Health & Wellness
What are Canada’s
Greatest Challenges and Opportunities?
Keeping a Public Health Service Viable by Directing the Focus to Prevention: Health Reform—and How We Can Bury Canadians’ Most “Sacred Cow” Without Sacrificing Canadian Values
The present Canadian health service model with its ever-escalating cost is not sustainable. People need to take ownership of their health and well-being again and be encouraged to make conscious choices for a healthy lifestyle.
Some time before the Romanow Report was finalized and published in 2002, I led a brief but quite conclusive study on our Canadian health system at St. Lawrence College. A copy of this study was shared with Mr. Romanow and our political leaders. It was very disappointing to learn that his $16 million study found only a dramatic need for better communication and co-operation between the provinces and the federal government and drastic increases in federal and provincial funding to keep the system afloat. There is not one single innovative proposal for launching a campaign on prevention or change in people’s behaviour and lifestyle in the report. What a waste of effort and resources. If that $16 million had been used for an awareness campaign for a better lifestyle as proposed in the SLC report, we would already be well on our way to improving health.
At the same time I also hand-delivered my study, which I originally called “Ontario Eat and Live Smart,” to the Ontario Mike Harris government through the Chair of the Cabinet, the Honourable Bob Runciman. I chose this route because of the good relationship I had developed with him as our local MPP in Brockville. It had proven quite successful two years before when a study I conducted on apprenticeships with Bob Runciman’s support actually did get a long overdue $88 million new apprenticeship funding for the Ontario College System (I will report on this under the skills/education agenda).
I recall clearly how excited Bob Runciman was about the SLC health system study and that he indicated that he would try to champion this in a similar fashion. I do not doubt Mr. Runciman’s good intentions to also champion this cause, but it soon became clear that the change from Mike Harris as Premier of Ontario to Ernie Eves left the province in a state that made innovative changes more unlikely.
Having failed to start the implementation of “Ontario Eat and Live Smart,” I renamed it “Canada Eat and Live Smart.” The renamed report was at a later date, in April 2003, presented to the Right Honourable Paul Martin and, at around the same time, to people like the then Ontario opposition critic on education (present Minister of Education) Gerard Kennedy and a little later to the then opposition leader (present Premier of Ontario) Dalton McGuinty.
The Hon. Paul Martin, M.P. LaSalle-Emard
Room 458 Confederation Building
House of Commons
“Canada Eat and Live Smart”
Dear Mr. Martin:
I’m pleased to present you with an innovative proposal that would address the serious problem of increasing demand on health services as a result of a growing need to treat degenerative and chronic illnesses, many of which are directly related to lifestyle and diet. Done right, this proposed campaign will not create additional cost but relieve the system and start a turnaround with potential cost savings in the billions of dollars.
In Canada, we have one of the best health care systems in the world. But here, as elsewhere, the cost of health care is increasing at such an alarming rate that many now believe our publicly financed system is “unsustainable.”
The challenge, therefore, is to find ways to control costs while promoting people to be healthy and productive.
There is increasing evidence of a link between illness, poor diets and a sedentary lifestyle. An unhealthy lifestyle—especially during pregnancy, early childhood and among young people—escalates health care costs, reduces productivity and threatens our ability as a society to remain competitive.
I’m proposing a campaign in which the Government of Canada takes a leadership role in developing a series of unique incentives and programs in partnership with its many funding partners and the private sector and acts as a model for other jurisdictions.
What leadership did to combat smoking and its high cost to society, leadership can do to promote a healthier lifestyle and its many benefits to our society. Opportunities now exist in preventive and holistic approaches, and I believe we should take advantage of these practical solutions to some of the challenges facing us.
“Canada Eat and Live Smart” is a proposal that will lead to better health and well-being and conserve valuable public resources needed for such areas as education, the environment and economic development.
St. Lawrence College is dedicated to playing a responsible and leading role in helping to make this change happen. The proposal, which I am forwarding to you, outlines some of the ways we believe we can be helpful.
The Romanow report identified the present needs, but it missed seeing the opportunities that could make Canada a world leader in innovation and health.
We are most anxious to see this attached proposal go ahead, and I would welcome the opportunity to discuss it with you or other members of your platform.
