Chronic Disease and Obesity in Canada
Each year in Canada, more than two-thirds of deaths result from four groups of chronic diseases – cardiovascular, cancer, type 2 diabetes and respiratory. These chronic diseases share common preventable risk factors (physical inactivity, unhealthy diet and tobacco use) and the environmental determinants that underlie these personal health practices, including income, employment, education, geographic isolation, social exclusion, and other factors. According to the World Health Organization, over 90 percent of type 2 diabetes and 80 percent of coronary heart disease could be avoided or postponed with good nutrition, regular physical activity, the elimination of smoking and effective stress management.
- The estimated total cost in Canada of illness, disability and death attributable to chronic diseases amounts to over $80 billion annually.Footnote 1
The number of Canadians who are overweight or obese has steadily increased over the last 25 years. Today, nearly one-quarter (23.1%) of adult Canadians, 5.5 million people aged 18 or older, are obese. An additional 36.1% (8.6 million) are overweight – bringing the total number of adult Canadians who are overweight or obese to over 59%.Footnote 2 Of even greater concern, 26% of Canadian children and adolescents aged 2 to 17 are overweight or obese; 8% are obese.Footnote 3 For children aged 6 to 11 and adolescents aged 12 to 17, the likelihood of being overweight or obese tends to rise as time spent watching TV, playing video games or using the computer increases. For the majority of Canadians, current physical activity patterns are not optimal for health. Obese individuals tend to have sedentary leisure-time pursuits and to consume fruits and vegetables relatively infrequently.
- Physical inactivity costs the Canadian health care system at least $2.1 billion annually in direct health care costs,Footnote 4 while the estimated annual economic burden is $5.3 billionFootnote 5
Less is known about the eating practices of Canadians, but we do know that the proportion of Canadians reporting poor eating habits is increasing.In 2001, 21% of Canadians reported their eating habits as fair or poor compared to 17% in 1997, and 15% in 1994.Footnote 6 We also know that those who eat fruit and vegetables less than three times a day are more likely to be obese than are those who consume such foods five or more times a day.Footnote 7
The Need For Collaborative Action
The need for a pan-Canadian healthy living approach was expressed in 2002 by the Federal, Provincial and Territorial (F/P/T) Ministers of Health, who sought a collaborative and coordinated approach to reducing non-communicable diseases by addressing their common risk factors and the underlying conditions in society that contribute to them.Footnote 8
An extensive consultation process, including a national symposium, was undertaken to develop a Healthy Living Strategy. Consensus was achieved, and endorsed by Ministers, that the first areas of emphasis would be healthy eating, physical activity and their relationship to healthy weights, with other areas such as mental health and injury prevention identified for potential future action.
The World Health Organization’s Global Strategy on Diet, Physical Activity and Health supports an integrated, collaborative approach, stating that the responsibilities for action to bring about changes in dietary habits and patterns of physical activity rest with many stakeholders from public, private and civil society, over several decades.
Without integrated effort on healthy living:
- Opportunities for collaboration will not be fully realized;
- Gaps in knowledge development and exchange will persist;
- Public “messages” will be inconsistent and confusing;
- Community capacity to promote healthy living will be limited;
- Chronic diseases and obesity rates are likely to continue to rise; and
- Disparities will continue to grow and widen.
The Healthy Living Strategy
The Healthy Living Strategy is a conceptual framework for sustained action based on a population health approach.Footnote 9 Its vision is a healthy nation in which all Canadians experience the conditions that support the attainment of good health. To achieve this, the goals of the Strategy are to:
- Improve overall health outcomes; and
- Reduce health disparities.Footnote 10
As an integrated approach involving many sectors working together towards common goals, the Strategy offers a means to ensure greater alignment, coordination and direction for all sectors, and provides a forum for multiple players to align efforts and to work collaboratively to address common risk factors. This integration ensures that stakeholders are better and more broadly informed, thereby facilitating greater synergy and improved identification of opportunities across sectors. The intersectoral nature of the Healthy Living Strategy also provides a national context and reference point for all sectors, governments and Aboriginal organizations to measure success of their own strategies and interventions.
Healthy Living Targets
Given the trends in current eating and physical activity patterns, and in the consequent increases in rates of overweight and obesity, decisive action is required by all partners and sectors with an interest in improving the health of Canadians.
