Pop. health context: Romanow and the 3 burning health policy issues
description
Transcript of Pop. health context: Romanow and the 3 burning health policy issues
![Page 1: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/1.jpg)
Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - Atlantique
New Directions for Health Policy in Nova Scotia:
The Genuine Progress Index
Health Law and Policy Seminar Series
Dalhousie University, 29 September, 2006
![Page 2: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/2.jpg)
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......
![Page 3: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/3.jpg)
The larger context – how to create a healthier
Canada?
![Page 4: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/4.jpg)
Valuing a Healthy Population – the
importance of indicatorsGPI 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
![Page 5: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/5.jpg)
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
![Page 6: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/6.jpg)
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%+
![Page 7: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/7.jpg)
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....
![Page 8: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/8.jpg)
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
![Page 9: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/9.jpg)
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 = $3,200 per person per yr = 13% GDP
![Page 10: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/10.jpg)
Cost of Chronic Illness in Nova Scotia 1998 (2001$
million) Hosp. Doctor Drugs Other
TotalDirect
Premat.Death
Dis-ability
TOTAL
Circulatory 161.6 26.6 63.6 137.8 389.6 326.8 244.4 960.8
Cancer 71.4 11.8 7.5 49.6 140.3 427.2 14.5 582.1
Respiratory 21.6 3.2 16.6 22.7 64.1 43.4 78.1 185.5
Musculoskeletal 55.9 20.3 22.0 53.8 152.0 3.5 307.2 462.8
Endocrine 18.5 7.2 29.3 30.1 85.0 43.8 27.0 155.8
Nervous system 55.3 27.9 19.2 56.0 158.5 30.0 158.6 347.0
Mental 104.2 17.7 39.2 88.2 249.2 16.0 72.3 337.5
TOTAL: 488.4 114.8 197.5 438.1 1,238.8 890.8 901.9 3,031.5
![Page 11: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/11.jpg)
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 2 afflicts 4% (38,000) Nova Scotians, disables 3,300, kills 230 - 850
![Page 12: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/12.jpg)
![Page 13: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/13.jpg)
![Page 14: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/14.jpg)
![Page 15: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/15.jpg)
![Page 16: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/16.jpg)
![Page 17: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/17.jpg)
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)
![Page 18: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/18.jpg)
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
![Page 19: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/19.jpg)
Costs of Key Risk Factors, Nova Scotia
(2001 $ millions)Deaths Direct Indirect Total
Tobacco 1,700 $188 $300 $488
Obesity 1,000 $120 $140 $260
PhysicalInactivity 700 $107 $247 $354
![Page 20: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/20.jpg)
![Page 21: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/21.jpg)
![Page 22: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/22.jpg)
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
![Page 23: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/23.jpg)
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.
![Page 24: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/24.jpg)
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.
![Page 25: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/25.jpg)
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
![Page 26: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/26.jpg)
Low-income, poorly educated, elderly = higher rates overweight,
obesityPercent of Canadians who believe that low-fat foods are expensive, 1994-95
40
37
34
32
40
25
27
29
31
33
35
37
39
41
lowest low-middle middle upper middle highest
Pe
rce
nt
![Page 27: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/27.jpg)
Overweight- by Education and Age (20-64), Canada, 1997
(%)
30 29
22
15
24
29
3639
36
0
5
10
15
20
25
30
35
40
45
Pe
rce
nt
![Page 28: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/28.jpg)
Obesity Trends* Among U.S. Adults, 1985Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
![Page 29: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/29.jpg)
Obesity Trends* Among U.S. Adults, 1986
![Page 30: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/30.jpg)
Obesity Trends* Among U.S. Adults, 1987
![Page 31: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/31.jpg)
Obesity Trends* Among U.S. Adults, 1988
![Page 32: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/32.jpg)
Obesity Trends* Among U.S. Adults, 1989
![Page 33: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/33.jpg)
