Chronic diseases or noncommunicable diseases, are diseases that are not passed from person to person, are of long duration, and are generally slow in progression. Chronic diseases of public health importance include, but are not limited to, obesity, cardiovascular diseases, respiratory disease, cancer, diabetes, intermediate health states (such as metabolic syndrome and prediabetes), hypertension, dementia, mental illness, and addictions.
Public Health Ontario states that “Ontario’s population is projected to continue aging and growing, reaching 16.9 million in 2031, when nearly 25% of Ontarians will be aged 65 and over.” With increasing aging population, the increase in chronic disease is predictable, however, there is still opportunity to prevent many of these diseases. Although some chronic disease may be hereditary there are also many that are preventable. The underlying risks factors such as alcohol consumption, tobacco use, physical inactivity, and an unhealthy diet are all life style choices that have a direct impact on one’s health. Our ability to improve our outcomes are influenced in many respects by our environment. Ontario has developed a Chronic Disease Prevention and Management Framework which identifies mutually dependent practice changes which support prevention and management of chronic disease.
Despite population growth and aging, the substantial burden of chronic disease is not inevitable. Chronic diseases share underlying modifiable risk factors: tobacco use, alcohol consumption, physical inactivity and unhealthy eating. Changing the “environment” in which the population makes lifestyle choices can help to reduce exposure to these risks. (For example, laws prohibiting smoking in restaurants eliminate population exposure to second-hand smoke in restaurants)
· Health Care Organizations that make systematic efforts to improve prevention and management of chronic disease;
· Delivery System Design that is focused on prevention and that improves access, continuity of care and flow through the system;
· Provider Decision Supports that integrate evidence-based guidelines into daily practice;
· Information Systems that enhance information for providers so they can provide quality care, that support individuals in managing their diseases, and that integrate services across the system;
· Personal Skills and Self-Management Supports that empower individuals to build skills for healthy living and coping with disease;
· Healthy Public Policies that improve individual and population health and address inequities;
· Supportive Environments that remove barriers to healthy living and promote safe, enjoyable living and working conditions;
· Community Action that encourages communities to increase control over issues affecting the health of their residents.
As in Canada and around the world, the prevalence of chronic disease in Newfoundland and Labrador (NL) is growing rapidly. This is a result of our aging population, increasing obesity rates, and high levels of modifiable risk factors such as smoking, unhealthy diet, and sedentary lifestyle (Stats Canada, 2012). The correlation between age and chronic disease means that NL will likely have higher rates of chronic disease than other provinces and will have a rising financial burden on the health system (Stats Canada, 2010).
Cardiovascular disease (CVD) affects one in three Newfoundlanders and Labradorians, while it affects one in 12 Canadians. (Government of Canada, 2017). Working within the cardiac and critical care program for the last 4 years has really opened my eyes to not only the number of people living with cardiac disease, but the effect it has on their lives and the health care system. Costs related to cardiovascular disease, including hospital care, drugs, and physician care, in Canada are estimated to be $6.8 billion annually. (Pswarayi, et al., 2018). NL spends $6,531 per capita on healthcare and still has the highest CVD related mortality in the country. (Pswarayi, et al., 2018). These numbers are concerning given the population on NL is just over 500,000 people.
1. Better value through improvement outcome: “An improved health and community services system that achieves better value through lower costs while improving patient outcomes through appropriateness of care and the appropriate utilization of resources” (Government of NL, 2017). There will be focus on: E-health technology, performance measurement, health workforce planning, policy development, and sharing and coordinating services.
2. Better health for the population outcome: Improve the health outcomes of the people of Newfoundland and Labrador by supporting a healthy population and focusing on: cardiovascular health, chronic disease prevention and management, mental health and addictions, primary healthcare, and public health.
3. Better care for individuals’ outcome: Improved accessibility of health and community programs and services to better the care of the population, including vulnerable persons, by improving wait times, community supportive services, and infrastructure Improvement.
Through our collaboration it has become quite evident that both Ontario and Newfoundland and Labrador are facing a rocky future with an aging population and increasing rates of chronic illness if there are not some drastic changes made. Both governments have started some great projects and made some strides in improving the health of the population through improved accessibility, increased chronic disease monitoring, and improved population and public health, but we still have such a long way to go. We need to focus on the “why” as much as the “who” when looking at the prevalence of chronic disease.
Through our collaboration it has become quite evident that both Ontario and Newfoundland and Labrador are facing a rocky future with an aging population and increasing rates of chronic illness if there are not some drastic changes made. Both governments have started some great projects and made some strides in improving the health of the population through improved accessibility, increased chronic disease monitoring, and improved population and public health, but we still have such a long way to go. We need to focus on the “why” as much as the “who” when looking at the prevalence of chronic disease.
Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario. Public Health Ontario. (2012). http://www.publichealthontario.ca/en/data-and-analysis/chronic-disease/taking-action-chronic-disease-prevention. Chronic disease prevention guideline, 2018 [PDF]. (2018).
(n.d.). https://www.publichealthontario.ca/-/media/documents/T/2012?taking-action-chronic-diseases.pdf?la=en
Department of Health and Community Services. (2014). Healthy People, Healthy Families, Healthy Communities: A Primary Health Care Framework for Newfoundland and Labrador 2015-2025. St. John's, NL.
105-0501 – Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2013 boundaries) and peer groups, occasional. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009601.
Statistics Canada (2020). Health characteristics, annual estimates. https://www.health.gov.on.en/pro/programs/publichealth/oph_standards/docs/protocols_guidlines/Chronic_disease_Prevention_Guidlines_2018.pdf
Pswarayi, H., Dankwah, E., Kaur, M., et al. (2018). Provincial health expenditure and cardiovascular disease mortality, a panel data study of Canadian provinces. International Journal of Health Planning and Management, 33. https://doi.org/10.1002/hpm.2582
Preventing and managing chronic disease – health care professionals – mohltc. (n.d.). http://www.health.gov.on.ca/en/pro/programs/cdpm/Statistics Canada (2016). Table
Statistics Canada (2010).
Population projections for Canada, provinces and territories, 2009 to 2036. Population Projections for Canada, Provinces and Territories (statcan.gc.ca)
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