al Med Sci Sports Exerc 2007 Leatherdale et al IJBNPA 2010 Mullally, Taylor et al CJPH 2010

13. Comprehensive School Health • Can we implement it? • Is it effective?

14. Benefits to Diets 10% increase

15. Benefits to Diets 12% reduction

16. Benefits to Physical Active

17. Benefits to Body Weights 14% reduction in obesity

18. Other Benefits: School Performance Low diet quality: reference Middle group: 17% less failure Best diet quality: 30% less failure Florence et al. JSH 2008

19. Other Benefits: Self esteem Physical activity Diet quality Socio- economic status School quality Place of residency Physical Health Body weight School performance Wealth Mental Health Self esteem Wang et al. Obesity Reviews 2008

20. Barriers? • Schools or school staff do not support CSH • Parents don’t want schools to address healthy eating and active living • Kids don’t want this • Promotion programs are too costly?

21. Parental support for school policies Spitters et al. Physical Health Education Journal, 2009

22. Children’s support for school policies Spitters et al. Physical Health Education Journal, 2009

23. Costs for School Health Programs

24. Costs for School Health Programs To reach all Canadian Children: $100 million to $8 billion Health care costs • Long term • Short term Indirect costs • Productivity loss • Societal burden Costs for School Health Programs

25. Costs: What research tells us: • Annual healthcare costs: • $43 higher for obese kids • $12 higher for overweightkids • By age 14, obese children have incurred $400 higher physician costs • $50 million in annual costs for healthcare Kuhle et al. International Journal for Paediatric Obesity, 2010

26. Costs: What research tells us: • US Preventive Services Task Force (USPSTF): • 2010 recommendations on the basis of systematic review of the evidence • evidence for the effectiveness of interventions that are primary care feasible or referable • USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to intensive counseling and behavioral interventions • 75+ hours of intensive counseling in specialty health care facilities may lead to a 1.9 to 3.3 kg/m2 reduction in a 6 to 12 month period • Costs: 75 * $100 * 8,000,000 * 8%: $4.8 billion / year Paediatrics, 2010;125:361-367

27. Costs: What research tells us: • Dr. Hepple: • You live to be 80 of which 70 in good health • You live to be 100 of which 95 in good health • Compression of morbidity / Quality of life • Dr. Katzmarzyk: • The economic burden of physical inactivity in Canada in 2001 was $5.3 billion • Dr. Ohinmaa: • Canadian healthcare costs for diabetes increased from $4.66 billion in 2000 to $8.14 billion in 2016 • Chronic disease costs $183 billion annually

28. Costs for School Health Programs $183 billion for health care costs Indirect costs? Health care costs • Short term • Long term Indirect costs • Productivity loss • Societal burden $100 million to $8 billion Costs for School Health Programs

29. Return on Investment Gains: • Healthy diets • Active lifestyles • Better health • Better learning • Better self esteem • Compression of morbidity • Prevent chronic diseases • A healthy workforce • Avoid healthcare costs • Needs: • More best practices • Financial investments • Partnerships • Policies to facilitate change

30. Acknowledgements • Students, parents, schools and school districts • Philanthropist • Alberta and Nova Scotia Governments • CRC program, AIHS, CIHR, HSFC, CPHI • My team

31. Questions • APPLESchools.ca • REALKidsAlberta.ca • NSCLASS.ca