A Comparison of a Traditional "Have" with a Traditional "Have Not" Province: ON vs. NL
- sflevac
- Mar 8, 2021
- 6 min read
Updated: Apr 2, 2021
This work was done with fellow student Travis Bolt
Surveillance
In Ontario, the Public Health Ontario (PHO) agency is responsible for surveillance of chronic diseases. They collect a great deal of information and submit this data as all provinces and territories do to Health Canada. Comparisons can be noted at the website https://health-infobase.canada.ca/ccdss/data-tool/Comp?G=35&V=1&M=1. See below for the example of Chronic Obstructive Pulmonary Disease (COPD).
According to Preventing and Managing Chronic Disease: Ontario’s Framework (2007), "this document has been developed to inform planning for chronic disease prevention and management (CDPM) in Ontario. It provides the evidence base for Ontario's CDPM Framework, which has evolved from the Chronic Care Model developed at the MacColl Institute of Healthcare Innovation, U.S.A.; and been informed by the Expanded Chronic Care Model from British Columbia, that incorporates the Ottawa Charter of Health Promotion".
Management
Managing chronic diseases is everyone’s responsibility. It is done by primary care (physician/NP/family health teams), tertiary care - hospitals (admission of patients, out-pt. clinics), Ministry of Health/Ontario Health, Home and Community Care (under the Local Health integrated Networks), pharmacies (pharmacists), Public Health Units, but most importantly those who live with chronic diseases: the patients and their caregivers. Holman and Lorig (2004) note:
There is no cure for chronic disease; instead, management over time is essential.
For effective treatment of chronic disease, the patient must engage continuously in different health care practices.
The patient knows the most about the consequences from the chronic disease and its therapies, and must apply that knowledge to guiding the management over time.
To achieve effectiveness and efficiency in treatment, the patient and health professional must share complementary knowledge and authority in the health care process.
Also, as cited in “The burden of chronic diseases in Ontario: key estimates to support efforts in prevention” (2019):
Cancers, cardiovascular diseases, chronic lower respiratory diseases and diabetes cause about two-thirds of all deaths in Ontario. This report, produced jointly by CCO and Public Health Ontario, estimates the burden of these four chronic diseases through their mortality, incidence, prevalence and hospitalizations. It shows that the overall burden is considerable and that there is a disproportionately high burden of these diseases in Indigenous populations and people with lower socioeconomic status in Ontario. Chronic diseases not only reduce the quality and length of people’s lives, they are also expensive to treat.
Funding
According to the Ontario Auditor General’s report for the fiscal year 2016/17, the “Ministry of Health and Long-Term Care spent $1.2 billion on public health and health promotion programs. Public health units received $702 million (58%) and PHO $163 million (14%) of provincial public health funding. Overall, Ontario spent about $192 million (16% of total public health spending) on preventing chronic diseases.”
PHO provides an important role, which includes providing technical advice and support activities, public health research, epidemiology, and program planning and evaluation to protect and improve the health of Ontarians. PHO is also responsible for various health issues, which of course includes chronic diseases. They also look at the social determinants of health and how these may affect chronic diseases.
The Auditor General report found that Chronic Disease Prevention and Well-Being cost $85 018 923 that fiscal year, which was 10.78% of the total Ontario Government’s budget.
From the PHO website, I was able to find the most recent information on these three chronic diseases and their incidence (age standardized as all adults 20 years and over, rates are per 100 000 population):
Diabetes 855.7
COPD 544.6
Hypertension 1876.3
Primary Determinants
Primary determinants can vary in a large province like Ontario. The highest population in the country is situated within the Greater Toronto Area (GTA). There is a vast immigrant population there, and many live in substandard housing. In contrast, the far north is almost exclusive to the indigenous population, and by their very distance from main towns/cities (and many lacking roads except in winter), food insecurity and housing insecurity are important factors which contribute to chronic diseases.
From the image below, it can be concluded that these are some of the determinants of these three chronic diseases:
COPD – smoking/education
Hypertension – diet/poor exercise/education
Diabetes – genetics/age/poor exercise/diet
(From Preventing and Managing Chronic Disease: Ontario’s Framework 2007)
Chronic Disease in Newfoundland and Labrador
Chronic disease surveillance
NL uses Newfoundland and Labrador Center for Health Information (NLCHI) for chronic disease surveillance. The center developed the provinces first Chronic Disease Registry which include surveillance of seven chronic diseases: diabetes, asthma, chronic obstructive pulmonary disease, heart failure, hypertension, ischemic heart disease and stroke.
In addition to health surveillance, the chronic disease registry allows for a provincial approach to identifying new and existing chronic disease patients and includes information about how these patients are being managed, their health services, health outcomes and health costs.
The Registry also informs policy decision-making, program planning and program monitoring and with appropriate approvals, the data may be used for research (NLCHI, 2018).
