Improving the Health of Manitobans: Economic Analysis and Business Case

1. Improving the Health of Manitobans:Economic Analysis and Business Case Heart and Stroke Foundation of Manitoba October 14, 2009

2. Overview of Presentation • Understanding the Manitoba Context • Prevalence and Historical Trends in the Risk Factors • Risk Factors and the Burden of Disease • The Economic Burden of the Risk Factors in Manitoba • The Benefits of Reducing Risk Factors

3. Overview of Presentation • Identify ‘Best Practices’ for Reducing the Risk Factors • Estimating the Cost of Implementing ‘Best Practices’ • Cost-Benefit Analysis

4. Caveats • Research Project(s)? • Each step could be it’s own research project • Business Case? • Need to convince decision-makers • Business Plan? • Detailed plan for moving forward in a certain direction • Focus on • Tobacco consumption • Unhealthy eating / Obesity • Physical inactivity

5. Understanding the Manitoba Context • Relevant policies/legislation/regulations in Manitoba • Manitoba’s partners in healthy living • Current programs with a focus on the risk factors in Manitoba

6. Understanding the Manitoba Context • Process • Review websites, grey literature, etc. E.g. CPAC PPAG review of policy and legislation as it relates to food, physical activity, etc. in Canada • Input from Steering Committee and Reference Group • Interviews – personal and telephone

7. Prevalence and Historical Trends in the Risk Factors (or, What’s the Problem?) • Recent study completed for CPAC – “An Overview of Selected Cancers and Modifiable Cancer Risk Factors in Canada” • Covers the current risk factors as well as a few others (alcohol, breastfeeding) • Full report available at www.krueger.ca

16. Risk Factors and the Burden of Disease • What evidence is there for the relationship between the risk factors and the burden of disease? • Review from “The Health Impact of Smoking & Obesity and What to Do About It”(2007) by Krueger, Williams, Kaminsky and McLean

23. The Economic Burden of the Risk Factors (in Manitoba) • Excess cost per individual with the risk factors • Direct and indirect costs • Annual cost to the province

29. The Benefits of Reducing Risk Factors • What evidence is there that a change in risk factors is associated with a change in health? • Research complicated by the fact that changes in behavior (e.g. quitting smoking) often associated with diagnosis of a disease (e.g. cancer) • Health improvements not always immediate

30. The Benefits of Reducing Risk Factors (cont’d) • Weight loss – intentional (24% mortality rate) vs. unintentional (31% mortality rate) (Greg et al. Ann Int Med (2003) • Smoking cessation associated with a spike in costs • Early death of smokers spares them from poor health during their later years (if they had not smoked)

32. Identify ‘Best Practices’ for Reducing the Risk Factors • Review of the available literature • Much more research on effective interventions for smoking cessation • Identify ‘best’ and ‘promising’ interventions, particularly for other risk factors

33. Identify ‘Best Practices’ (cont’d) What can we learn from the ‘Tobacco Wars’ about effective interventions? • Increasing Prices • Reducing Opportunities to Promote the Product • Smoke-free Public Places • Counter Advertising • Primary Care Based Cessation Programs

35. Identify ‘Best Practices’ (cont’d) What can we learn from the ‘Tobacco Wars’? • No single intervention can account for the successes seen since the 1960s • Each intervention is enhanced synergistically by other components • Required systemic changes (ban on advertising, price increases, legislated smoke-free places) and social ‘denormalization’ • Governments and communities must work together with adequate financial and organizational resources over the long haul • Interventions must be available for individuals who seek to make a lifestyle change

36. Identify ‘Best Practices’ (cont’d) • Overweight: What Can we Learn from the ‘Tobacco Wars’ - Differences • Food and activity are essential; tobacco is not • Possible negative consequences (disordered eating) • Underlying genetic/disease conditions • Limited research on effective interventions

37. Identify ‘Best Practices’ (cont’d) Overweight: What Can we Learn from the ‘Tobacco Wars’ - Similarities • Social influences and advertising pressures influence what we eat • Environmental constraints can lead to limitations on physical activity • ‘Obesogenic environment’

39. Identify ‘Best Practices’ (cont’d) • Regulatory and Economic Interventions(cont’d) • Consider restrictions on food advertising aimed at children • Consider a focused trial of taxation measures for specific unhealthy foods • Continue to protect against creative attempts by the tobacco industry to market their product, e.g., retail “power walls,” product placements, smoking in movies & magazines • Improve compliance with restrictions on tobacco sales to minors

40. Identify ‘Best Practices’ (cont’d) • Community-Based Interventions • Establish Community Action Coordinators (2 per electoral riding) to mobilize strategies for risk factor reduction • Provide modest funding for up to 1,200 community groups throughout the province with ideas on how to address risk factors • Develop a strategic media plan with clear, common messages for different at-risk populations with well-conceived short and long term advocacy goals • Consider subsidizing pedometers as a source of instant feedback to individuals who are attempting to become more physically active • Implement “point-of-decision” prompts to encourage healthy behaviours • Encourage and support walking groups and physical activity events • Enhance access to places of physical activity; both indoor and outdoor

41. Identify ‘Best Practices’ (cont’d) • School-Based Interventions • Expand Action Schools! BC program and encourage a more rapid implementation of some of its recommendations, plus coordination with anti-smoking resources, to move towards significant levels of primordial prevention among young people • Focus on environmental approaches to risk factor interventions, including options for promoting healthy foods, curtailing access to unhealthy foods, creating opportunities for physical activity and tobacco free sites. • Workplace-Based Interventions • In partnership with WCB, unions, business and others, offer funding to assist employers and employees to create a healthier work environment, from stairway walking campaigns to exercise facilities and healthy food choices

42. Identify ‘Best Practices’ (cont’d) • Clinical Interventions and Management • Implement a program of ‘prevention detailing’ to provide education and feedback to enable primary health care providers to more fully address risk factors • Cover out-of-pocket expenses for nicotine replacement therapy initiated within a recognized clinical program • Provide reimbursement for lifestyle counselling around physical activity, healthy eating and living smoke free • Provide compensation to primary health care providers for lifestyle counselling around physical activity, healthy eating and living smoke free

43. Estimating the Cost of Implementing ‘Best Practices’ • High level costing of implementing the major interventions • E.g. from increased taxation to community-based action co-ordinators to prevention detailing, etc.

45. Cost-Benefit Analysis • Combining information on • Potential Targets • Cost of interventions required to achieve targets • Potential costs avoided if the targets are achieved

50. Logical Pathway