Download Against the Growing Burden of Disease

Against the Growing Burden of Disease
Kimberly Elmslie
Director General, Centre for Chronic Disease Prevention
Against the Growing Burden of Disease
Chronic diseases are an increasing global challenge…
Most significant cause of death (63%) worldwide1
Chronic diseases cause premature deaths under age 60:
13% in high income countries
29% in low middle income countries
Even in African nations, chronic diseases are rising rapidly, projected to
exceed communicable, maternal/perinatal, and nutritional diseases as
the most common causes of deaths by 2020
Source: World Health Organization (WHO).
2
1Except
in sub-Saharan Africa.
Against the Growing Burden of Disease
…and their impacts extend beyond health.
• Chronic diseases represent a major fiscal
and productivity risk for the economies of
low, middle, and high income countries
• Chronic diseases increase income
inequities, deplete household wealth,
increase health spending and lower
labour productivity
• Most countries will not be able to address
chronic disease challenge with medical
care alone: Prevention is critical
Source: World Bank 2011.
3
Against the Growing Burden of Disease
In Canada, deaths due to chronic diseases are rising…
100
Others
90
Infectious
80
Other NCDs
Four Major NCDs
70
Age-adjusted 60
Proportion
of Canadians
50
(%)
The proportion of people
dying from chronic conditions
is constantly increasing
40
30
20
10
0
1960
1964
1968
1972
1976
1980 1984
Year
1988
1992
1996
2000
2004
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010, June.
4
Against the Growing Burden of Disease
…and chronic disease rates are increasing at 14% each year.
0.7
0.6
0.5
Age-adjusted
Prevalence
(%)
Cancer
0.4
Cardiovascular
diseases
0.3
Diabetes
0.2
Hypertension
3 out of 5 Canadians
older than 20 have a
chronic disease
4 out of 5 are at risk
0.1
0
2001
2010
2020
2030
2039
Year
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using POHEM Model, Statistics Canada.
5
Against the Growing Burden of Disease
Rising obesity rates are driving the chronic disease epidemic.
Obesity increasing among
Canadians, especially in
children, youth and
Aboriginal peoples
30
20
1 out of 4 Canadian
children are overweight or
obese
Proportion
of Adult
Canadians
(%)
10
2004
2005
2008
0
Total
Females
1 out of 6 Canadians
aged 20 and older are
obese
Males
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010, June.
6
Against the Growing Burden of Disease
Canada’s population is changing…
Aging population
•
Today, 14% of the population is over 65 years. By
2036, this number will increase to almost 25%, or
10 million people
Increase in chronic disease prevalence
•
Canadians are living longer and more likely to
experience chronic conditions more common at
older ages, including neurological diseases
Living with chronic diseases earlier in life
•
Chronic disease rates are increasing faster among
Canadians aged 35-64 years than Canadians aged
65 years and over
•
More children are being affected by chronic
diseases previously only seen in adults
Aboriginal peoples at higher risk
•
Experience higher rates of diseases such as heart
disease, diabetes, cancer, and asthma
•
Aboriginal population expected to grow at more
than twice the rate of 0.7% of the general
population (1.8% annually)
7
Against the Growing Burden of Disease
… and chronic disease trends are shifting.
More working
age Canadians
are living with
diabetes
800
700
600
500
Increase of 1% per
year in 35-44 year
age group
Number
of
400
Persons
(000)
300
200
2003
2005
2007
2008
100
0
12 to 19 years 20 to 34 years 35 to 44 years 45 to 64 years
Increase of 1.5%
per year in 45-64
year age group
65 years and
over
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from Labour Force Survey, Statistics Canada.
8
Against the Growing Burden of Disease
We understand
the pathway to
chronic
diseases…
Chronic
diseases
Raised blood pressure
Overweight/obesity
Raised blood glucose
Raised lipids
Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol
Social
Determinants
of Health
Source: Global Status Report on Noncommunicable Diseases 2010, World Health Organization.
9
Globalization
Urbanization
Population ageing
Against the Growing Burden of Disease
…including the four most common risk factors.
80% of heart disease,
diabetes and respiratory
diseases and 40% of
cancers are preventable
by eliminating four
common risk factors
Common Risk Factors
Tobacco
use
Unhealthy
diets
Physical
inactivity
Harmful use
of alcohol
Cardiovascular
diseases
Chronic
Diseases
Diabetes
Cancer
Respiratory
diseases
10
Source: WHO, Raising the priority of non-communicable disease in development
work at global and national levels.
Against the Growing Burden of Disease
We are now seeing the consequences of chronic disease.
• Greater demands for health
services
• Workforce absenteeism
• Increasing productivity losses
• Escalating economic costs
11
Against the Growing Burden of Disease
Chronic diseases account for the majority
of direct health care costs.
•
Treatment of chronic disease
consumes 67% of all direct health
care costs, and cost the Canadian
economy $190 billion annually – $68
billion is attributed to treatment and
the remainder to lost productivity.
•
Health expenditures to treat chronic
diseases are rising faster than our
economic growth.