Obesity Trends* Among U.S. Adults, 1991
![Page 34: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/34.jpg)
Obesity Trends* Among U.S. Adults, 1990
![Page 35: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/35.jpg)
Obesity Trends* Among U.S. Adults, 1991
![Page 36: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/36.jpg)
Obesity Trends* Among U.S. Adults, 1992
![Page 37: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/37.jpg)
Obesity Trends* Among U.S. Adults, 1993
![Page 38: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/38.jpg)
Obesity Trends* Among U.S. Adults, 1994
![Page 39: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/39.jpg)
Obesity Trends* Among U.S. Adults, 1995
![Page 40: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/40.jpg)
Obesity Trends* Among U.S. Adults, 1996
![Page 41: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/41.jpg)
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%
![Page 42: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/42.jpg)
Obesity Trends Among U.S. Adults, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
![Page 43: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/43.jpg)
Obesity Trends Among U.S. Adults, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
![Page 44: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/44.jpg)
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%
![Page 45: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/45.jpg)
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%
![Page 46: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/46.jpg)
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends Among U.S. Adults2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
![Page 47: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/47.jpg)
Obesity Trends Among U.S. Adults 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
![Page 48: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/48.jpg)
Obesity Trends Among U.S. Adults 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
![Page 49: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/49.jpg)
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%
![Page 50: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/50.jpg)
1995
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1995, 2005
(*BMI 30, or about 30 lbs overweight for 5’4” person)
2005
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
![Page 51: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/51.jpg)
Overweight Canadians (BMI = >27),Canada and Provinces, Age 20-64,
(%)Overweight Adults
38.537 37.6
41
26.528.4
34.2 35.3
29.426.4
29
0
5
10
15
20
25
30
35
40
45
Per
cent
![Page 52: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/52.jpg)
European studies: e.g.• Netherlands: Obese individuals 40% more
likely visit doctors; 2.5 times more likely take drugs for CVD = direct costs
• Sweden: Obesity accounts for 7% of lost productivity due to sick leave, disability. Obese workers = 2x more likely to take long-term sick leave = indirect costs
NS, NB – highest # sick days in Canada
![Page 53: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/53.jpg)
Solutions must address causes of obesity
epidemic• Poor diet
• Physical inactivity
• Poverty, illiteracy
• Employment patterns
• Other underlying social causes (e.g. work schedules)
![Page 54: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/54.jpg)
Obesity is only one consequence of poor
diet• Nutrient-poor, high-fat, high-sugar diets,
with low fibre and chemical additives contribute to cancers of breast, colon, mouth, stomach, pancreas, prostate
• 30% of cancers worldwide could be prevented by switching to healthy diets
• USA: fat + sugar = 50%+ average caloric intake; complex carbohydrates just 1/3
![Page 55: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/55.jpg)
Dangers are out of sight
• Fats, oils, sugars, salt added to processed and prepared foods
• 1909: 2/3 discretionary sugar added in household. Today, more than 3/4 of sugar consumed is added to processed and prepared food, out of sight of consumer
• Whole grains largely replaced by refined grains (lack vitamins, minerals). Only 2% wheat flour in U.S.= unrefined
![Page 56: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/56.jpg)
Fast food• Single fast-food meal may exceed daily fat,
sugar, cholesterol, and sodium RDAs
• Marketing: “Supersize” meal for 79c = 42 fl.oz. Coke (vs 16) + free refills; more than double weight of french fries = increases calories of nutrient poor, fat-rich meal from 680 to more than 1,340
• 1/5 “vegetables” consumed in U.S. = french fries and potato chips
![Page 57: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/57.jpg)
Ignorance re processed food
• Surveys show food labels widely misunderstood, misinterpreted, esp. ingredient lists, nutritional panels, validity of food claims on labels
• $30 billion annual food advertising dwarfs nutritional education budgets. Consumers get their knowledge from industry.
New DHPP school program step in right direction…..!
