Make Ontario the Healthiest Province in Canada

Statement to the Premier of Ontario

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The Ontario government needs to take action to make Ontario the healthiest province in Canada by investing at least 0.5% of the Ontario budget towards health promotion and chronic disease prevention.

ISSUE: Ontarians are concerned about the overall state of health and want their government to commit to make Ontario the healthiest province.  According to a recent poll by Ipsos Reid, 9 in 10 Ontarians favour an increased investment in health promotion. ¹ Ontario is facing an impending health care system crisis. One in three Ontarians is affected by chronic disease. ²  Since 2003, the rate of obesity increased by 23%, the rate of high blood pressure increased by 19%, and the diabetes rate increased by 57% in Ontario ³. Moreover, even younger age groups are experiencing increases in risk factors: among Canadians those 35 to 49 years of age, the prevalence of high blood pressure increased 127%, diabetes by 64% and obesity by 20%. ⁴ It is also estimated that 45 per cent of males and 40 per cent of females in Ontario are likely to develop cancer in their lifetime. ⁵

Canada’s Ministers of Health have declared that the promotion of health and the prevention of disease, disability and injury are a priority and necessary to the sustainability of the health system. The government needs to act now to make Ontario the Healthiest Province in Canada by investing at least 0.5% of Ontario’s budget towards health promotion and chronic disease prevention.

RECOMMENDATION:

1. Commit to invest 0.5% ($170 million more) of the Ontario budget towards health promotion
2. Apply a health lens to ensure that any government department or agency involved in formulating a legislative or regulatory proposal must assess the potential impact of its actions on the health of Ontarians.

CHRONIC DISEASE COSTS:

• The cost of medical treatment for chronic disease and associated cost in lost productivity is estimated at $80 billion annually. ⁶
• The direct and indirect costs of cardiovascular disease and stroke have reached $22.2 billion annually. ⁷
• The economic burden of diabetes will increase from $12.2 billion to nearly $17 billion by 2020. ⁸
• The economic burden of dementia will rise from $15 billion in 2008 to $153 billion in 2038. ⁹
• Alcohol-related health and social costs were $5.3 billion in 2002. ¹⁰
• The Ontario government currently spends approximately $2 billion per year on cancer care. The indirect costs associated with cancer, such as loss of productivity in Ontario, are approximately $5 billion per year. ¹¹  

ONTARIO FACTS:

• One in three Ontarians is affected by chronic disease. ¹² 
• 80% of the population aged above 45 has at least one chronic disease, and 70 percent of these Ontarians suffer two or more. ¹³
• Chronic diseases are the leading causes of death in Canada and Ontario. Together in Ontario, heart disease, stroke and cancer combine to account for 60% of all deaths (or 6 in 10 deaths) nearly doubling all other causes. ¹⁴
• Up to 80% of premature heart disease and stroke can be prevented with lifestyle changes related to increased physical activity, healthy eating, reducing high-risk drinking, and eliminating tobacco use ¹⁵
• About half of all cancers in Ontario can be prevented through healthy living and policies that protect the health of the public. ¹⁶
• Investment in health promotion currently comprises 0.35% of the Ontario budget.
• The Ontario government invests only $7.40 per person per year in health behaviour strategies, as compared to British Columbia’s $21.00 per person per year, and Quebec’s $16.80 per person per year. ¹⁷  
• Overall health spending is likely to grow by 6.5 percent a year, while government revenues grow only at 4 percent a year. ¹⁸ 
• Health care would take up 80 percent of the province’s program budget by 2030, up from 46 percent of the current spending on health care. ¹⁹
• The TD Bank observes that a healthier population is less costly to serve, and prevention is the key to a more sustainable health system in Ontario. ²⁰ 

BACKGROUND:

Ontario is facing a health care crisis — one that is preventable.
Nearly 50 cents of every dollar that Queen’s Park spends goes towards health care costs ²¹. By 2030 health care costs could take up to 80% of the provincial program spending budget ²².  This is clearly not sustainable but the good news is that these costs can be avoided.

As stated by the Institute of Clinical and Evaluative Sciences (ICES) in their report, What does it take to make a healthy province?, “Leadership and senior government structures must be developed and/or nurtured to develop specific health strategies … many effective policies and programs are relatively inexpensive and should be considered for implementation and/or expansion.” ²³ In the face of current economic uncertainties and mounting fiscal pressures in Ontario’s health care system, TD Bank released a special report in May 2010 that urges the Province to lead an “extraordinary effort” to improve the health of Ontarians through health promotion.

