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Chronic Disease in Ontario and Canada: Determinants, Risk Factors and Prevention Priorities

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Chronic Disease in Ontario and Canada: Determinants, Risk Factors and Prevention Priorities Chronic Disease in Ontario and Canada: Determinants, Risk Factors and Prevention Priorities Emma Haydon, Michael Roerecke, Norman Giesbrecht, Jürgen Rehm & Marianne Kobus-Matthews Prepared for the Ontario Chronic Disease Prevention Alliance and the Ontario Public Health Association March 2006 Acknowledgements The production of this document was made possible through the financial support of the Public Health Agency of Canada to the Ontario Public Health Association (OPHA). Special thanks to Emma Haydon, Michael Roerecke, Norman Giesbrecht, Jürgen Rehm, Marianne Kobus-Matthew and the Centre for Addiction and Mental Health for the preparation of this document. The Ontario Chronic Disease Prevention Alliance would also like to thank the following individuals for their comments and contributions: Sunny Ba, Elfreda Burkholder, Connie Clement, Erica Di Ruggiero, John Garcia, Dexter Harvey, Tracy Howson, Meera Jain, Marjorie Keast, Mary Lewis, Gregory Taylor and Connie Uetrecht. The views, opinions and policies expressed in this document are those of the authors and do not necessarily reflect the perspectives of the organizations that they are affiliated with nor the Public Health Agency of Canada or the Ontario Public Health Association. Please address any correspondence to: Ontario Chronic Disease Prevention Association (OCDPA) c/o OPHA 700 Lawrence Ave. W., Ste. 310 Toronto ON M6A 3B4 Or email [email protected] ii TABLE OF CONTENTS FOREWORD............................................................................................................................. VII EXECUTIVE SUMMARY ........................................................................................................IX 1. CHRONIC DISEASE IN CANADA: DEFINITIONS, EPIDEMIOLOGY AND DISEASE ....................................................................................................................................... 1 1.1 BURDEN OF ILLNESS ........................................................................................................ 1 1.2 ECONOMIC COSTS ............................................................................................................ 8 1.3 EPIDEMIOLOGY OF SELECTED CHRONIC CONDITIONS.................................................... 14 1.3.1 Cancer....................................................................................................................... 15 1.3.2 Cardiovascular Diseases .......................................................................................... 22 1.3.3 Respiratory Disease.................................................................................................. 29 1.3.4 Diabetes .................................................................................................................... 36 1.3.5 Mental Health ........................................................................................................... 42 2. THE SOCIOBEHAVIOURAL RISKS AND DETERMINANTS OF CHRONIC DISEASE ..................................................................................................................................... 47 2.1 DEFINING RISK .............................................................................................................. 47 2.1.1 Risk on the Individual Level and on the Population Level ....................................... 48 2.1.2 Conceptualization of the Sociobehavioural Risks of Chronic Disease..................... 50 2.2 PROXIMAL FACTORS IN CHRONIC DISEASE.................................................................... 53 2.2.1 Physical Inactivity..................................................................................................... 56 2.2.2 Unhealthy Eating ...................................................................................................... 58 2.2.3 Overweight and Obesity............................................................................................ 61 2.2.4 Tobacco Smoking...................................................................................................... 65 2.2.5 High Blood Pressure................................................................................................. 69 2.2.6 Alcohol ...................................................................................................................... 73 2.2.7 Substance Use ........................................................................................................... 80 2.3 DISTAL FACTORS IN CHRONIC DISEASE: THE SOCIAL ENVIRONMENT ........................... 85 2.3.1 Sociodemographics................................................................................................... 86 2.3.2 Socioeconomic Status................................................................................................ 87 2.3.3 Social Support Networks – Social Exclusion............................................................ 97 2.3.4 Physical and Built Environments.............................................................................. 99 2.3.5 The Obesogenic Environment................................................................................. 102 3. FRAMEWORKS FOR HEALTH PROMOTION .................................................... 105 3.1 INDIVIDUAL LEVEL MODELS........................................................................................ 105 3.2 COMPREHENSIVE POPULATION LEVEL MODELS .......................................................... 107 4. CHRONIC DISEASE PREVENTION INITIATIVES: DO WE KNOW WHAT WORKS? ................................................................................................................................... 113 4.1 THE IMPLICATIONS OF ROSE’S WORK FOR PREVENTION.............................................. 113 4.2 THE CANADIAN SITUATION OF CHRONIC DISEASE PREVENTION ................................. 114 4.2.1 Canadian Chronic Disease Prevention Programs and Frameworks ..................... 114 4.2.2 The State of Program Evaluation in Canada.......................................................... 119 iii 4.3 LESSONS LEARNED FROM TOBACCO CONTROL............................................................ 122 4.4 RECOMMENDED PRACTICES FOR PREVENTING CHRONIC DISEASE............................... 125 5. RECOMMENDATIONS FOR A COMPREHENSIVE CHRONIC DISEASE PREVENTION FRAMEWORK ............................................................................................. 141 5.1 THE IMPORTANCE OF AN ECOLOGICAL MODEL – SMEDLEY & SYME’S (2000) RECOMMENDATIONS................................................................................................................ 141 5.2 CHRONIC DISEASE PREVENTION POLICY AND SOCIAL JUSTICE.................................... 143 5.3 RECOMMENDATIONS FOR A COMPREHENSIVE CHRONIC DISEASE PREVENTION FRAMEWORK ........................................................................................................................... 144 6. CONCLUSION ............................................................................................................. 151 7. FUTURE CONSIDERATIONS................................................................................... 153 REFERENCES.......................................................................................................................... 155 APPENDIX I: DATA SOURCES AND DEFINITIONS....................................................... 184 NATIONAL POPULATION HOUSEHOLD SURVEY........................................................................ 186 CANADIAN COMMUNITY HEALTH SURVEY.............................................................................. 186 AGE-STANDARDIZED MORTALITY RATE ................................................................................... 187 AIDS DEATHS.......................................................................................................................... 187 AIDS DEATHS POTENTIAL YEARS OF LIFE LOST (PYLL)........................................................ 188 ALL DISEASES OF THE CIRCULATORY SYSTEM DEATHS............................................................. 188 ALL DISEASES OF THE RESPIRATORY SYSTEM DEATHS ............................................................. 188 ALL MALIGNANT NEOPLASMS (CANCER) DEATHS..................................................................... 189 ASTHMA................................................................................................................................... 189 BODY MASS INDEX (BMI)........................................................................................................ 189 CANCER DEATHS POTENTIAL YEARS OF LIFE LOST (PYLL).................................................... 190 CANCER INCIDENCE ................................................................................................................. 190 CIRCULATORY DISEASE DEATHS POTENTIAL YEARS OF LIFE LOST (PYLL) ............................ 191 DEPRESSION............................................................................................................................. 191 DIABETES................................................................................................................................. 192 DIETARY PRACTICES ................................................................................................................ 192 EXPOSURE TO SECOND-HAND SMOKE AT HOME........................................................................ 192 FREQUENCY OF HEAVY DRINKING...........................................................................................
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