It will take real leadership to move this exciting vision forward. I do not doubt for a minute that you, if you want to, could make this agenda for the future a reality, and I would of course be willing to help to get this initiative off the ground and make it a success for your government.
I look forward to learning your reaction to these proposals and how we can advance them through the bureaucratic and political process.
With my best regards,
President and CEO
St. Lawrence College
“Canada Eat and Live Smart”
A Program to Improve Canadians’ Health and Conserve Resources
All across Canada, governments and the private sector are struggling to curb ever-increasing health care costs.
The Canadian Institute for Health Information says total health care spending in Canada—mostly by the public sector—reached the $100 billion mark in 2001. In Ontario, 46 cents out of every provincial tax dollar now go to health care, severely limiting funds available for other vital public services. The cost of health care is increasing at such an alarming rate that many now believe our publicly financed system is “unsustainable.” Such major factors as an aging population and costly new drugs and medical procedures mean that ways of curbing costs must be found.
An unhealthy lifestyle—especially during pregnancy and early childhood and among young people—causes major health problems, escalates health care costs, reduces productivity and threatens our competitiveness.
There is increasing evidence of a link between illness and both poor diets and a sedentary lifestyle. The concern is especially pronounced as it relates to embryos, babies, children and youth.
• The Early Years Study co-chaired by Margaret McCain and Fraser Mustard (1999) clearly shows the relationship between early brain and child development and learning, behaviour and health throughout all stages of life.
• Heart disease and strokes remains the number one killer in Canada, claiming 79,000 lives this year, according to the Heart and Stroke Foundation of Canada.
• Obesity, a known risk factor for heart disease and stroke, has been called an “epidemic” by some health care experts. Statistics Canada estimates 46 percent of all adult Canadians are overweight or obese and current trends indicate this number will increase. Almost one in four (23 percent) of children age 7 to 12 are obese.
• In the U.S., the Surgeon General estimates that the total costs attributed to overweight and obesity amount to $ 117 billion in the year 2000 in a country where obesity among adults has doubled since 1980 and the prevalence among adolescents has tripled in the past two decades. Type 2 diabetes has shown a sharp rise among children and adolescents. Over 80 percent of Americans with diabetes are overweight or obese, according to the same Dec. 2001 report.
• The number of Canadians age 12 and over who have diabetes is estimated at 1.4 million. The prevalence rate among aboriginals is triple that of the general population.
• While 70 percent of Canadians know that eating fruits and vegetables can prevent cancer, heart disease and stroke, only 36 percent consume the Health Canada Food Guide recommended daily servings of these products (A. C. Nielsen study, July 2001).
• Studies increasingly show that physical activity is as essential to good health as a balanced diet and avoiding tobacco (Health Canada, March 2001). The Canadian Medical Association Journal estimates that about $2.1 billion of the total direct health costs in Canada were attributable to such inactivity in 1999 and a 10 percent reduction in the prevalence of physical inactivity has the potential to reduce costs by $ 210 million a year.
As consumer interest in healthy living increases, there is a corresponding increase in public concern related to health and safety regulation issues in the food and agriculture industries.
The growing popularity and availability of organic foods and the increased interest in fitness is testimony to the desire by many to stay healthy. (Agriculture Canada predicts the domestic organic industry will grow at an average 20 percent a year to become a $3.1 billion industry by 2005.)
As well, a major demand has developed for herbal medicines, dietary supplements and other forms of holistic health care, as evidenced in the spread of so-called health food outlets and the increased availability of these products in grocery and drug stores. However, consumers often lack the knowledge to differentiate between the ways various food products are produced and processed and their impact on healthy eating. Information is often conflicting or confusing.
In addition, high profile issues such as tainted blood supplies, mad cow disease and contaminated water have raised many questions about the role of both the public and private sectors in ensuring public safety.
Modern methods of food production have given rise to concerns over the effects of insecticides and pesticides and genetically engineered products. Concern over chemical use is evidenced at the community level, where 37 municipalities across the country have banned the cosmetic use of pesticides in response to scientific studies indicating they are a potential threat to human health, especially for children. The Government of Canada has recently introduced legislation that responds to this trend.
As well, the public’s heavy reliance on meat as a major component of North American diets is creating for all governments new public policy issues, such as the amount of natural resources required in the production process and environmental and health concerns linked to so-called “factory farms.”