Sustainable health care requires greater focus on health promotion.
The cost of chronic disease is on the rise. In Canada, the cost of medical treatment for chronic disease and associated cost in lost productivity is estimated at $80 billion annually ²⁴; $22.2 billion is attributable to cardiovascular disease and stroke ²⁵.  This amount will rise as the prevalence of chronic disease rises.  For example, the economic burden of diabetes will increase by $4.7 billion by 2020 from $12.2 billion ²⁶, while the economic burden of dementia will rise from $15 billion in 2008 to $153 billion in 2038. ²⁷  In 2009, mental illnesses and addictions cost Ontario upwards of $29 billion in lost productivity, and in 2007-08, the province’s health care system spent more than $2.5 billion on mental health and addiction services. An upstream investment in supporting people to stay mentally healthy saves money, that is, every $1 spent on mental health and addictions saves $7 in health costs and $30 dollars in lost productivity and social costs. ²⁸  Specific to alcohol, the related health and social costs were 5.3 billion in 2002 ²⁹, while the government spends over $2 billion on costs related to cancer care. ³⁰  Overall health spending is likely to grow by 6.5 percent per year, while government revenues grow at only 4 percent per year.  This will lead to health care costs increasing from 46 percent of current government spending to 80 percent of the Province’s program budget by 2030. ³¹ 

Ontarians want the government to invest in our health now and for future generations.
According to a poll conducted in May of 2011 by Ipsos Reid, 9 out of 10 Ontarians think it is imperative that we invest in health promotion and introduce policy changes to promote healthy living. Investing an additional $170 million or just 0.5% of the Ontario budget, toward health promotion would help to:

• Improve diet and the consumption of healthy foods
• Increase prevalence of physical activity
• Prevent Ontarians from consuming tobacco, and helping those who do to quit
• Reduce high-risk alcohol consumption

Better health is worth 0.5% of the budget. 
Already the Ontario government has committed 0.35% of the budget; all we’re asking for is an additional 0.15%, equal to $170 million – a small increase with monumental impact. Prevention saves government dollars in the long run. In Ontario, 80% of people over 45 years old have at least one chronic disease, and 70% of these Ontarians have at least two chronic conditions ³². More than half (55%) of the costs of medical treatment, lost productivity, and premature death in Ontario are due to chronic diseases such as heart disease, stroke, diabetes, high blood pressure, and cancer ³³. Over the past 30 years childhood obesity rates have tripled in Canada and today’s children are poised to become the first generation who may not live as long as their parents ³⁴. Over 60 % of adults and a shocking 28% of Ontario children and youth are overweight or obese ³⁵. Every year 13,000 people in Ontario die because of tobacco use – one person every 40 minutes ³⁶.

Our Health is our Wealth.
The health of Ontarians is critical to our future socio-economic prosperity. Better health not only improves quality of life, it also increases workforce productivity, corporate competitiveness, and other societal benefits including higher education rates and lower crime ³⁷. It is estimated that if all Ontario residents had healthy weights, the province would save up to $2.5 billion a year in direct healthcare expenditures ³⁸. If all Ontarians had healthy weights and did not smoke, the province could be saving up to $6.5 billion a year ³⁹. Smoking alone is estimated to cost the province $1.6 billion in direct health care costs, $4.4 billion in lost productivity, and at least 500,000 hospital stays ⁴⁰. Research demonstrates that an investment in effective community-based disease prevention and health promotion programs can return over $5 for every $1 spent ⁴¹. The Ontario Tobacco Research Unit estimates that for every dollar invested in addressing tobacco use, the government saves three dollars in health care spending. ⁴²

Ontario has an opportunity to lead and become the healthiest place in North America.
Prevention is a priority and a hallmark of a quality health care system ⁴³. The United Nation’s World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD) recognize Ontario as a model for its focus on quality indicators to improve outcomes, and British Columbia for its ActNow “all-of-government” approach that sets long term targets for key risk factors ⁴⁴.  Ontario should continue to show leadership and aggressively promote interventions to reduce the main risk factors for non-communicable diseases: tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol.