Every province and territory in Canada, and the federal government, has adopted the Physical Activity target of increasing regular levels of physical activity by 10 percentage points (endorsed by Ministers responsible for Physical Activity, Recreation and Sport in June 2003), and most already have targets on healthy eating and healthy weights which are consistent with those proposed for the Healthy Living Strategy. A list of provincial/territorial targets for healthy eating, physical activity and healthy weights is included as Appendix A.
Around the world, other countries are striving to address the same issues. England, Scotland, New Zealand and the United States are only some of the countries that have set targets to increase physical activity, improve healthy eating and healthy weights – targets that are consistent with the Canadian healthy living targets.
The proposed pan-Canadian Healthy Living targets seek to obtain a 20% increase in the proportion of Canadians who are physically active, eat healthy and are at healthy body weights.
While ambitious, these targets can be achieved through collaborative action and will serve to sustain momentum from the existing physical activity target set by Ministers for Physical Activity, Recreation and Sport. Although set to roll out over 10 years, success will require sustained effort over a much longer period. For this reason, 2015 should be considered as a first marker, with ongoing monitoring and evaluation undertaken in order to assess progress and allow for adjustments as appropriate.
The targets of the Healthy Living Strategy are:
- By 2015, increase by 20% the proportion of Canadians who make healthy food choices according to the CCHS, SC/CIHI Health Indicators.Footnote 11
- By 2015, increase by 20% the proportion of Canadians who participate in regular physical activity based on 30 minutes/day of moderate to vigorous activity as measured by the CCHS and the Physical Activity Benchmarks/Monitoring Program.Footnote 12
- By 2015, increase by 20% the proportion of Canadians at a “normal”Footnote 13 body weight based on a Body Mass Index of 18.5 – 24.9 as measured by the NPHS, CCHS, SC/CIHI Health Indicators.Footnote 14
Healthy Living targets will need to be aligned with the Public Health Goals (currently in discussion), accompanied by measures of disparities and disparities reduction, and may be adjusted in the future for consistency. It is expected that the Healthy Living targets will complement and support the broader Public Health Goals.
It is recognized that targets still need to be set for specific populations (including new Canadians, minority cultural communities, and others) as well as indicators to measure reduction of disparities among Canadians by characteristics of gender, race (Aboriginal identity), geographic location and socio-economic factors. As well, the measurement tools for the targets will evolve as data become available (e.g. CCHS; measured BMI results, Physical Activity Benchmarks/Monitoring Program, and others), and appropriate tools will be used or developed where possible to measure progress within older adults, Aboriginal Peoples and other cultures, and other target populations.
Intersectoral Partnerships/Collaboration in Action
To support the intersectoral development of the Strategy, theCoordinating Committee of the Intersectoral Healthy Living Network was established in September 2004, led by three chairs representing federal, provincial/territorial governments, and the non-government sector. Comprised of representatives from regional networks, governments, private and voluntary sectors, and National Aboriginal Organizations,Footnote 15 the Coordinating Committee acts as an engine to move the Pan-Canadian Healthy Living agenda forward.
A number of Working Groups were formed, comprised of members of the Coordinating Committee, and experts drawn from across the Network, to advise and support the implementation of the ‘action’ areas identified by the F/P/T Conference of Deputy Ministers and by F/P/T Ministers of Health in September 2003, including the development of:
- healthy living priorities and targets for the Strategy;
- an integrated research and surveillance agenda, including best practices; and
- a public information campaign and social marketing program.
In addition, there was continued dialogue with Aboriginal communities.
Opportunities for Action
While the Healthy Living goals and targets provide a standard reference point for all sectors to measure the success of their own strategies and interventions, to be successful, coordinated effort is required. Proposed activities have been developed through intersectoral working groups to be considered in the implementation of the Strategy.
Policy and Program
From a policy and program perspective, a number of opportunities for action have been identified to:
- Improve physical activity and healthy eating patterns, behaviours and choices among Canadians;
- Improve access to, and affordability of, healthy food choices and physical activity opportunities;
- Reduce the gap in physical activity levels that exists at different age, sex, education and income levels; and
- Enhance collaboration and planning across health and “non-health” sectors.
Research and Surveillance
At the same time, an integrated research and surveillance agenda, including best practices, outlines gaps and details specific recommendations to: enable increased capacity for knowledge development and exchange; increased population-level intervention research to understand and address the determinants of healthy eating, physical activity and their relationship to healthy weights; and an integrated system for knowledge development and exchange.