In Canada, governments have regarded health promotion as part of their mandate for the past 25 years as it is widely accepted that to protect and improve health, preventive efforts have to go beyond education and the clinic. Government’s role has long been established in using social marketing techniques of persuasion to modify behaviour. There is no better example of this than anti-smoking campaigns.
Twenty years ago, it would have been considered impossible to seriously change long-held attitudes and customs related to smoking and their impact on health. Today, Canada leads the world in the success and commitment of its various anti-smoking efforts, which have reduced disease and premature death, health care costs and lost productivity.
The same opportunity now exists to take a lead role in discouraging unhealthy diets and lifestyles and promoting changes that will make children and adults healthier and happier while reducing health care costs and conserving resources.
This can be done through a high profile program that brings together leaders who are visionaries, conducts and coordinates research, trains early-childhood teachers, other teachers and health care workers about the benefits of good nutrition and exercise, develops sponsorship and marketing programs with the private sector and spearheads reliable, effective public education programs.
The program is focused on the belief that there is more to health than health care.
From a financial perspective, the benefits are awesome:
This year, the Canadian government will spend approximately $100 billion on health care (www.hc-sc.gc.ca/english/can/spending). Just saving one percent per year represents conserving some $1 billion annually—money badly needed for such other areas as education, the environment and economic development.
Ideally, we must plan a future in which over a 10-year period the level of health is improved so that we actually save at least 10 percent. Using today’s figures, this represents a $10 billion saving per year by the end of the decade.
This is a far cry from some forecasts, which suggest that if we continue at our current rate of increase, our health budget will go up by 20 percent over the next 10 years. Therefore, a real 10 percent decrease would actually represent a difference in saving of 30 percent or about $30 billion for the period or 3 billion per year. These are the direct costs. However, if productivity loss and other factors are included, the difference can easily be quadrupled and total a 10 year contribution of about $120 billion for government, business and communities.
How this can be accomplished
It will be argued that changing lifestyles is a difficult task. However, the long-range awareness campaign around the harmful effects of smoking is surely an excellent example of how an effective program can successfully modify behaviour. This Canadian success story has saved our economy untold billions of dollars and spared millions of people from the misery of a nicotine addiction and the health problems resulting from it.
Only 25 years ago almost 50 percent of Canadian adults were smokers; the rate dropped to 31 percent in 1990 and is now just under 25 percent (www.cancer.ca, www.heartandstroke.ca). Arguably, turning smokers into non-smokers is a bigger challenge than convincing the public of the merits of eating well and exercising.
• Launch “CANADA EAT AND LIVE SMART,” a medium- to long-range campaign to improve Canadians’ health and conserve resources, supported by strong political and private sector leadership.
• Establish a small, effective office consisting of highly motivated professionals (run like a company with a CEO). This office should be independent—perhaps a Quality of Life Secretariat—but report to the Prime Minister and work closely with all ministries and agencies involved (e.g. health, education, training, colleges and universities, environment, economic development, community and social services, agriculture, food and rural affairs etc.).
• Develop partnerships in both the public and private sectors.
• Develop an awareness and public information campaign.
• Offer training to early childhood educators and teachers about the impact of diet, lifestyle, exercise etc. This can be delivered, for example, through the Canadian College System. Curriculum can be made available immediately by combining existing programs and adding some material from The Canadian College of Naturopathic Medicine. For example, the training will give teachers credit under the point system recently launched by the Ontario College of Teachers.
The curriculum for early childhood education, primary school, junior high school and high-school will be altered and enriched by an entertaining and exciting program designed to appeal to young people.
Promotional materials and media will be appropriate for the various target audiences. For example, daily 5-minute skits can be prepared for airing by CBC and other broadcasters, in which a well-known personality will introduce products, basic recipes, sports and any other issues promoting a happy/healthy lifestyle. This program could also involve some well-known Canadians who have recovered from serious illnesses by changing their lifestyles and diets. Wide use would also be made of public service announcements, talk shows, print materials, public speaking opportunities, web sites and interactive materials of particular interest to young people.