To improve the health of Ontarians and prevent the unsustainable rising cost of health care, the OCDPA recommends Ontario achieve the following targets by 2017:

1. More than 73% of Ontarians physically active ⁴⁵
2. Fewer than 32% of Ontarians are either overweight or obese ⁴⁶
3. Decrease the prevalence of tobacco use in Ontario by another 5% ⁴⁷
4. Reduce the proportion of overweight and obese children in Ontario to 20% ⁴⁸

 
In order to make Ontario the healthiest province in Canada, a collaborative approach - which includes multi-sectors and stakeholders at the local, regional and provincial levels - must be taken.  Through leadership and commitment from the Ontario government the goal of making Ontario the healthiest province in Canada can be achieved. ⁴⁹   This will require a comprehensive and multi-faceted strategy that will include effective policies, environmental supports, and public education to effect broad societal changes in health behaviours. ⁵⁰  

The Ontario Chronic Disease Prevention Alliance (OCDPA), consisting of over 25 member organizations, is the province’s collective voice on effective chronic disease prevention policy and programming.  More information on the 0.5% campaign is available at www.healthiestprovince.ca.

References

¹ OCDPA “Healthiest Province” Survey. Ipsos Reid, February, 2011. Conducted online January 24 - February 1, 2011.

² Ontario Health Quality Council. Q Monitor Report: 2008 Report on Ontario’s Health Care System. OHQC, 2008; p. 85.

³ Statistics Canada. 2011. Health Trends. Statistics Canada Catalogue No. 82-213-XWE. Ottawa. Released October 25, 2011.

⁴ Heart and Stroke Foundation (2010).  A Perfect Storm:  A 2010 Annual Report on Canadians’ Health.

⁵ Cancer Care Ontario. Ontario Cancer Plan 2011-2015. Available at: http://www.cancercare.on.ca/cms/one.aspx?portalId=1377&pageId=8630, pg. 5.

⁶ World Health Organization. Primary Health Care: A Framework for Future Strategic Directions. Geneva, 2003.

⁷ Public Health Agency of Canada (2009). Tracking Heart disease and stroke in Canada. Cat.: HP32-3/2009E ISBN: 978-1-100-12541-1   http://www.phac-aspc.gc.ca/publicat/2009/cvd-avc/pdf/cvd-avs-2009-eng.pdf

⁸ Canadian Diabetes Association. An Economic Tsunami: The Cost of Diabetes in Canada. CDA, December 2009; p. 12

⁹ Alzheimer Society of Canada. Rising Tide: The Impact of Dementia on Canadian Society. Alzheimer Society, 2010, p. 8

¹⁰ Rehm, J; Baliunas, D.; Brochu, S.; Fischer, B.; Gnam, W.; Patra, J.; Popova, S.; Sarnocinska-Hart, A.; Taylor, B.; Adlaf, E.; Recel, M.; Single. E.  The costs of substance abuse in Canada 2002: highlights. Canadian Centre on Substance Abuse, 2006.

¹¹ Cancer Care Ontario. Ontario Cancer Plan 2011-2015. Available at: http://www.cancercare.on.ca/cms/one.aspx?portalId=1377&pageId=8630, pg. 5.

¹² Ontario Health Quality Council. (2008).

¹³ Ministry of Health and Long-Term Care. Preventing nad Managing Chronic Disease: Ontario’s Framework, May, 2007. http://www.health.gov.on.ca/english/providers/program/cdpm/index.html#1.

¹⁴ Statistics Canada. Mortality, Summary List of Causes 2008. Released October 18, 2011.

¹⁵ WHO, 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases.

¹⁶ http://www.cancer.ca/Ontario/Prevention.aspx?sc_lang=en

¹⁷ Institute for Clinical Evaluative Sciences. What Does it Take to Make a Healthy Province? ICES, November 2009.

¹⁸ TD Economics (2010). Charting a Path to Sustainable Health Care in Ontario - 10 proposals to restrain cost growth without compromising quality of care. Special report. 2010.  http://www.td.com/economics/special/db0510_health_care.pdf

¹⁹ TD Economics (2010)

²⁰ TD Economics (2010)

²¹ TD Economics. Charting a path to sustainable health care in Ontario. 10 proposals to restrain cost growth without compromising quality of care. May 27, 2010.

²² TD Economics. Charting a path to sustainable health care in Ontario. 10 proposals to restrain cost growth without compromising quality of care. May 27, 2010.

