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Taking Action to Prevent Chronic Disease: Recommen- Further Permission from Cancer Care Ontario Or Public Health Ontario for Non- Dations for a Healthier Ontario Taking Action to Prevent Recommendations for a Healthier Ontario Chronic Disease Chronic diseases are the leading cause of death in Ontario. These largely preventable diseases diminish our quality of life, economy and communities. Published by the Ontario Agency for Health Protection and Promotion, and Cancer Care Ontario Agency for Health Cancer Care Ontario Protection and Promotion 620 University Avenue, Toronto, Ontario M5G 2L7 Agence de protection et de promotion de la santé Telephone: 416.971.9800 www.cancercare.on.ca Public Health Ontario 480 University Avenue, Suite 300, Toronto, Ontario M5G 1V2 Telephone: 647.260.7100 www.oahpp.ca © Queen’s Printer for Ontario, 2012 Permission to reproduce How to cite this publication Except as otherwise specifi cally noted, the information in this publication Cancer Care Ontario, Ontario Agency for Health Protection and Promotion may be reproduced, in part or in whole and by any means, without charge or (Public Health Ontario). Taking action to prevent chronic disease: recommen- further permission from Cancer Care Ontario or Public Health Ontario for non- dations for a healthier Ontario. Toronto: Queen’s Printer for Ontario; 2012. commercial purposes, provided that due diligence is exercised in ensuring the accuracy of the information reproduced; that Cancer Care Ontario and Public Additional copies Health Ontario are identifi ed as the source institution; and that the reproduc- For additional copies please contact: Cancer Care Ontario’s Public Aff airs tion is not represented as an offi cial version of the information reproduced, nor Department at 416.971.9800, TTY 416.217.1815, or at as having been made in affi liation with, or with the endorsement of, Cancer publicaff [email protected] or Public Health Ontario’s Public Aff airs Care Ontario and Public Health Ontario. Department at 647.260.7100, or at [email protected]. For permission to reproduce the information in this publication for commercial We are committed to ensuring accessible services and communications to redistribution, please email: publicaff [email protected] or [email protected] individuals with disabilities. To receive any part of this document in an alter- nate format, please contact Cancer Care Ontario’s Public Aff airs Department at ISBN 978-1-4435-8969-7 Print 416.971.9800, TTY 416.217.1815, or at publicaff [email protected] or Public ISBN 978-1-4435-8970-3 PDF Health Ontario’s Public Aff airs Department at 647.260.7100, or at [email protected]. Canadian cataloguing in publication data This publication is also available online at Taking Action to Prevent Chronic Disease: Recommendations for a Healthier www.cancercare.on.ca/takingaction or www.oahpp.ca/takingaction. Ontario Aussi off ert en français sous le titre Agir pour prévenir les maladies chroniques : Includes bibliographical references. Recommandations pour améliorer la santé de la population ontarienne. Public Health Ontario I Cancer Care Ontario — Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario i Acknowledgements This report was produced by the joint Public Health Ontario/Cancer Care Ontario Prevention Working Group. Public Health Ontario (Ontario Agency for Health Protection and Promotion) Prevention Working Group Heather Manson, MD, FRCPC, MHSc is a Crown corporation dedicated to Director, Health Promotion, Chronic Disease and Injury protecting and promoting the health Chairs Prevention, Public Health Ontario of all Ontarians and reducing inequities Heather Manson, MD, FRCPC, MHSc (Capacity for change recommendations) in health. As a hub organization, Public Director, Health Promotion, Chronic Disease and Injury Health Ontario links public health Prevention, Public Health Ontario Loraine Marrett, PhD Director, Surveillance, Prevention and Cancer Control, practitioners, front-line health workers Linda Rabeneck, MD, MPH, FRCPC Cancer Care Ontario and researchers to the best scientifi c Vice President, Prevention and Cancer Control, (Risk factor and disease evidence) intelligence and knowledge from around Cancer Care Ontario the world. Mary Fodor O’Brien, MHSc, RD Leads Nutrition Specialist, Public Health Ontario Kenneth R. Allison, PhD (Healthy eating recommendations) Senior Scientist, Health Promotion, Chronic Disease and Ruth Sanderson, MSc Injury Prevention, Public Health Ontario Manager, Analytic Services, Public Health Ontario (Physical activity recommendations) (Risk factor and disease evidence) Brian Hyndman, MHSc Beth Theis, MSc Senior Planner, Public Health Ontario Manager, Surveillance, Prevention and Cancer Control, (Alcohol recommendations) Cancer Care Ontario Alethea Kewayosh (Risk factor