NL also uses The Canadian Chronic Disease Surveillance System (CCDSS) like the rest of Canada. This system collects data relating to chronic diseases and can generate national estimates and trends over time for over 20 chronic diseases (Public Health Agency of Canada, 2020).
Chronic Disease Management
The province of NL is very focused on supporting active self-management to increase the individual’s capacity in preventing and managing chronic disease. Self-management support is designed to provide individuals the personal tools to manage their own disease and cope with the challenges of living with and treating chronic disease. Individuals living with chronic disease, and their families, are taught effective strategies that include assessment, goal setting, action planning, problem solving and follow-up to assist them with self-care and reduce disease symptoms and complications.
Chronic Disease Funding
Chronic disease places an economic burden on individuals and society in terms of purchasing individual services and funding the health care system. According to the Government of NL report “Chronic Disease Prevention and Management Strategy”:
“As it is currently funded, the sustainability of the health care system is being negatively impacted by chronic disease. According to the provincial government, 36.4% ($2,330,918,000) of the 2011-12 provincial budget is used in health care. In comparison, Ontario currently utilizes 46% of its budget for health care expenditures. Cost projections reported by the Canadian Academy of Health Sciences state that if the current trend prevails, by 2030 health care expenditures will make up 80% of their total program spending”.
Chronic Disease Rates
In NL, acute myocardial infarctions and hypertension accounted for 73.5% of all hospitalizations for ischaemic heart disease. COPD was responsible for 82.5% of all hospitalizations due to chronic lower respiratory disease.Diabetes ranked 4th as a leading cause of death in both Eastern Health and Newfoundland and Labrador (Eastern Health, 2012).
Table 1: NLCHI(2018)
Primary Determinants of Chronic Disease
The main determinants of health that I feel increase the prevalence of chronic disease in NL are income and social status and education. Income affects many factors such as diet, educational levels, alcohol use and has been linked to physical activity levels (Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A., 2020). Education also allows a person to understand the importance of health promotion and disease prevention in life (Raphael, D. et. Al, 2020). The presence of risk factors such has obesity, physical inactivity, and poor diet can increase the likelihood of a person developing a disease. Risk factors can be biological, environmental, and behavioural (Government of NL, 2019). Another Important risk factor for developing chronic diseases is alcohol consumption. In 2009, male residents of the Eastern Health region self-reported drinking significantly more than female residents (Figure 5), and significantly more than males within the province as a whole (25.1%) and Canada (17.2%) (Eastern Health, 2012).
Figure 1 shows the percentage of Eastern Health and Newfoundland and Labrador residents who report having selected risk factors (obesity, physical inactivity, and poor diet).
Eastern Health (2012)
References
CCO and Ontario Agency for Health Protection and Promotion (Public Health Ontario).The burden of chronic diseases in Ontario: key estimates to support efforts in prevention. Toronto: Queen’s Printer for Ontario; 2019, retrieved from https://www.ola.org/en/legislative-business/committees/public-accounts/parliament-42/reports/2019-nov-5--report-public-health-chronic-disease-prevention---standing-committee-public-accounts
Eastern Health (2012). Chronic Disease Prevention and Management Strategy. Retrieved from: file:///Users/travis/Downloads/Chronic%20Disease%20Prevention%20and%20Manage
ment%20Strategy_Final.pdf.
Government of NL. (2019). Chronic Disease Action Plan. Retrieved from:
Holman, H. and Lorig, K. (May – June 2004). Patient Self-Management: A Key to Effectiveness and Efficiency in Care of Chronic Disease. Public Health Reports (Volume 119).
NLCHI-Newfoundland and Labrador Center for Health Information. (2018). eHealth Report.
Retrieved from: https://www.nlchi.nl.ca/images/FINAL_NLCHI_-_eHealth_Report_-
_Feb_2018.pdf.
Ontario Agency for Health Protection and Promotion (Public Health Ontario). Snapshots: Chronic Disease Incidence and Prevalence Snapshot: prevalence of asthma–age standardized rate (both sexes) 2017 [Internet]. Toronto, ON: Queen’s Printer for Ontario; 2020 [cited 2020 Apr 30]. Available from: https://www.publichealthontario.ca/en/data-and-analysis/chronic- disease/chronic-diseaseincidence-prevalence
Preventing and Managing Chronic Disease: Ontario’s Framework (May 2007). Ministry of Health and Long-Term Care.
Public Health Agency of Canada. (2020). The Canadian Chronic Disease Surveillance System – An Overview. Retrieved from: https://www.canada.ca/en/public-health/services/publications/canadian-chronic-disease-surveillance-system-
factsheet.html.
Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social determinants of health: The Canadian facts (2nd edition). Ontario Tech University Faculty of Health Sciences and
York University School of Health Policy and Management.
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