²³ TD Economics  (2010).

²⁴ Ontario Health Quality Council. Q Monitor Report: 2008 Report on Ontario’s Health Care System. OHQC, 2008; p. 85.

²⁵ Canadian Heart Health Strategy-Action Plan Steering Committee. Building a Heart Healthy Canada. Released February 2009.

²⁶ Canadian Diabetes Association. An Economic Tsunami: The Cost of Diabetes in Canada. CDA, December 2009; p. 12

²⁷ Alzheimer Society of Canada. Rising Tide: The Impact of Dementia on Canadian Society. Alzheimer Society, 2010, p. 8

²⁸ Ontario Ministry of Health and Long-term Care.  Every Door is the Right Door. Towards a 10-Year Mental Health and Addictions Strategy A discussion paper. July 2009

²⁹ Rehm, J; Baliunas, D.; Brochu, S.; Fischer, B.; Gnam, W.; Patra, J.; Popova, S.; Sarnocinska-Hart, A.; Taylor, B.; Adlaf, E.; Recel, M.; Single. E.  The costs of substance abuse in Canada 2002: highlights. Canadian Centre on Substance Abuse, 2006.

³⁰ Cancer Care Ontario. Ontario Cancer Plan 2010-2011. Available at: http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13808.

³¹ TD Economics. (2010)

³² Ministry of Health and Long-Term Care. Preventing and Managing Chronic Disease: Ontario’s Framework, May 2007. http://www.health.gov.on.ca/english/providers/program/cdpm/index.html#1

³³ Ontario Ministry of Health and Long-term Care. Preventing and Managing Chronic Disease: Ontario’s Framework. May 2007. http://www.health.gov.on.ca/english/providers/program/cdpm/pdf/framework_full.pdf

³⁴ Tremblay, M et al. Fitness of Canadian children and youth: Results from the 2007-2009 Canadian Health Measures Survey. Statistics Canada, Health Reports, 2010.

³⁵ Shields M. Measured obesity. Overweight Canadian children and adolescents. In: Nutrition: findings from the Canadian Community Health Survey 2004;issue 1 (cat no 82-620-MWE2005001). Available from: http://www.statcan.gc.ca/pub/82-620-m/2005001/pdf/4193660-eng.pdf

³⁶ Ontario Ministry of Health and Long-term Care.  Initial Report on Public Health Smoking Prevalence August 2009. http://www.health.gov.on.ca/english/public/pub/pubhealth/init_report/pdfs/initial_rep_on_public_health_rep_20090821.pdf

³⁷ Tremblay M et al. Fitness of Canadian children and youth: Results from the 2007-2009 Canadian Health Measures Survey. Statistics Canada, Health Reports, 2010

³⁸ http://www.gpiatlantic.org/pdf/health/obesity/on-obesity.pdf

³⁹ http://www.gpiatlantic.org/pdf/health/obesity/on-obesity.pdf

⁴⁰ Ontario Tobacco Research Unit. The Burden of Tobacco Use in Ontario June 2006. http://www.otru.org/pdf/updates/update_june2006.pdf

⁴¹ Trust for America's Health. Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities. July 2008. http://healthyamericans.org/reports/prevention08/

⁴² Tobacco Strategy Advisory Group. Building on our gains, taking action now: Ontario’s tobacco control strategy for 2011-2016. Toronto, ON: Ministry of Health Promotion and Sport; 2010 [cited 2011 Oct 18]. Available from: http://www.mhp.gov.on.ca/en/smoke-free/TSAG%20Report.pdf

⁴³ WHO, 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases.

⁴⁴ Ibid.

⁴⁵ Manuel DG, Creatore MI, Rosella LC, Henry DA. What does it take to make a healthy province? A benchmark study of jurisdictions in Canada and around the world with the highest levels of health and the best health behaviours. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2009.

⁴⁶ Ibid.

⁴⁷ Tobacco Strategy Advisory Group. Building On Our Gains, Taking Action Now: Ontario’s Tobacco Control Strategy for 2011-2016. October 18, 2010.

⁴⁸ Ontario Liberal Party Platform, 2011 http://www.ontarioliberal.ca/OurPlan/Platform.aspx.

⁴⁹ TD Economics. (2010)

⁵⁰ Institute for Clinical Evaluative Sciences. (2009)