Provincial Comparison: Ontario vs Alberta
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This week I was challenged to team up with a classmate and compare provincial frameworks for chronic disease management. We also compared the different in each provinces prevalent chronic diseases. Below is the comparison between Ontario and Alberta created in collaboration with Brogan Gordon, a Registered Nurse from Alberta. Check out her blog here
Chronic disease is an issue worldwide, leading to early morbidity if left untreated. In Canada, the 3 most prominent chronic disease include cancer, cardiovascular and diabetes (Canadian Nurses Association). In addition to these diseases, Canada also fights additional chronic disease issues such as COPD, asthma, mental illness and arthritis. Ontario estimates that 80% of residents in Ontario over the age of 45 live with a chronic disease and 70% of those people suffer from multiple chronic diseases (Ministry of Health and Long-Term Care 2018). Chronic diseases with the highest morbidity rates in Ontario include, cancer causing 40% of Ontario deaths, cardiovascular causing 36.1% of Ontario deaths, lower respiratory diseases causing 6% of Ontario deaths and diabetes causing 3.6% of Ontario deaths (Public Health Ontario 2019). Cancer Care Ontario is a framework developed for all Ontarians for screening and early detection of cervical, breast, and colorectal cancers. This program uses the power of primary care providers and government policy use, tracking last tests performed and performing automated mailouts when the individual the meets screening criteria is due to be screened. For cardiovascular disease (CVD) there is a less prominent program in place to address chronic CVD. CVD is screened for during annual checkup within your primary care provider and prevention is advocated for in Ontario's healthy living campaign promoting smoking cessation, reduced alcohol consumption, healthy eating and increased physical activity (Public Health Ontario 2019). Socioeconomic status plays a pivotal role in the determinants of health. Income, education and housing status are the leading socioeconomic determinants of health that influence chronic disease and its management (Public Health Ontario 2019).
Ontario developed a chronic Disease Prevention and Management Framework, used to guide Ontario The Ontario framework provides a systematic approach to prevention and management of chronic disease. Individuals are empowered to have a greater role in managing their illness by becoming more involved with the health care team. Interdisciplinary teams have become an important part of chronic disease management aligning the patient with the right provider in the right setting at the right time for better management and outcome of the disease (Ministry of Health and Long-Term Care 2018).
Created by the ministry of health and long term care, this chart demonstrates the chronic disease causes of death versus all causes of death. This allows us to visualize the impact of chronic disease for Ontario residents.
Using the determinants of health, we can compare mortality rates from chronic diseases, assessing how inequity effects disease and mortality.
Alberta has also developed a guiding framework called the AHS Chronic Disease Prevention Action Plan (Action Plan). This framework was developed by the chronic disease prevention team (CDP) within Healthy Living, Population, Public and Indigenous Health in 2016. Alberta has the highest health expenditure per Capita in Canada with the majority of health care costs going towards the treatment and management of chronic disease. Within Alberta, the CDP (2016) determined that there was little to no organized effort to address chronic disease risk factors at the adult level. Furthermore, the CDP (2016) found that there is a lack of an overarching supports for chronic disease prevention, such as a risk factor surveillance system. In fact, Alberta only spends 3% of its total health budget on preventing disease and promoting health. Therefore, it was important to create a framework to:
1) Identify gaps and priorities in chronic disease prevention
2) Identify key actions to address gaps and priorities
3) Identify strategies to improve the coordination of chronic disease prevention and management across the province
The Action Plan created by the CDP focuses on 5 key behavioural risk factors: nutrition, physical activity, alcohol, tobacco and stress. It also acknowledges the significant impact of the social determinants of health. In particular, the Action Plan mentions living and working conditions, unequal distributions of income and wealth, health and social services, the ability to access food, housing and quality. The CDP spent 3 years developing the Action plan to ensure it was in line with evidence relating to the burden of chronic disease prevention in Alberta as well as provincial wellness documents.
(AHS Chronic Disease Action Plan, 2016)
Many chronic diseases are influenced by common, preventable risk factors. The Action Plan created by the CDP places a heavy focus on these modifiable risk factors. The following chart from the Action Plan outlines some major chronic diseases, as well as their underlying risk factors.
(AHS Chronic Disease Action Plan, 2016)
Given clear impact of these 5 risk factors in the development of chronic disease, the Action Plan suggests interventions targeting each of the risk factors which could significantly improve the health of all Albertans.
