Pop. health context: Romanow and the 3 burning health policy issues

Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - AtlantiqueNew Directions for Health Policy in Nova Scotia: The Genuine Progress Index Health Law and Policy Seminar SeriesDalhousie University,29 September, 2006

Pop. health context: Romanow and the 3 burning health policy issues 1) How to treat the sick - supply side 2) How to prevent disease and improve the health of Canadians 3) How to check spiralling health care costs - demand side The next Royal Commission......

The larger context – how to create a healthier Canada?

Valuing a Healthy Population – the importance of indicators GPI population health reports include: • Costs of chronic disease in Canada and NS • Women’s health in Canada + Atlantic Canada • Income, Equity and Health in Canada/Atl Can. • Costs of tobacco, obesity, physical inactivity, HIV • Economic Impact of Smoke-Free Workplaces • Value of care-giving

Economic Language:- Chronic Disease as Cost,- Prevention = Investment • Costs of chronic disease are very high • Indirect costs, particularly, are huge • Large proportion of costs preventable • Disease prevention (esp. dealing with root causes) is cost-effective

¾ Canadians die from 4 types of chronic disease = 5,800 deaths in NS (cf 1900) • Cardiovascular: 2,800 36% • Cancer 2,400 30% • COPD 370 5% • Diabetes 230+ 3%+

NS: High Rate Chronic Disease • NS - highest rate of deaths from cancer and respiratory disease • Highest rate arthritis, rheumatism • 2nd highest circulatory deaths, diabetes • 2nd highest psychiatric hospitalization + Gap with Canada is growing....

Chronic Disease Disability • 1/4 Nova Scotians have long-term activity limitation - highest in country • NS has highest use of disability days • 20% have arthritis or rheumatism • 16% have high blood pressure • 14% have chronic back problems

Costs of 7 types non-infectious chronic disease, NS, 1998 • 60% medical costs = $1.2 billion / year • 76% disability costs = $900 million • 78% premature death costs = $900 mill. • 70% total burden of illness = $3 billion = $3,200 per person per yr = 13% GDP

Cost of Chronic Illness in Nova Scotia 1998 (2001$ million)

These are under-estimates • Exclude diseases: Digestive, cirrhosis of liver, congenital, perinatal/LBW, blood, skin, genitourinary (chronic renal failure), etc. • “Principal diagnosis”: e.g. injury/fall vs osteoporosis; diabetes under-reported (complications: blindness, kidney failure, amputations, cardiovascular disease, infections). Diabetes 2afflicts 4% (38,000) Nova Scotians, disables 3,300, kills 230 - 850

What portion is preventable? Excess risk factors account for: • 40% chronic disease incidence • 50% chronic disease premature mortality • Small number of risk factors account for 25% medical care costs = $500 mill./yr (->Creation of OHP) • 38% total burden of disease = $1.8 bill. (includes direct and indirect costs)

A few risk factors cause many types of chronic disease • Tobacco - heart disease, cancers, respiratory disease • Obesity - hypertension, diabetes 2, heart disease, stroke, some cancers • Physical inactivity - heart disease, stroke, hypertension, colon and breast cancer, diabetes 2, osteoporosis • Diet/fat - heart disease, cancer, stroke, diabetes

Costs of Key Risk Factors, Nova Scotia (2001 $ millions)

Case Study:Obesity-related illness • Costs U.S. $118 billion / year (Colditz) - now exceeds smoking; but doctor, drug, hospital costs make economy grow • More than 50% diabetes 2 due to obesity • Type 2 diabetes grown 5-fold globally since 1985 from 30 to 150 million (17 million in US). WHO predicts 300 million by 2025

Health Impacts • BMI >30 = 4x diabetes; 3.3x high blood pressure; 56% more likely have heart disease; 2.6 times urinary incontinence; 50% less likely rate health positively (Statcan) • Association with some cancers, gallbladder disease, stroke, asthma, arthritis, thyroid problems, back problems, sleep disorders, impaired immunity, depression, etc.

A “Global Epidemic” (WHO) • Obesity increased 400% in the western world in the last 50 years. • Underfed and Overfed: The Global Epidemic of Malnutrition: “ for the first time in human history the number of overweight people in the world now equals the number of underfed people, with 1.1 billion each.”March, 2000, Worldwatch Institute, Washington D.C.

Underfed and Overfed • The hungry and the overweight share high levels of sickness and disability, shortened life expectancies, and lower levels of productivity -- all of which impede a country's development • Among the overweight, "obesity often masks nutrient starvation," as calorie-rich junk foods squeeze healthy items from the diet. In Europe and North America, fat and sugar now account for more than half of total caloric intake BUT few doctors give nutrition counselling

Low-income, poorly educated, elderly = higher rates overweight, obesityPercent of Canadians who believe that low-fat foods are expensive, 1994-95

Overweight- by Education and Age (20-64), Canada, 1997 (%)

Obesity Trends* Among U.S. Adults, 1985Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults, 1986

Obesity Trends Among U.S. Adults, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends Among U.S. Adults 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends Among U.S. Adults 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends Among U.S. Adults2002 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends Among U.S. Adults 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS,1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5’4” person) 1995 1990 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Pop. health context: Romanow and the 3 burning health policy issues