![Page 58: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/58.jpg)
Physical activity
• U.S. Surgeon-General: Physical activity promotes fat loss; weight loss (dose-response a/c frequency, duration of session and program)
• Sedentary = 44% higher rate of obesity than physically active; 5x risk of heart disease; 60% higher depression (see GPI report on cost of physical inactivity)
![Page 59: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/59.jpg)
Television Viewing, Average Hours per Week;
1999
24.5
20.7
22.1
22.9
24.7
20.5 20.320.8
19.6
20.7
21.6
15
17
19
21
23
25
27
Canada Nfld PEI NS NB Que Ont Man Sask Alta BC
Ho
urs
![Page 60: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/60.jpg)
TV linked to child obesity
• American Academy of Pediatrics: “Increased television use is documented to be a significant factor leading to obesity.”
• Study in JAMA: Children lost weight if they watched less television
• Add computer games. Childhood obesity rate has doubled in 20 years
Value of physician and school counselling…
![Page 61: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/61.jpg)
Stress, health, and weight
• Women w. high levels of job strain 1.8 times more likely experience unhealthy weight gain vs low job strain. Reduced work hours = 1/2 odds of weight gain cf standard hours
• Longer hours = 40% more likely decrease physical activity; 2.2 times more likely experience major depression; higher levels smoking (stress-related) and drinking
(Statistics Canada)
Value of counselling on stress, lifestyle
![Page 62: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/62.jpg)
Eating out has increased sharply,
but...• Harvard study - 16,000 children- the
more families eat at home together, the more fruits & vegetables are eaten, less fried food + higher intake of important nutrients (calcium, fiber, folate, iron, vitamins B & E
• Healthy diets persist into adulthood
Counsel eating home-cooked meals, breast-feeding
![Page 63: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/63.jpg)
Promote Healthy Diets and Nutritional Literacy
– Teachers can be trained to explain nutritional labels in class
– Singapore “Trim and Fit” program cut school children’s obesity 33%-50%
– Doctors, nurses given more explicit diet and nutritional training, yet only 23% U.S. medical schools require separate nutrition course
![Page 64: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/64.jpg)
Practising what we preach• Schools, universities, hospitals, work-
places can act alone to improve food quality, nutritional content (vs contract with fast food companies)
• Berkeley schools - vegetable gardens to teach, supply school cafeteria. 1999 - organic lunches
• DHPP’s new school food guidelines
![Page 65: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/65.jpg)
Case studies and models
• U.S. grade 3-5 “Child and Adolescent Trial for Cardiovascular Health” found lower fat, higher physical activity well into adolescence - Behavioural changes at young age have lasting effects
• Finland - nutrition media campaign, strict food labelling (e.g. “heavily salted”), education - helped cut heart disease deaths 65% 1970-95
![Page 66: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/66.jpg)
And in the future....?• Restrictions on advertising (cf tobacco)
• Tax on foods inversely proportion to nutrient value per calorie (Kelly Brownell, Yale). Fatty, sugary, high-calorie, low nutrition = highest taxes, ; fruits, vegetables, whole grains exempt
• Tax revenues to nutritional education just as portion of cigarette, gambling revenues fund anti-smoking, counselling
![Page 67: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/67.jpg)
Socio-economic Determinants of Health• Education, income, employment, stress,
social networks are key health determinants. These too are modifiable
• Lifestyle interventions effective for higher income/education groups, not lower - can widen inequity, health gap
The need for health promotion personnel to be political……
![Page 68: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/68.jpg)
Health Costs of Poverty
• Most reliable predictor of poor health, premature death, disability: 4x more likely report fair or poor health = costly
• e.g. Increased hospitalization: Men 15-39 = +46%; 40-64
= +57% Women 15-39 = +62%; 40-64 = +92%
![Page 69: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/69.jpg)
Heart Health Costs of Poverty
• Low income groups have higher risk of smoking, obesity, physical inactivity, cardiovascular risk = costly
• NS could avoid 200 deaths, $124 million/year if all Nova Scotians were as heart healthy as higher income groups
![Page 70: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/70.jpg)
…delayed child development• 31 indicators - as family income falls,
children have more health problems, (NLSCY, NPHS, Statistics Canada)
• Child poverty -> higher rates respiratory illness, obesity, high blood lead, iron deficiency, FAS, LBW, SIDS, delayed vocabulary development, injury+….