Tobacco
Preventing tobacco use and helping all users quit could:
-eliminate 30% of all cancer deaths
-eliminate 30% of all coronary heart disease deaths
-eliminate 85–90% of COPD
-eliminate/reduce many other tobacco-related illnesses
Nutrition:
Consuming a diet higher in fibre, and lower in fats and sodium could:
-result in a 14% reduction in coronary risk
-result in a 16% reduction in cardiovascular risk
-result in a 12-22% reduction in coronary heart disease
-result in a 30% reduction in incidence of hypertension
-promote healthier weights and reduce the incidence of type 2 diabetes
Physical Activity:
Regular physical activity and reduced sedentary behaviour could:
-result in a 30-50% lower chance of developing type 2 diabetes
-result in a 20-35% lower risk of developing breast cancer (women only)
-result in lower incidences of hypertension and heart disease
-improve mental health and quality of life
-reduce health care spending from 6.8 billion to 2.6 billion
Alcohol:
Reducing the misuse and overuse of alcohol could:
-result in a lower risk of developing some cancers, type 2 diabetes, cirrhosis, pancreatitis, gastrointestinal diseases, and neurological disorders.
Stress:
Reducing ongoing chronic stress could:
-reduce incidence of cardiovascular disease, obesity, type 2 diabetes, asthma, anxiety, and depression
To improve in many of the above risk factors, the CDP highlights the importance of the social determinants of health. They stress the need to focus on supportive environments and building capacity within communities, addressing disparities and health inequities, and taking an integrated approach that looks at multiple risk factors.
(AHS Chronic Disease Action Plan, 2016)
Regarding the surveillance and monitoring of chronic disease in Alberta, the Primary Health Care Opioid Resource Initiative has put together a document listing 14 different administrative datasets regarding the health of Albertans available for research, planning, policy, development, and quality improvement projects. In addition, Alberta has programs used in the surveillance of specific chronic diseases such as the Alberta Diabetes Surveillance System (Lix et al., 2018). However, as indicated in the report by the CDP, there is more work to be done in the surveillance of chronic diseases, specifically chronic disease risk factors, in adults. Lix et al. (2018) adds to this, suggesting the need for population-based electronic data sources that are routinely collected and consistently available in all Canadian jurisdictions.
One source of funding in relation to chronic disease in both Ontario and Alberta is Public Health Agency of Canada’s Healthy Living and Chronic Disease Prevention – Multi-sectoral Partnerships (MSP Program). This program has invested $92 million dollars into chronic disease prevention and healthy living promotion strategies. However, the program is currently paused and not accepting any new requests for funding until later in 2021. Alberta also has funds available for research of specific chronic diseases, such as the AHS Alberta Cancer Prevention Legacy Fund.
Chronic disease accounts for 53% of total healthcare costs in Canada and is therefore a top priority for health care professionals (CDP, 2016). Both Alberta and Ontario have created frameworks to address chronic disease, its treatment, and its management. Some similarities in both frameworks include the identification of cancers, cardiovascular diseases, chronic lower respiratory diseases, and diabetes as diseases which could be significantly improved by addressing the social determinants of health. In addition, both frameworks highlight a need for a multidisciplinary, integrated approach to chronic disease prevention and management. Furthermore, both frameworks identified income, education and housing status as some of the leading socioeconomic determinants of health which influence chronic disease and its management. However, Alberta also emphasized food security as a serious problem contributing to chronic disease in the province. However, more funding and better health surveillance systems will increase the capacity for both provinces to make meaningful improvements in the treatment and prevention of chronic disease.
References:
Canadian Nurses Association (?) Charonic Disease and Nursing: A Summary of the Issues Retrieved from: https://cna-aiic.ca/~/media/cna/page-content/pdf-en/bg3_chronic_disease_and_nursing_e.pdf
Ministry of Health and Long Term Care (2018) Ontario’s Framework, Preventing and Managing Chronic Disease, Retrieved from: http://www.health.gov.on.ca/en/pro/programs/cdpm/
Public Health Ontario (2019) The Burden of Chronic Disease in Ontario: Key Estimates to Support Efforts ibn Prevention, CCO and Ontario Agency for Health Protection and Promotion, Retrieved from: https://www.publichealthontario.ca/-/media/documents/C/2019/cdburden-report.pdf?la=en
Chronic Disease Prevention team. (2016). AHS Chronic Disease Prevention Action Plan. Healthy Living, Population, Public and Aboriginal Health. https://www.albertahealthservices.ca/assets/info/cdp/if-cdp-action-plan.pdf
Government of Canada. (2021). Multi-sectoral Partnerships to Promote Healthy Living and Prevent Chronic Disease. https://www.canada.ca/en/public-health/services/funding-opportunities/multi-sectoral-partnerships-promote-healthy-living-prevent-chronic-disease.html
Lix, L. M., Ayles, J., Bartholomew, S., Cooke, C. A., Ellison, J., Emond, V., Hamm, N. C., Hannah, H., Jean, S., LeBlanc, S., O'Donnell, S., Paterson, J. M., Pelletier, C., Phillips, K., Puchtinger, R., Reimer, K., Robitaille, C., Smith, M., Svenson, L. W., Tu, K., … Pelletier, L. (2018). The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance. International journal of population data science, 3(3), 433. https://doi.org/10.23889/ijpds.v3i3.433
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