chronic diseases in canada canada report presented to the carmen directing board meeting san juan,...
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Chronic Diseases in Canada
Canada Report presented to the CARMEN Directing Board Meeting
San Juan, Puerto RicoJune 30, 2003
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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
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First, some good news….
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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.
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20-Year Trends in SmokingCurrent smokers by age, Canada, 1981-
2001
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The not so good news…
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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.
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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.
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Cardiovascular deaths in women is projected to increase
Growing Burden of Heart & Stroke, 2003
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Cancer Progress Report, 2003
Burden of cancer in Canada is expected to double over the next 20 years
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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
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A Rich History in Health Promotion
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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
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Towards a Common Risk Factor Approach
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National Disease / Risk Factor Strategies
Partnership models Good foundation for integrated
chronic disease policies / programs
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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
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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
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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
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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
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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
…
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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”
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Towards an integrated approach to chronic disease prevention
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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
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Current Opportunities
Provinces & Territories
Several provinces and territories have made significant strides in strategies and alliances
Alberta Nova Scotia British Columbia Québec
…
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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…
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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
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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
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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.
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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
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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