and disease evidence, physical activity and A/Director, Aboriginal Cancer Control, alcohol recommendations) Cancer Care Ontario Rebecca Truscott, MHSc, RD (Capacity for change recommendations) Health Promotion Specialist, Nutrition, Prevention Scott Leatherdale, PhD and Cancer Control, Cancer Care Ontario Associate Professor and Cancer Care Ontario (Healthy eating recommendations) Research Chair, School of Public Health and Health Systems, University of Waterloo (Tobacco recommendations) Special thanks go to the expert panels on tobacco, alcohol, physical activity, healthy eating and capacity for change. Please see Appendix 2 for membership. ii Public Health Ontario I Cancer Care Ontario — Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario Cancer Care Ontario—an Ontario government agency—drives quality Contributors Cancer Care Ontario and continuous improvement in disease Dafna Carr, MBA, Director, Policy, Planning and Public Health Ontario prevention and screening, the delivery Knowledge Translation and Exchange Marlon Drayton, MSc, MSA, Senior Policy Analyst of care and the patient experience, Phat Ha, MPH, Research Coordinator Elisa Candido, MPH, Research Associate (epidemiology) for cancer, chronic kidney disease and access to care for key health services. Karin Hohenadel, MSc, Epidemiologist Maria Chu, MA, MISt, Health Information Specialist Known for its innovation and results Juliana Jackson, MHA, Senior Policy Analyst Stephanie Ryan-Coe, BA Hons, Senior Communications Strategist driven approaches, Cancer Care Ontario Alexandra Kyriakos, MA, Director, External Affairs leads multi-year system planning, Steven Savvaidis, MHSc, Manager, Program Training contracts for services with hospitals and Allison McArthur, MISt, Library and Information and Consultation Centre Specialist providers, develops and deploys infor- Suriya Veerappan, MA (Candidate), Public Affairs mation systems, establishes guidelines Christiane Mitchell, MAP, Research Assistant Advisor and standards and tracks performance Jennifer Modica, MA, Communications Specialist targets to ensure system-wide improve- Cancer Quality Council of Ontario liaison (Secretariat) Michelle Murti, MD, CCFP, MPH, Public Health and ments in cancer, chronic kidney disease Rebecca Anas, MBA, Director Preventive Medicine Resident and access to care. Christine Chan, PGDipPH (Distinction), MPH Jennifer Robertson, PhD, Senior Evaluator Epidemiology (Candidate), Senior Policy Advisor Beate Sander, PhD, Scientist, Health Economics Jennifer Stiff, MRes, Senior Policy Advisor Anne Simard, MHSc, Chief Public Affairs Officer Project lead Peter Tanuseputro, MHSc, MD, CCFP, Public Health and Melissa Tamblyn, MPA Preventive Medicine Resident Writer Christine Mercer, BA, Adhawk Communications Inc. Public Health Ontario I Cancer Care Ontario — Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario iii Contents Executive Summary . .1 Recommended Population-level Interventions . 2 Introduction . .6 1. Taking Action on Chronic Disease Prevention . .9 2. How Risk Factors Relate to Chronic Disease . 13 3. Mapping the Evidence . 21 4. Population-Level Interventions . 25 Tobacco Use Recommendations. 25 Alcohol Consumption Recommendations . 30 Physical Activity Recommendations . 34 Healthy Eating Recommendations . 40 5. Building Our Capacity for Change . 49 Enabling Evidence-Informed Action . 53 Coordinated Health Communications . 58 6. Health Equity . 61 Working Towards Equity. 61 Chronic Disease and First Nations, Inuit and Métis Peoples. 62 Health Equity Impact Assessment. 65 Conclusion . 69 Appendix 1: Methodology . 71 Authors and Experts . 71 Technical Appendix. 72 Risk Factors, Disease Burden and their Connection . 72 Economic Burden of Risk Factors . 74 Appendix 2: Expert Panel Members Consulted . 77 References. 81 Accompanying Technical Appendix: www.oahpp.ca/takingaction and www.cancercare.on.ca/takingaction iv Public Health Ontario I Cancer Care Ontario — Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario Executive Summary Chronic diseases are the leading cause of death in This report complements the priorities set out in Ontario. In 2007, chronic diseases, including cancers, Ontario’s Action Plan for Health Care, which also cardiovascular diseases, chronic respiratory disease and mentions the need for an integrated approach diabetes were responsible for 79% of all deaths in the with partners across Ontario’s health care system. province. These largely preventable diseases diminish our Components of the Action Plan related to the preven- quality of life, economy and communities. As Ontario’s tion of chronic disease include the establishment of population increases and gets proportionately older, a panel to address childhood obesity and expanding the rising burden of chronic disease on the health
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