By Coralee Sonnenburg and Gordon Tse
As healthcare costs continue to rise across the country, local governments seek to target healthcare spending towards the highest priority needs in their respective regions. In comparing Ontario and British Columbia provincial governments have identified different priority determinants based on the prevalence of chronic diseases in the different provinces.
The province of British Columbia in partnership with the city of Vancouver has identified mental health and addictions as a health priority. This effort is in response to a surge people that require in mental service services in Vancouver, as highlighted by a 43% increase in inpatient mental health services and an 18% increase in apprehension by police for those with mental illness (City of Vancouver, 2014). In comparison, Ontario’s public health sector has not been as active in addressing mental illness as it has been in responding to chronic disease (Ratnasingham, Cairney, Rehm, Manson, & Kurdyak, 2012). This despite that fact that “burden of mental illness and addictions in Ontario is more than 1.5 times that of all cancers, and more than seven times that of all infectious diseases” (Ratnasingham et al, 2012, p. 7). In its report addressing chronic disease in Ontario, Public Health Ontario does not even address mental illness (Public Health Ontario, 2018). Instead mental illness is considered its own individual focus outside the field of chronic disease management and despite evidence outlining the devastating effects of mental illness in terms of health adjusted life years (HALY’s) mental illness in Ontario continues to be undertreated (Ratnasingham et al, 2012).
In Ontario the primary focus for health prevention in chronic disease management focuses the prevention of heart disease, cancer, chronic respiratory disease and stroke (Cancer Care Ontario & Ontario Agency for Health Protection and Promotion, 2012). In Ontario 79% of all deaths can be attributed to one or more of these diseases and as such Ontario targets key risk factors related to these diseases (Cancer Care Ontario & Ontario Agency for Health Protection and Promotion, 2012). This includes policy change and educational program targeted at smoking cessation, increased alcohol consumption, healthy eating and increasing physical activity levels (Cancer Care Ontario & Ontario Agency for Health Protection and Promotion, 2012). The continued need to identify and resolve health inequities in Ontario has also been identified as a key determinant of health and the need for Ontario to improve its methods of data collection on inequity (Cancer Care Ontario & Ontario Agency for Health Protection and Promotion, 2012) and increase the public's awareness of inequities (Kirst et al, 2017) are essential.
While Ontario chooses to focus public health efforts on prevention of specific chronic disease, the focus of public health in British Columbia is “to optimize health by increasing the adoption of healthy behaviours by British Columbians” (Kothari et al, 2013, p. 7). This involves focus on active lifestyle, smoking cessation and healthy living as the primary areas of focus (Kothari et al, 2013). British Columbia also specifically focuses interventions using an equity lens, ensuring creating socio-economic awareness in policy decision and program planning, whereas Ontario acknowledges the importance of social and economic awareness and applies equity measures at the individual program level (Kothari et al, 2013).
Although the governments of Ontario and British Columbia outline different priorities for chronic disease prevention and management based on the differences in regional prevalence, many of the risk factors they target are similar as multiple risk factors affect many chronic diseases. Programs targeted at smoking cessation, an active lifestyle and resolving health inequities and are common to both provinces with a focus on lifestyle modifications in order to prevent chronic disease development.
References
Cancer Care Ontario & Ontario Agency for Health Protection and Promotion
(2012). Taking action to prevent chronic disease: recommendations
for a healthier Ontario. Toronto: Queen’s Printer for Ontario. Retrieved from https://www.publichealthontario.ca/en/eRepository/5870%20CCO%20EXEC%20 SUM%20ENG%20MAR%2015_12.pdf
City of Vancouver. (2014). Caring For All: Priority Actions to Address Mental Health and Addictions. Retrieved from http://vancouver.ca/files/cov/mayors-task-force-mental- health- addictions-priority-actions.pdf
Kothari, A., Gore, A., MacDonald, M., Bursey, G., Allan, D., Scarr, J., & The Renewal of Public Health Systems Research Team. (2013). Chronic disease prevention policy in British Columbia and Ontario in light of public health renewal: a comparative policy analysis. BMC Public Health, 13(934). Retrieved from https://doi.org/10.1186/1471-2458-13-934
Kirst, M., Shankardass, K., Singhal, S., Lofters,A., Muntaner, C., & Quiñonez, C. (2017). Addressing health inequities in Ontario, Canada: what solutions do the public support? BMC Public Health, 17(7). doi 10.1186/s12889-016-3932-x
Public Health Ontario. (2018). Taking Action to Prevent Chronic Disease. Retrieved from https://www.publichealthontario.ca/en/BrowseByTopic/ChronicDiseasesAndInjuri es/Pages/Taking-Action-to-Prevent-Chronic-Disease-Recommendations-for-a- Healthier-Ontario.aspx
Ratnasingham, S., Cairney, J., Rehm, J., Manson, H., & Kurdyak, P. A. (2012). Opening Eyes, Opening Minds: The Ontario Burden of Mental Illness and Addictions Report. An ICES/PHO Report. Toronto: Institute for Clinical Evaluative Sciences and Public Health Ontario. Retrieved from https://www.publichealthontario.ca/en/eRepository/Opening_Eyes_Report_En_2012.pdf
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