Social marketing efforts in the area of physical activity and healthy eating abound across the country, whether from governments, the voluntary sector or the private sector. With support from the working group, plans for continued efforts to leverage opportunities and ensure consistent messaging are underway. This coordination aims to bring about positive change in healthy eating behaviours and levels of physical activity among Canadians.
Implementing the Healthy Living Strategy
Having set targets and priorities, and identified opportunities for action, the Coordinating Committee for the Healthy Living Network will provide leadership in the implementation of the Strategy where the focus will be on activities with the greatest potential to impact positively on the health of Canadians. In this phase, an evaluation strategy will be a first priority to ensure that, collectively, we can measure not only progress on targets, but also the success of and benefit to Canadians of this intersectoral healthy living strategy. Annual progress reports to F/P/T Conference of Deputy Ministers of Health and to F/P/T Ministers of Health will be provided.
- Footnote 1
- Federal/Provincial/Territorial Advisory Committee on Population Health. Advancing Integrated Prevention Strategies in Canada: An Approach to Reducing the Burden of Chronic Diseases. Ottawa, June 2002; Health Canada. Economic Burden of Illness, 1998. Ottawa, 2002; World Health Organization. World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva, 2002.
- Footnote 2
- Nutrition: Findings from the Canadian Community Health Survey. Issue no.1 Measured Obesity: Adult Obesity in Canada, Michael Tjepkema and Margot Shields, 2004.
- Footnote 3
- Nutrition: Findings from the Canadian Community Health Survey. Issue no.1 Measured Obesity: Overweight Canadian Children and Adolescents, Michael Tjepkema and Margot Shields, 2004.
- Footnote 4
- Katzmarzyk, P.T., Gledhill, N. & Shephard, R.J. (2000). The economic burden of physical inactivity in Canada. Canadian Medical Association Journal, 163(11), 1435–1440.
- Footnote 5
- Katzmarzyk, P.T. & Janssen, I. (2004). The economic costs of physical inactivity and obesity in Canada: An update. Canadian Journal of Applied Physiology, 29(1), 90-115.
- Footnote 6
- Tracking Nutrition Trends 1989-1994-1997, 2000. An Update on Canadians’ Attitudes, Knowledge, and Reported Actions, 2001.
- Footnote 7
- Statistics Canada. The Daily., July 6, 2005.
- Footnote 8
- It should be noted that although Quebec shares the general goals of this strategy it was not involved in developing it and does not subscribe to a Canada-wide strategy in this area. Quebec intends to remain solely responsible for developing and implementing programs for promoting healthy living within its territory. However, Quebec does intend to continue exchanging information and expertise with other governments in Canada.
- Footnote 9
- A population health approach focuses on improving the health status of the population. Action is directed at the health of an entire population, or sub-population, rather than individuals. Focusing on the health of populations also necessitates the reduction in inequalities in health status between population groups.
- Footnote 10
- Health disparities refer to differences in health status that occur among population groups defined by specific characteristics. The most prominent factors in Canada are socio-economic status (SES), Aboriginal identity, gender, disabilities, culture and geographic location.
- Footnote 11
- This target would seek to measure, for instance, the food insecurity index and the consumption of vegetables and fruits where 5-10 servings/day of vegetables and fruit are recommended in Canada's Food Guide to Healthy Eating, and “increasing the consumption of fruits and vegetables” is one of the dietary recommendations in the WHO Global Strategy on Diet, Physical Activity and Health. ref: Health Canada. Summary document from: “The Food and Nutrition Surveillance System: Moving Forward with Nutrition” meeting, March 31, 2003.
- Footnote 12
- The physical activity target builds on the target of 10 percentage points by 2010 set by Ministers responsible for Physical Activity, Recreation and Sport. The benchmark of 30 minutes / day is consistent with the WHO Global Strategy on Diet, Physical Activity and Health.
- Footnote 13
- “normal” (instead of “healthy”) is used to be consistent with terminology used in the Body Mass Index
- Footnote 14
- ref: Health Canada, Canadian Guidelines for Body Weight Classification in Adults, 2003.
Available at: http://www.hc-sc.gc.ca/hpfb-dgpsa/onpp-bppn/weight_book_cp_e.html
- Footnote 15
- Assembly of First Nations, Inuit Tapiriit Kanatami, and Métis National Council.