1. Chronic Diseases in Canada Canada Report presented to the CARMEN Directing Board Meeting San Juan, Puerto Rico June 30, 2003

2. 2 The Burden of Chronic Disease in Canada Individuals and families 16,000,000 live with chronic illness Chronic disease accounts for 87% of disability High risk groups Increased prevalence in vulnerable communities (e.g. Aboriginals) and in socio-economically disadvantaged groups. Economy Direct health care costs: 67% of total direct costs are expended on chronic diseases Indirect costs: 60% of total indirect costs ($52B), e.g, loss of productivity and foregone income All these numbers will increase Aging, increased prevalence of some risk factors, e.g. obesity

3. 3 First, some good news….

4. 4 Age-Standardized Mortality Rates for Cardiovascular Diseases, Canadian Males and Females, 1950-1999 Source: Health Canada, 2003. Age-standardized to the 1991 Canadian population.

5. 5 20-Year Trends in Smoking Current smokers by age, Canada, 1981-2001

6. 6 The not so good news…

7. 7 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.

8. 8 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.

9. 9 Cardiovascular deaths in women is projected to increase Growing Burden of Heart & Stroke, 2003

10. 10 Cancer Progress Report, 2003 Burden of cancer in Canada is expected to double over the next 20 years

11. 11 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

12. 12

13. 13 A Rich History in Health Promotion

14. 14 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

15. 15 Towards a Common Risk Factor Approach

16. 16 National Disease / Risk Factor Strategies z Partnership models z G ood foundation for integrated chronic disease policies / programs

17. 17 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

18. 18 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

19. 19 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

20. 20 National Action Plan for Children Intersectoral and inclusive partnership Multi-pronged approach - Centres of Excellence for Childrens Well- Being - Aboriginal Head Start - Community Action Program for Children - Canada Prenatal Nutrition Program - Fetal Alcohol Syndrome/Fetal Alcohol Effects Initiative

21. 21 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 …

22. 22 Many achievements to date… But still… z Fragmentation and duplication of prevention and resources across strategies z Lack of coherence and consistency of prevention messages and approaches z Lack of integrated evaluation framework Lost opportunities to maximize prevention efforts and … achieve the preventive dose

23. 23 Towards an integrated approach to chronic disease prevention

24. 24 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

25. 25 Current Opportunities Provinces & Territories Several provinces and territories have made significant strides in strategies and alliances Alberta Nova Scotia British Columbia Québec …

26. 26 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 …

27. 27 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

28. 28 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

29. 29 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.

30. 30 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

31. 31 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