12
Against the Growing Burden of Disease
Health expenditures are increasing as a relative
proportion of Canada's GDP...
Note
f = forecast.
Sources
National Health Expenditure Database, CIHI; The Conference Board of Canada.
13
Against the Growing Burden of Disease
… and in British Columbia health care costs are projected to
quickly crowd out other expenditures by 2017.
Source: British Columbia Ministry of Health, 2004.
14
Against the Growing Burden of Disease
It will take everyone working together to turn the tide.
The challenge:
• Developing countries face a double burden of
malnutrition and obesity
• Circular relationship between poverty and
chronic disease
• Infectious diseases are an on-going threat
• Disease prevention requires a multisectoral
approach
15
Against the Growing Burden of Disease
Poverty is a significant issue.
Poverty creates
conditions for
chronic diseases:
16
•
Tobacco use/exposure
•
Poor nutrition
•
Low physical activity
•
Harmful use of alcohol
•
Poor indoor air quality
•
Decreased access to health
care
Chronic diseases
create poverty:
•
Low productivity
•
Increased risk of
disabilities &
premature death
•
Increased household
expenditures
Against the Growing Burden of Disease
Canada’s approach to public health…
17
•
Public health places a focus on prevention over
treatment. It works to keep people healthy, safe, and
productive by responding to direct risks to health (e.g.
infectious diseases, emergency events) or trends that
contribute to risk (e.g. obesity).
•
The Public Health Agency of Canada seeks to protect
and promote the health of Canadians through
leadership, partnership, innovation and action in
public health
•
By helping to support conditions for healthy aging,
chronic diseases can be prevented or delayed
•
Investments in research help us to better understand
disease and the wide range of determinants that
affect health over the life course
•
Working with a range of partners is also critical to
providing information and tools to promote healthy
aging and prevent chronic disease
Against the Growing Burden of Disease
…involves working together towards prevention.
18
Against the Growing Burden of Disease
Prevention is
everyone’s
business…
Finance
Agri-food
Trade
Environment
and
Sustainable
Development
Work
Places
Chronic
Diseases
Urban
Planning
Transport
Economic
Development
Income
Education
19
Against the Growing Burden of Disease
… and we are building critical partnerships to
deliver results.
20
•
Provinces / Territories
» Federal support for health system innovation towards sustainability, with a
focus on health system efficiency and better patient outcomes
» Key partnerships on northern health issues
» Federal government provides added value to collaborative strategies
through leadership and strategic investments to address key issues while
respecting jurisdictional responsibilities
•
Stakeholders
» Strategic partnerships across critical areas, such as:
» Canadian Partnership Against Cancer
» Mental Health Commission of Canada
» Canadian Diabetes Association
» National Aboriginal Organizations
•
International partnerships
» Multilateral (e.g. through World Health Organization, Pan-American Health
Organization)
» Bilateral key partnerships
Against the Growing Burden of Disease
Canada is investing domestically…
21
•
Significant investments in disease-specific strategies: Canadian Strategy for Cancer
Control, implemented by the Canadian Partnership Against Cancer, the Canadian
Diabetes Strategy, the Aboriginal Diabetes Initiative and the National Lung Health
Program
•
The Canadian Task Force on Preventive Health Care provides national expert guidance
on effective prevention for primary care providers
•
Age-Friendly Communities Initiative with provinces and territories brings older
Canadians into the planning and design of their communities to create healthy, safe and
supportive environments
•
The National Population Study on Neurological Conditions is advancing the knowledge
of neurological diseases – a leading cause of disability in Canada
•
Canadian Longitudinal Study on Aging will increase our understanding of health, social,
and economic issues of Canadians age 45 to 85 over the next 20 years
•
Many initiatives promoting healthy lifestyles: Healthy Living Fund, Aboriginal Head Start,
Community Action Program for Children, Canada Prenatal Nutrition Program, and
Nutrition North Canada program
Against the Growing Burden of Disease
…and working with partners globally to make a
difference.
22
•
The Government of Canada is part of an international
effort to prevent chronic disease
•
In September 2011, the United Nations Political
Declaration on the prevention and control of
noncommunicable diseases was adopted
•
The UN Political Declaration calls for the WHO to
establish a Comprehensive Global Monitoring
Framework and develop Voluntary Global Targets by
the end of 2012
•
The WHO is also to develop an updated Global Action
Plan for the Prevention and Control of NCDs 2013-2020
•
Multisectoral action is a key element, and the health
sector can be a catalyst for change by building
understanding about chronic disease prevention across
many sectors
Against the Growing Burden of Disease
In summary,
23
•
The health and economic pressures of a changing, aging population are not
unmanageable. We know that a longer lifespan comes with an increased
risk of chronic disease. And we can work to prevent and manage that risk
•
We know that health promotion interventions benefit people of all ages.
Research shows that health promotion across the life course not only
improves health behaviours and, as a result, health outcomes and quality of
life, but also has very a real impact on reducing health care costs
•
Quite simply, healthy people make less use of health care services, and
they live longer and better
•
We must recognize that public health is not just a health issue. Promotion
and prevention involve all of us, in many different sectors and across levels
of governments