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Improving the Health of Manitobans: Economic Analysis and Business Case Heart and Stroke Foundation of Manitoba October 14, 2009.

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Presentation on theme: "Improving the Health of Manitobans: Economic Analysis and Business Case Heart and Stroke Foundation of Manitoba October 14, 2009."— Presentation transcript:

1 Improving the Health of Manitobans: Economic Analysis and Business Case Heart and Stroke Foundation of Manitoba October 14, 2009

2 Overview of Presentation Understanding the Manitoba Context Prevalence and Historical Trends in the Risk Factors Risk Factors and the Burden of Disease The Economic Burden of the Risk Factors in Manitoba The Benefits of Reducing Risk Factors 2

3 Overview of Presentation Identify Best Practices for Reducing the Risk Factors Estimating the Cost of Implementing Best Practices Cost-Benefit Analysis 3

4 Caveats Research Project(s)? Each step could be its own research project Business Case? Need to convince decision-makers Business Plan? Detailed plan for moving forward in a certain direction Focus on Tobacco consumption Unhealthy eating / Obesity Physical inactivity 4

5 Understanding the Manitoba Context Relevant policies/legislation/regulations in Manitoba Manitobas partners in healthy living Current programs with a focus on the risk factors in Manitoba 5

6 Understanding the Manitoba Context Process Review websites, grey literature, etc. E.g. CPAC PPAG review of policy and legislation as it relates to food, physical activity, etc. in Canada Input from Steering Committee and Reference Group Interviews – personal and telephone 6

7 Prevalence and Historical Trends in the Risk Factors (or, Whats the Problem?) Recent study completed for CPAC –An Overview of Selected Cancers and Modifiable Cancer Risk Factors in Canada Covers the current risk factors as well as a few others (alcohol, breastfeeding) Full report available at 7

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16 Risk Factors and the Burden of Disease What evidence is there for the relationship between the risk factors and the burden of disease? Review from The Health Impact of Smoking & Obesity and What to Do About It (2007) by Krueger, Williams, Kaminsky and McLean 16

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23 The Economic Burden of the Risk Factors (in Manitoba) Excess cost per individual with the risk factors Direct and indirect costs Annual cost to the province 23

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29 The Benefits of Reducing Risk Factors What evidence is there that a change in risk factors is associated with a change in health? Research complicated by the fact that changes in behavior (e.g. quitting smoking) often associated with diagnosis of a disease (e.g. cancer) Health improvements not always immediate 29

30 The Benefits of Reducing Risk Factors (contd) Weight loss – intentional (24% mortality rate) vs. unintentional (31% mortality rate) (Greg et al. Ann Int Med (2003) Smoking cessation associated with a spike in costs Early death of smokers spares them from poor health during their later years (if they had not smoked) 30

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32 Identify Best Practices for Reducing the Risk Factors Review of the available literature Much more research on effective interventions for smoking cessation Identify best and promising interventions, particularly for other risk factors 32

33 Identify Best Practices (contd) What can we learn from the Tobacco Wars about effective interventions? 1.Increasing Prices 2.Reducing Opportunities to Promote the Product 3.Smoke-free Public Places 4.Counter Advertising 5.Primary Care Based Cessation Programs 33

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35 Identify Best Practices (contd) What can we learn from the Tobacco Wars? 1.No single intervention can account for the successes seen since the 1960s 2.Each intervention is enhanced synergistically by other components 3.Required systemic changes (ban on advertising, price increases, legislated smoke-free places) and social denormalization 4.Governments and communities must work together with adequate financial and organizational resources over the long haul 5.Interventions must be available for individuals who seek to make a lifestyle change 35

36 Identify Best Practices (contd) Overweight: What Can we Learn from the Tobacco Wars - Differences Food and activity are essential; tobacco is not Possible negative consequences (disordered eating) Underlying genetic/disease conditions Limited research on effective interventions 36

37 Identify Best Practices (contd) Overweight: What Can we Learn from the Tobacco Wars - Similarities Social influences and advertising pressures influence what we eat Environmental constraints can lead to limitations on physical activity Obesogenic environment 37

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39 Identify Best Practices (contd) Regulatory and Economic Interventions (contd) Consider restrictions on food advertising aimed at children Consider a focused trial of taxation measures for specific unhealthy foods Continue to protect against creative attempts by the tobacco industry to market their product, e.g., retail power walls, product placements, smoking in movies & magazines Improve compliance with restrictions on tobacco sales to minors 39

