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Presentation to Folkehelsealliansen Nordlund Health Issues in British Columbia Mary Collins, Director BC Healthy Living Alliance May 4 2011

BC Healthy Living Alliance

Mission is: To improve the health of all British Columbians through leadership and collaboration to address the risk factors and health inequities that contribute significantly to chronic disease

Map of British Columbia

• From south to north, BC stretches

2,100 km

• From east to west, as much as

1,050 km

• Its deeply indented, island‐dotted

coastline extends 7,000 km

• Population 4.4 million
• Concentrated in the south, rest of

province sparsely populated

Map of British Columbia

• Many communities in coastal, northern and interior
• f BC are hard to reach
• Victoria to Alberta border is 1,113 km and 15 hours

to drive

• Vancouver to Watson Lake, Yukon is 2,100 km or 26

hours drive

• Some areas of the North and Central Coast are

accessible only by ferry

Health System in BC

• Canada Health Act provides that all citizens receive medically

necessary services provided by physicians and in hospital – free of charge ‐ provinces must comply to receive federal transfer payments but health care is a provincial responsibility ‐ and jealously guarded by the provinces and territories

• BC has a premium system – approx $50 per month ( covers
• nly a very small part of the cost)
• Province can add other insured services – e.g. prescription

drugs over a certain amount

Health System in BC

• 5 Regional health authorities with their own boards deliver

acute care, residential care, some primary care, mental health, as well as public health services – receive funds from province

• One provincial health services authority provides province

wide services – e.g. cancer, children’s hospital

• Physicians are primarily independent, work solo or in groups

and paid by fee for service

• Public health expenditures are 3% of total provincial

government health spending – recommend 6%

BC Health Expenditures – 2011/12 (est)$1 C = $1.05 US = 5.6 NK

• Total expenditures $ 15.7 billion ( approx $ 3500

per capita) includes: Regional Services ‐ $ 10.5 billion ( 5 regional health authorities and one provincial services authority) Medical Service Plan ( physicians) ‐ $ 3.8 billion Pharmacare ‐ $ 1.1 billion

Overview of the draft policy paper:

Provincial Budget across BC Ministries, 2004-2018 (proj.)

Health Adjusted Life Expectancy at Birth BC ‐ 2001

• In 2001, HALE at birth was 71.2 years for females and

68.9 years for males in B.C. In Canada the HALE was slightly lower at 70.8 years for females and 68.3for males.

• For males the estimated difference between British

Columbia and Canada is statistically significant at the five per cent level.

HALE by income

• Health Adjusted Life Expectancy for females in B.C.

was 73.4 years for those in the upper third of the income distribution, 70.7 years for those in the middle third and 69.3 for those in the bottom third.

• The values are slightly lower for males at 70.7 years,

69.0 years and 66.9 years for the high, middle and low thirds of the income distribution.

3 Cancer 21% Cardiovascular Disease 18% I njuries 12% M ental Disorders 11% All Others 22% Neurological & Sensory Disorders 9% Chronic Respiratory Disease 7%

Burden of Disease in BC

Causes of Premature Mortality & Years Lived in Poor Health The current health burden – BC 1998

Leading Causes of Death in BC 2005

• Malignant neoplasms – 29% ‐ $1.2 billion
• Cardiovascular disease – 23% ‐ $944 million
• Cerebrovascaular diseases – 7% ‐ $ 242 Million
• COMBINED – 57%
• Other 27% ‐ influenza 4%, CPD 4%, unintentional

injuries 4%, diabetes mellitus 3%

• Other causes‐ 15%

4

Burden of Disease in BC

12% 10% 2% 5%

0% 2% 4% 6% 8% 10% 12% 14%

Tobacco Alcohol Obesity Physical inactivity Occupation Illicit drugs

Key Risk Factor % of Total DALY

Estimated 10% Estimated 10%

Key Risk Factors Contributing to the Burden of I llness

Healthy Living in BC

• 44.5 percent of British Columbians (18+) were classified as
• verweight or obese;
• 43.4 percent of British Columbians consumed vegetables and

fruit at least five times per day;

• 57.7 percent of British Columbians aged 12 + were classified

as active or moderately active during their leisure time; and

• 14.7 percent of British Columbians were classified as current
• smokers. This translates to over half a million people.

( 2007‐08 figures)

Overweight and Obesity in BC

• Rates of overweight have exploded in BC over the past 25

years, with the most recent data from 2007/8 identifying 44.5% of the population as overweight or obese. Lowest in Canada but still alarming.

• Highest in age group 45‐64 (52.3%) and over 65 (48.8%)
• Even more alarming is the increase in overweight and obesity

in children. The number of children who are either

• verweight or obese between the ages of 6‐11 and 12‐17 has

more than doubled in the last 25 years.

Measuring our Success – Progress Report II – ActNow BC 2010

Physical Activity in BC residents

• In British Columbia, an estimated 36.8 per cent of males and

29.3 per cent of females report being physically active. This compares to 30.3 per cent of Canadian males and 23.2 per cent of Canadian females.

• An estimated 35.3 per cent of British Columbia males and

41.3 per cent of British Columbia females report being physically inactive. This compares to 42.9 per cent of Canadian males and 49.6 per cent of Canadian females.

Tobacco use in teenagers – BC

• In B.C. an estimated 9.0 per cent of male teens and

10.9 per cent of female teens report current smoking

• habits. This is substantially lower than the 14.4 per

cent of Canadian male teenagers and 15.2 per cent

• f Canadian female teenagers who report being

current smokers.

Risk Factors for chronic disease in BC

• Unhealthy eating
• Poor consumption of veggies & fruit in adults and

children

• Trend towards increasing obesity in children
• Food insecurity is related to poor access & 

consumption of veggies & fruit and  consumption

• f unhealthy choices
• Lack of physical activity

– High rates of physically inactive (44.1%)

Risk Factors for chronic disease in BC

Smoking

• Young adults ‐highest prevalence rate in BC
• More likely than older adults to be social smokers
• 45% of daily smokers began between the ages of 18

and 29 years

Healthy Living: Targets for 2010

7/10 will be at a healthy weight 7/10 will be a healthy weight + 349,000 British Columbians 5/10 are a healthy weight 7/10 will get enough activity for health benefits 7/10 will be physically active + 351,000 British Columbians 6/10 are physically active 5/10 will eat at least 5 servings of vegetables & fruits a day 7/10 will eat over 5 servings of vegetables & fruit a day + 948,000 British Columbians 4/10 eat at least 5 servings of vegetables & fruit a day 8.5/10 will not smoke 9/10 will not smoke ‐ 225,000 British Columbians 8/10 do not smoke

ActNow BC TARGETS BCHLA TARGETS CURRENT STATE [Source: BCHLA]

British Columbia Population

Number of Smokers and Former Smokers

If BCHLA Targets Acheived

• 100,000

200,000 300,000 400,000 500,000 600,000 700,000 800,000 2003 2004 2005 2006 2007 2008 2008 2010

Year # of Individuals

Current Smokers Former Smokers

225,000

Considering the Social and Economic Determinants of Health

• Health is not equitably distributed
• Need to consider other social and economic factors
• Major focus of BCHLA Work in past three years
• Getting traction with wide range of groups –

particularly with respect to children

Stikine Fort Nelson Prince G eorge Nechako Peace River North Quesnel Cariboo-Chilcotin Burns Lake T errace Kamloops Merritt Kitimat Snow Country Golden Peace River South T elegraph Creek Bella Coola Valley Fernie Smithers Lillooet Hope Alberni W indermere Revelstoke V ernon North Thompson Howe Sound 100 Mile House Nelson Nisga'a South Cariboo Arrow Lakes Campbell River Princeton Vancouver Island North Creston Kootenay Lake Kimberley Cranbrook Powell River Queen Charlotte Prince Rupert Kettle Valley Vancouver Island North Upper Skeena Sooke Trail Campbell River Salmon Arm Keremeos Agassiz-Harrison Sunshine Coast Enderby Vancouver Island W est Grand Forks Central Coast Kitimat Mission Central Coast Courtenay Lake Cowichan Queen Charlotte Kitimat Nanaimo Central Coast Chilliwack Maple Ridge Central Coast Prince Rupert Central Coast Central Coast V ancouver Island W est Saanich