![Page 71: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/71.jpg)
Highest Risk Groups• Single mothers & their children
• Homeless: longer hospital stay cf low income
• Unemployed, Aboriginals, migrants, minorities, disabled
= Clustered disadvantages (poverty, illiteracy, unemployment, ill-health): “Social exclusion”
![Page 72: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/72.jpg)
……health of single mothers• Worse health status than married
(NPHS); higher rates chronic illness, disability days, activity restrictions
• 3x health care practitioner use for mental, emotional reasons = costly
• Longer-term single mothers have particularly bad health (Statcan)
![Page 73: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/73.jpg)
Employment of Female Lone Parents 1976-2001
![Page 74: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/74.jpg)
Low Incomes : 1991-2000Single mothers w/out paying jobs
![Page 75: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/75.jpg)
The Economics of Single-Parenting
• Single mothers with pre-school children spend 12% income on child care cf 4% in 2-parent families. In one pocket .........
• CPI for child care, restaurant good rises faster than wages
• Robin Douthitt: “time poverty”. Full-time single mothers = 75 hour week
![Page 76: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/76.jpg)
Health Cost of Inequality
• British Medical Journal: “What matters in determining mortality and health is less the overall wealth of the society and more how evenly wealth is distributed. The more equally wealth is distributed, the better the health of that society.”
• e.g. Sweden, Japan vs USA
![Page 77: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/77.jpg)
Costs of Inequality in NS
• Excess physician use (Kephart) (Small fraction of total costs):
– No high school = +49% than degree Lower income = +43% than higher
– Educational inequality = $42.2 million Income inequality = $27.5 million = costs avoided if all Nova Scotians were as healthy as higher income / BA
![Page 78: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/78.jpg)
If Equality->Health, What are Trends?
Average Disposable H’hold Income Ratios, 1980-98
![Page 79: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/79.jpg)
Social Supports
• Health Canada: “...as important as established risk factors” in contributing to health and medical outcomes, and reducing premature death, depression, mental illness, stress, chronic disability, aiding recovery from illness
• Family, friends, communities, volunteers
DHPP actions to strengthen social support networks….
![Page 80: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/80.jpg)
The economic case for prevention: Aging -
Delay vs Cure Saves $
• NS 65+: 2001 = 14%; 2011 = 16%; 2036 = 28%
• 5-year delay in onset cardiovascular disease could save NS $200 million / yr
• Physically active - lower lifetime illness
• Nutritional intervention - reduce hospital use 25-45% among elderly
![Page 81: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/81.jpg)
“Compression of Morbidity”
• Fries: “The amount of disability can decrease as morbidity is compressed into the shorter span between the increasing age at onset of disability and the fixed occurrence of death.” (= about 85: analysis of 1900s data)
• “Successful aging” can preserve independence into old age
![Page 82: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/82.jpg)
Disease Prevention is Cost-Effective
InvestmentFor example:
• Workplace = 2:1
• WIC = 3:1
• “Smoke-Free for Life” = 15:1
• Pre-natal counselling = 10:1
![Page 83: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/83.jpg)
Brief physician counselling • Highly effective and cost-
effective. Start with adding lifestyle, work hours and other questions to intake surveys
• Be aware of cultural factors – WHOM we are counselling
Next Steps....A Chronic Disease Prevention Strategy for Nova Scotia is the responsibility of all sectors
![Page 84: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/84.jpg)
Can it be done?...1900s/1980s...
![Page 85: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/85.jpg)
New measures of progress are needed to help create a healthier
Nova Scotia for our children –
![Page 86: Pop. health context: Romanow and the 3 burning health policy issues](https://reader035.fdocuments.us/reader035/viewer/2022062423/568145ce550346895db2d617/html5/thumbnails/86.jpg)
Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - Atlantique
www.gpiatlantic.org