40 Identify Best Practices (contd) Community-Based Interventions Establish Community Action Coordinators (2 per electoral riding) to mobilize strategies for risk factor reduction Provide modest funding for up to 1,200 community groups throughout the province with ideas on how to address risk factors Develop a strategic media plan with clear, common messages for different at-risk populations with well-conceived short and long term advocacy goals Consider subsidizing pedometers as a source of instant feedback to individuals who are attempting to become more physically active Implement point-of-decision prompts to encourage healthy behaviours Encourage and support walking groups and physical activity events Enhance access to places of physical activity; both indoor and outdoor 40

41 Identify Best Practices (contd) School-Based Interventions Expand Action Schools! BC program and encourage a more rapid implementation of some of its recommendations, plus coordination with anti-smoking resources, to move towards significant levels of primordial prevention among young people Focus on environmental approaches to risk factor interventions, including options for promoting healthy foods, curtailing access to unhealthy foods, creating opportunities for physical activity and tobacco free sites. Workplace-Based Interventions In partnership with WCB, unions, business and others, offer funding to assist employers and employees to create a healthier work environment, from stairway walking campaigns to exercise facilities and healthy food choices 41

42 Identify Best Practices (contd) Clinical Interventions and Management Implement a program of prevention detailing to provide education and feedback to enable primary health care providers to more fully address risk factors Cover out-of-pocket expenses for nicotine replacement therapy initiated within a recognized clinical program Provide reimbursement for lifestyle counselling around physical activity, healthy eating and living smoke free Provide compensation to primary health care providers for lifestyle counselling around physical activity, healthy eating and living smoke free 42

43 Estimating the Cost of Implementing Best Practices High level costing of implementing the major interventions E.g. from increased taxation to community-based action co-ordinators to prevention detailing, etc. 43

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45 Cost-Benefit Analysis Combining information on Potential Targets Cost of interventions required to achieve targets Potential costs avoided if the targets are achieved 45

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50 Logical Pathway 50

51 Lessons Learned (What can we do better in Manitoba?) Stretch targets too ambitious over too short a time frame – politically motivated Clearer linkage between the effectiveness of interventions and actual changes in population behavior required 51

52 Four Fundamentals: What Will it Take? 1.A Long Obedience in the Same Direction 2.Employing proven, comprehensive interventions 3.Risking innovation to increase knowledge 4.Addressing behavioural factors in the context of vital environmental changes 52

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54 Employing Comprehensive Interventions Veugelers and Fitzgerald, March 2005, AJPH Nova Scotia 5 th graders Comprehensive program –Nutritious food –Encourages physical activity –Health promotion for teachers –Results 17.9% overweight; 4.1% obese 54

55 Employing Comprehensive Interventions (contd) Limited nutrition program –Provide breakfast, or –Ban junk food –Results 34.2% overweight; 10.4% obese No programs –Results 32.8% overweight; 9.9% obese 55

56 Risking Innovation to Increase Knowledge Implement promising interventions – incomplete knowledge But within a culture of continuous learning, administrative flexibility and program adaptability 56

57 The Dance Between the Environment and the Individual In the absence of changes to the environment, encouraging individual choice and goal-setting will not get you very far. Individuals must be supported in their behavioral change attempts. 57

58 Comments / Questions?

59 Further Details The Winning Legacy series of reports available at ww.krueger.caww.krueger.ca Smoking & Obesity Monograph by Krueger et al. 59

60 Tobacco - Effective Interventions Tobacco Control 40+ years of experience and hundreds of studies can be summarized into five general areas of effective interventions 60

61 Tobacco - Effective Interventions 1) Increasing Prices The single most effective intervention to reduce initiation and increase cessation 10% price increase leads to a 3-5% reduction in demand Adolescents more sensitive to price (6- 10%) 61

62 Tobacco - Effective Interventions 2) Reducing Opportunities to Promote the Product Promotion works! That is why companies spend millions on advertising Part of the denormalization process Companies continue to find ways e.g. product placement in movies and TV 62

63 Tobacco - Effective Interventions 3) Smoke-free Public Places Protects non-smokers from the health consequences of SHS Results in a number of positive spin-offs Continued denormalization Reduction in the number of cigarettes smoked and possibly increases cessation attempts 63

64 Tobacco - Effective Interventions 4) Counter Advertising High impact media advocacy Works best in the context of an overall comprehensive strategy Young people, a primary audience, discount future health effects Focus on the complicity and manipulation of the tobacco industry e.g. Lovells You Are The Target Big Tobacco: Lies, Scams - Now the Truth 64

65 Tobacco - Effective Interventions 5) Primary Care Based Cessation Programs Unsupported quit attempts are successful only 5-10% of the time 4-8 sessions with NRT can increase this to 20+% Reduce the number of quit attempts from to less than 5 per successful cessation 65


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