Introduction

Chronic disease continues to be a critical focus in public health in Canada and globally.

“Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 63% of all deaths. Out of the 36 million people who died from chronic disease in 2008, nine million were under 60 and ninety per cent of these premature deaths occurred in low- and middle-income countries” (World Health Organization [WHO], 2011, para. 1).

While the overall health of Canada's population is considered very well, especially in comparison to many other countries, the management and prevention of chronic diseases in Canada represents the biggest challenge to our health-care system. Canadians are at risk of heart disease, obesity, high blood pressure, osteoporosis, diabetes, cancer and depression (Public Health Agency of Canada [PHAC], 2007).

Registered nurses (RN) and nurse practitioners (NP) have the highest proportion of direct interaction with Canadians of any health-care providers. Among these nurses are public and community health nurses, educators and researchers, who work with Canadians to prevent and manage chronic illnesses and who play an integral role in all aspects of health promotion and disease prevention (Canadian Nurses Association [CNA], 2011).

Epidemiology of chronic disease in Canada

Chronic diseases are the major cause of death in Canada, taking a significant toll on Canada’s health-care system, economy and quality of life.

• One-third of Canadians have at least one chronic health condition (Health Council of Canada, 2007). These figures will likely increase, given that the number of Canadians over the age of 65 is expected to rise from 4.2 million in 2005 to 9.8 million by 2036 (Statistics Canada, 2006).

• Chronic diseases are estimated to cost the system over $90 billion annually in treatment and lost productivity (Mirolla, 2004).

• Up to 80% of heart disease, stroke and Type 2 diabetes — as well as more than one-third of cancers — could be prevented by eliminating shared risk factors such as smoking, unhealthy diets, physical inactivity and the harmful use of alcohol (International Council of Nurses [ICN], 2010).

Economic costs

In Canada, chronic diseases are responsible for 67% of total direct costs in health care and 60% of total indirect costs ($52 billion) as a result of early death, loss of productivity and foregone income (PHAC, 2006).

In Canada, chronic conditions account for 67% of direct health care costs (PHAC, 2009).

According to the Conference Board of Canada (2008, p. ii), “Well targeted investments in preventive measures have the potential to produce long-term cost savings through reduced demand on health-care services and represent a more effective long-term strategy for spending scarce resources.”

Risks of chronic disease

The World Health Organization defines risk as “the probability of an adverse outcome, or a factor that raises this probability” (WHO, 2002, p. 7).

Proximal Risk Factors

Up to 80% of heart disease, stroke and type-2 diabetes ― as well as more than one-third of cancers ― could be prevented by eliminating shared risk factors … like smoking, unhealthy diets, physical inactivity and the harmful use of alcohol (ICN, 2010).

Seniors

According to the Canadian Institute of Health Information:

• The number of chronic conditions, not age, is a more important factor contributing to a senior’s level of health-care use.

• Seniors with high co-morbidity (three or more chronic conditions) report poorer health, more prescription drugs and the highest rate of health-care visits among seniors with chronic conditions.

• Seniors taking five or more prescription medications have increased risk of experiencing side-effects requiring medical attention compared with seniors taking fewer medications.

• Fewer than half of seniors with chronic conditions reported discussing their treatment goals with their physician or working with their physician to create a treatment (Canadian Institute for Health Information [CIHI], 2011).

Children

The health status of many of our children in Canada is concerning.

• “Three out of five children and youth between the ages of 5 and 17 are not active enough for optimal growth and development” (Canadian Fitness and Lifestyle Research Institute, 1998, p. 6).

• Overweight children are more likely to remain overweight or become obese in adulthood, and are at greater risk for chronic disease and mental health problems (Wang, Ge & Popkin, 2003).

• Only 7% of young people attain the recommended daily level of physical activity (Statistics Canada, 2011).

There is evidence that investment in programs that take multi-faceted approaches to address both physical activity and nutritional issues benefit children significantly (Doak et al., 2006; Summerbell et al., 2005; Thomas et al., 2004). Comprehensive health approaches in schools lead to improvements in children’s academic achievements, as well as in their health, well-being and quality of life – and help to reduce pressures on our health-care system over the long term (CNA, 2011).

Distal Risk Factors

Poverty, lack of education, unaffordable housing and environmental contaminants all make it difficult for people to stay healthy, profoundly affecting life choices among those in communities with little or no infrastructure or social supports. Living in these conditions can severely affect mental health and lead to chronic illness. The evidence clearly shows that Canadians who live in poverty are less healthy and die earlier than those who are better off.

Recognizing that risk factors for chronic disease can also lie outside the realm of the health sector means that interventions are necessary to alleviate poverty; provide basic health education, improved food security, housing and employment conditions; protect the environment; and ensure gender equity. Culturally competent and sensitive care also stands to lead to better health outcomes among immigrant, refugee and other marginalized populations (Thomas et al., 2007).