“Canada Eat and Live Smart” would require a partnership of governments and the non-profit and private sectors:
• strong political leadership to provide the catalyst for action
• government bureaucracy to promote co-operation among the various ministries and agencies involved, organize symposiums and recommend the process for administering the program—perhaps through a secretariat
• education partners (the Ministries of Education and Training, Colleges and Universities, faculties of education, community colleges, school boards, teachers, parent councils, physical education specialists, early childhood education centers) to provide institutions and staff with the knowledge and tools they need to promote the program among children and parents
• health care partners (ministry, district health councils, health units, professionals, professional associations, private companies) to develop and market programs to their staff and stakeholders (e.g. Physicians for a Healthy Lifestyle has been active on the federal level)
• foundations dedicated to helping children and families and strengthening social programs
• corporate leaders to pioneer new business opportunities and reduce/eliminate opposition from special interest groups affected by change
• agriculture and food industry members to take a leadership role in developing and promoting healthy lifestyle products and services
• high profile members of the entertainment/sports world to act as champions and role models promoting good diets and physical activity, especially among children (Canadian Olympic stars have shown a willingness to participate in health promotions. In the U.S., entertainer Bill Cosby has been used widely in public service announcements to promote healthy eating for children)
“Canada Eat and Live Smart” provides the opportunity for the Government of Canada to show it has the vision and determination to take a stand against current unhealthy lifestyles that exact such a high toll in human suffering, health care costs and lost productivity. By establishing an office with the necessary expertise and resources to design and implement the program, the government could provide unique incentives and programs in partnership with its many funding partners and the private sector and act as a role model for other jurisdictions.
What leadership did to combat smoking and its high cost to society, leadership can do to promote a healthier lifestyle and its many benefits to our society.
NB: At St. Lawrence College, we have already identified a specific role for ourselves by applying to the Ontario College of Teachers to be designated an official supplier of both elective and core courses for teachers. This is part of the OCT’s requirements for ongoing professional learning by all its registrants. Through our Kingston, Brockville and Cornwall campuses, we are proposing to offer to teachers a variety of courses, including courses on the importance of healthy lifestyles and the link between good food and exercise and good mental and physical health. Furthermore we would like to expand the “Early Childhood Education” curriculum to include some of the important aspects mentioned earlier.
We are most anxious to explore with the government additional ways in which we can be part of the “Canada Eat and Live Smart” program.
The author of this proposal is certainly willing to provide leadership to get this initiative off the ground and make it a success.
President and CEO
St. Lawrence College
Copies of this report were given to most of the leading Ontario and Federal politicians: including Roy Romanow, Chair of the Royal Commission on Health Reform, Dalton McGuinty, then leader of the Ontario Opposition, and Anne McLellan, Minister of Health. Their responses are included for your information.
What Do We Learn from These Responses?
It is quite clear that all parties are trapped somehow in the present health care system. This is really a “sacred cow” nobody dares to slaughter. We do not want to go away from a public system because of the justifiable fear we would create a divided society of some people who can afford to pay for quality service and others who cannot.
As I am proposing in the report “Canada Eat and Live Smart,” we can actually avoid leaving the public system and at the same time create a quality system with first-class service by creating awareness and some conditions that will ensure that people use the system in a responsible and economically feasible way.
Through all the measures proposed, we will be able to save in the neighbourhood of, at least, 1 percent per annum, accumulating, for example, up to 30 percent over thirty years. When we add the planned increase in spending of 20 billion for the same period, it amounts to $30 billion annual savings reached in year ten. This will result in improved health and a future savings of hundreds of billions of tax dollars!
The improvement in well-being and health will be even more important than the initial direct savings. In reality, we do not have another choice. We need to go back to a better lifestyle and a better quality of life. The sooner we start on this journey, the better off we will be. We can under no circumstances pay more for health care or let our health deteriorate in a way that we all end up with civilization diseases like cancer, obesity, diabetes, allergies, heart disease, etc. If we don’t change our lifestyle and our modern eating habits, it must be feared that the prolonged lifespan that was created as a blessing of civilization through improved hygiene, better medical services and more wealth will soon be drastically reduced again. A large percentage (around 40 percent) of the present generation of young Canadians is in such a bad shape that they will face great challenges to reach the age of forty or fifty!
It is somewhat encouraging to see elements of this kind of thinking in the Liberal provincial and federal platform, but a real commitment to change appears to still be missing.
As pointed out in the report, among other things we need to implement are the following measures: