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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 of 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 only 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.

Burden of Disease in BC Causes of Premature Mortality & Years Lived in Poor Health The current health burden – BC 1998 Cardiovascular I njuries Disease 12% 18% M ental Disorders 11% Cancer 21% Neurological & Sensory Disorders 9% Chronic Respiratory Disease 7% All Others 22% 3

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%

Burden of Disease in BC Key Risk Factors Contributing to the Burden of I llness 14% 12% Estimated Estimated 12% 10% 10% 10% 10% % of Total DALY 8% 6% 5% 4% 2% 2% 0% Tobacco Alcohol Obesity Physical Occupation Illicit drugs inactivity Key Risk Factor 4

Healthy Living in BC • 44.5 percent of British Columbians (18+) were classified as overweight 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 overweight 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 of 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 of 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 CURRENT STATE BCHLA TARGETS ActNow BC TARGETS [Source: BCHLA] 8/10 do not smoke 9/10 will not smoke 8.5/10 will not smoke ‐ 225,000 British Columbians 4/10 eat at least 5 servings of 7/10 will eat over 5 servings of vegetables & 5/10 will eat at least 5 servings of vegetables & fruit a day fruit a day vegetables & fruits a day + 948,000 British Columbians 6/10 are physically active 7/10 will be physically active 7/10 will get enough activity for health benefits + 351,000 British Columbians 5/10 are a healthy weight 7/10 will be a healthy weight 7/10 will be at a healthy weight + 349,000 British Columbians

British Columbia Population Number of Smokers and Former Smokers If BCHLA Targets Acheived 225,000 800,000 700,000 600,000 500,000 # of Individuals 400,000 300,000 200,000 100,000 - 2003 2004 2005 2006 2007 2008 2008 2010 Year Current Smokers Former Smokers

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

LE 0 for BC Total Population (2001-2005) by Local Health Area Stikine T elegraph Creek Fort Nelson Snow Country L ife E x p e c ta n c y a t B ir th Nisga'a Queen Charlotte 7 0 .2 7 9 .9 - 8 0 .2 Peace River North Upper Skeena Prince Rupert 7 4 .5 - 7 6 .1 8 0 .4 - 8 0 .9 T errace Prince Rupert 7 6 .8 - 7 7 .9 8 1 .0 - 8 1 .6 Queen Charlotte Kitimat Smithers Nechako Kitimat Kitimat 7 8 .2 - 7 9 .1 8 1 .9 - 8 3 .0 Central Coast Burns Lake 7 9 .2 - 7 9 .8 8 3 .5 - 8 5 .4 Peace River South Central Coast Central Coast Central Coast Prince G eorge Bella Coola Valley Central Coast Central Coast Quesnel North Vancouver Vancouver Island North Vancouver Island North Cariboo-Chilcotin Campbell River Vancouver Island W est City Centre North Thompson V ancouver Island W est Campbell River 100 Mile House Powell River North East Courtenay Lillooet Westside Sunshine Coast Howe Sound Burnaby Alberni Kamloops South Cariboo Maple Ridge Golden Midtown Revelstoke Nanaimo Agassiz-Harrison Salmon Arm Lake Cowichan Merritt Enderby Mission Hope Richmond V ernon Sooke Chilliwack Princeton Arrow Lakes Saanich W indermere Keremeos Kootenay Lake Richmond Kettle Valley Nelson Grand Forks Kimberley Trail Cranbrook Creston Fernie Delta Delta

BC Poverty rate by family type 60.0 50.0 40.0 Elderly Married Couples (couple means no children) 30.0 Non-Elderly Married Couples Tw o-Parent Families 20.0 Female Lone-parent families 10.0 0.0 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 (Based on after-tax income, standardized to 2006 dollars. Data source: Statistics Canada I ncome Trends in Canada 2006)