Chronic-disease rates cut in half!

This is the headline we would all like to read. But what would it take to make this headline a reality?

Chronic diseases have become the most common cause of death in Canada and around the world.[1] Today’s leading chronic diseases causing death are cardiovascular disease, cancer, diabetes, and respiratory disease.[2] We have made some progress, particularly in cardiovascular disease and cancer mortality rates, but diabetes rates are rising and projected to keep rising. And as our population ages the incidence of cardiovascular disease and cancer will increase as well. Mental health, also a significant concern, is impacted by chronic disease as well, and vice versa. So what is needed to reduce the rates of chronic disease?

The Chronic Disease Prevention Alliance of Canada (CDPAC) states that 40% of cancers and 80% of heart disease, type 2 diabetes, and respiratory disease are preventable by eliminating four common risk factors: poor nutrition, lack of physical activity, smoking, and harmful use of alcohol,[3] cleverly depicted in a CDPAC infographic that outlines the top four chronic diseases in Canada and healthy policies that can support chronic disease prevention (www.cdpac.ca/media.php?mid=1411). And there is evidence to support these statements.

Canada has had an Integrated Pan-Canadian Healthy Living Strategy since 2005. However, in reality, the prevention strategies for each disease tend to be separate, resulting in a siloed rather than an integrated approach. With the exception of smoking rates, Canada has not seen significant improvements in reducing these risk factors. Efforts to reduce smoking by increasing taxes, restricting cigarette advertising, expanding no-smoking areas, and increased smoking cessation interventions appear to be having a positive impact. But what about the other risk factors?

Alcohol is widely available and it is certainly acceptable to drink. And though it has become more difficult to drink and drive, and greater consequences to those caught driving over the legal limit have led to a 50% reduction in alcohol-related motor vehicle fatalities in BC since new legislation was passed,[4] the many other consequences of harmful alcohol consumption still exist.

Fruit and vegetable consumption, which is a marker of a healthy diet, has fallen from its peak incidence in 2009. Canada-wide, only 39.7% of adults eat the recommended five fruits and vegetables per day.[5] Of course, the cost of healthy foods is greater than that of fast food and junk food, and food costs continue to increase.

Physical activity rates (self-reported) run at 60% in BC (compared to 53.7% Canada-wide) but these dropped from 2013 to 2014.[6] In fact, accelerometer data show that, Canada-wide, only 24% of males and 21% of females meet the recommended Canadian guideline of 150 minutes of activity per week.[7] Together, poor nutrition and physical inactivity lead to increasing rates of obesity, with devastating consequences. Data show that these risk factors are highest in those with a lower socioeconomic status, lower education level, and those who already have one or more chronic conditions.[8] 

Strategies to reduce risk factors have been rolled out for 10 years or more and new approaches continue to be tested, but, other than for smoking and drinking and driving, these strategies have failed. One reason why they have not been successful is they have not included the important role that health care professionals can play. Doctors may be seen as too overwhelmed with their patients’ other needs to take an active role in health promotion; however, where do people go for help with their chronic diseases? They go to see their doctor. And though we may not have the time or the expertise to give patients all the tools they need to manage their chronic conditions, we can play a pivotal role in encouraging them to take steps that will prevent or ameliorate a chronic condition.

Let’s take every opportunity we have to remind patients of these risk factors and direct them to resources that will help them manage or prevent these chronic conditions. Then we will be helping our patients add years and quality to their lives.   
—Ron Wilson, MD
Athletics and Recreation Committee

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This article is the opinion of the Council on Health Promotion and has not been peer reviewed by the BCMJ Editorial Board.

References

1.    World Health Organization. Global status report on noncommunicable diseases 2010. Accessed 25 January 2016. www.who.int/nmh/publications/ncd_report2010/en.
2.    Chronic Disease Prevention Alliance of Canada. Improving the health of Canadians: Health promotion priorities for Canada. September 2007. Accessed 25 January 2016. www.cdpac.ca/media.php?mid=349.
3.    World Health Organization. Facing the facts: The impact of chronic disease in Canada. 2005. Accessed 25 January 2016. www.who.int/chp/chronic_disease_report/media/CANADA.pdf.
4.    British Columbia Ministry of Justice. RoadSafetyBC. Preliminary report on alcohol related motor vehicle (MV) fatalities. February 2015. Accessed 25 January 2016. www2.gov.bc.ca/assets/gov/driving-and-transportation/driving/publications/alcohol-related-fatalities.pdf.
5.    Statistics Canada. Fruit and vegetable consumption by sex, 5 times or more per day, by province and territory (percentage). 2014. Accessed 25 January 2016. www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health90b-eng.htm.
6.    Statistics Canada. Physical activity during leisure time, by sex, provinces and territories (percent). 2014. Accessed 25 January 2016. www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health78b-eng.htm. 
7.    Statistics Canada. Directly measured physical activity of adults, 2012 and 2013. Accessed 25 January 2016. www.statcan.gc.ca/pub/82-625-x/2015001/article/14135-eng.htm.
8.    Kendall P, Provincial Health Officer. Investing in prevention: Improving health and creating sustainability. September 2010. Accessed 25 January 2016. www.health.gov.bc.ca/library/publications/year/2010/Investing_in_prevent....