Delta Richmond Westside North Vancouver Burnaby Delta Midtown Richmond North East City Centre

LE0 for BC Total Population (2001-2005) by Local Health Area

L ife E x p e c ta n c y a t B ir th

7 0 .2 7 4 .5 - 7 6 .1 7 6 .8 - 7 7 .9 7 8 .2 - 7 9 .1 7 9 .2 - 7 9 .8 7 9 .9 - 8 0 .2 8 0 .4 - 8 0 .9 8 1 .0 - 8 1 .6 8 1 .9 - 8 3 .0 8 3 .5 - 8 5 .4

BC Poverty rate by family type

0.0 10.0 20.0 30.0 40.0 50.0 60.0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Elderly Married Couples (couple means no children) Non-Elderly Married Couples Tw o-Parent Families Female Lone-parent families

(Based on after-tax income, standardized to 2006 dollars. Data source: Statistics Canada I ncome Trends in Canada 2006)

Percentage of food insecure households in BC by income deciles (2005) (1 = lowest household income level; 10 = highest household income level)

22.2% 12.7% 7.9% 5.4% 3.8% 3.7% 0.8% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

DECILE 1 DECILE 2 DECILE 3 DECILE 4 DECILE 5 DECILE 6 DECILE 7- 10

(Data source: Statistics Canada Canadian Community Health Survey Cycle 3.1 2005)

Prevalence of heart disease

Men

6.4 7.0 10.0 16.6 5 10 15 20 25

Lowest Lower Middle Higher Middle Highest Household Income Quartiles Age-Standardized Percentage

Women

4.1 5.7 7.5 12.4 5 10 15 20 25

Lowest Lower Middle Higher Middle Highest Household Income Quartiles Age-Standardized Percentage

Heart disease in BC by income

(Data source: Statistics Canada Canadian Community Health Survey Cycle 3.1 2005; Percentages were standardized to the 2004 Canadian population as the reference with bootstrap weight valued provided by Statistics Canada. Confidence intervals for age-standardized percentages(45-64, 65+) were calculated with the method based on the gamma distribution developed by Fay and Feuer in 1997)

Prevalence of Diabetes

Men

3.6 7.7 9.2 16.1 5 10 15 20 25

Lowest Lower Middle Higher Middle Highest Household Income Quartiles Age-Standardized Percentage

Women

6.2 8.3 9.3 11.3 5 10 15 20 25

Lowest Lower Middle Higher Middle Highest Household Income Quartiles Age-Standardized Percentage

Diabetes in BC by income

(Data source: Statistics Canada Canadian Community Health Survey Cycle 3.1 2005; Percentages were standardized to the 2004 Canadian population as the reference with bootstrap weight valued provided by Statistics Canada. Confidence intervals for age-standardized percentages(45-64, 65+) were calculated with the method based on the gamma distribution developed by Fay and Feuer in 1997)

Smoking in BC by income

Men

8.2 14.6 15.4 24.2 10 20 30

Lowest Lower Middle Higher Middle Highest Household Income Quartiles Age-Standardized Percentage

Women

7.7 11.2 15.7 21.7 10 20 30

Lowest Lower Middle Higher Middle Highest Household Income Quartiles Age-Standardized Percentage

(Data source: Statistics Canada Canadian Community Health Survey Cycle 3.1 2005; Percentages were standardized to the 2004 Canadian population as the reference with bootstrap weight valued provided by Statistics Canada. Confidence intervals for age-standardized percentages(25-44, 45-64, 65+) were calculated with the method based on the gamma distribution developed by Fay and Feuer in 1997)

Prevalence of Smoking

Benefits of addressing health inequities

• Improves the health of all
• Reduce costs of lost productivity, improved health of

people and communities increases competitiveness productivity and profitability

• Decrease demand for health services

Healthy Living in BC

• While we are a relatively healthy population in BC

there is much work to be done

• BC Government planning some new initiatives on

healthy living ‐ expect announcements soon.

• Increasing information in the media and social media
• n healthy living
• But still many challenges to be overcome