We should all have the opportunity to live long, healthy and productive lives. Unfortunately not everyone gets the same opportunity when it comes to health. Indeed, our health is shaped by income and wealth. Education, income, food security, social inclusion, gender, race and early childhood development are all important social determinants of health.[i]
On the other hand, we are all very much in control of key lifestyle factors that are associated with health outcomes. For instance, it is well established that certain risk factors such as smoking, obesity, physical inactivity and poor diets increase the risks of developing chronic diseases such as diabetes, heart disease and chronic obstructive pulmonary disease. Unfortunately, the societal costs associated with these poor lifestyle choices are crippling. A Canadian study has established that the health care cost for Canadians over the age of twenty in all health states was $943 per year. Persons with no high risk behaviors had yearly costs of $517, while persons with some risk behaviour, but no chronic conditions had an average cost of $689. The costs associated with chronic conditions which largely result from poor lifestyles are far greater. Persons with diabetes only have a cost of $1,564. Patients with heart disease only, chronic obstructive pulmonary disease only or a combination of conditions cost ten times more than those in the no risk group.[ii]
So how do we reduce these costs?
Health care expenditures can be curbed by programs aimed at health promotion and disease prevention. Sadly, spending on these programs is dismal. In 2003, health and wellness spending in Alberta reached $7.35 billion of which $25 million was spent on chronic disease prevention which represents a mere 0.34% of the total budget. It should therefore come as no surprise that conditions associated with poor lifestyles are rapidly increasing.
In Alberta, between 1986 and 2004, the prevalence of obesity among adults rose from 16% to 25% and in 2004 60.9% of Albertans were either overweight or obese.[iii] Given that obesity predisposes individuals to dozens of chronic health conditions, the costs associated with obesity are staggering. Reports have estimated that these health conditions are responsible for roughly 20% of all health care costs in Alberta.
In Alberta, individuals have, on average, two significant risk factors for disease. Overall, 30% of Albertans are overweight, 19% are obese, 22% are smokers, 43% are inactive, 19% are heavy drinkers, 60% eat less than 5 servings of fruit and vegetables per day, 22% are highly stressed, 15% have arthritis, 9% have asthma, 20% have back problems, 5% have had cancer, 4% have heart disease and15% have high blood pressure.
So how do we get out of this situation?
Health care programs that focus on prevention can have significant benefits. Of the $25 million spent on chronic disease prevention in Alberta in 2003, 56% went towards tobacco reduction activities and Aboriginal programs. Efforts to curb smoking in Alberta have been effective. Since the Alberta Tobacco Reduction Strategy was introduced in 2002 Alberta has achieved significant results with the smoking rates for Albertans aged 15 to 19 dropping from 24% to 17%. Initiatives to reduce tobacco use focus on education, anti-smoking advertising, restricted sales, and very high tobacco taxes. More recently, focus has shifted to obesity prevention. Upstream investments that focus on prevention can be expected to lead to significant reductions in chronic disease in the coming years.
Greater personal responsibility is also key when it comes to health and wellness. This is where the importance of making the right choice the easy choice lies because white knuckling your way to the broccoli when your pantry is full of cookies and your freezer is filled with ice cream is not going to work. If you want to make lifestyle changes that last, New Year resolutions are probably not going to work. The reason is simple, motivation and will power work well for short term goals but not for long term lifestyle changes and for most of us by the time February rolls around, the good intentions and resolutions have fallen by the way side. The reason for this is simple; habits are largely controlled by the unconscious part of our brain. So when you make the very conscious decision on December 31st to stop smoking, the part of your brain that control habits is not listening.
You need to make a plan that will allow you to reach your goals one step at a time. Big change leads to push back from the unconscious brain. Unfortunately, small change doesn’t impress the conscious brain and this is where you need to start being disciplined. Make realistic goals, break down those goals into small steps, change one behaviour at a time, rely on your support network, ask for help when you need it and remember that you will have occasional setbacks.
Change is difficult, but no more difficult than remaining in a situation that is harmful to your health and financially unsustainable for our society. In the end, lifestyle changes are a worthwhile goal and one of the most important changes you can make in your life.
So what should your goals be?
- Your diet is linked to your risk of developing cancer, heart disease and stroke, diabetes, high blood pressure and obesity.
- You need to eat at least 5 servings of fruits and vegetable per day, avoid soda drinks and trans fats.
- Reduce your consumption of refined food products as much as you can.
- Smoking remains the leading preventable cause of premature death in Canada.
- Do not smoke; if you smoke make every attempt to quit.
- Excessive alcohol consumption is linked to over 60 chronic and acute conditions such as cancer, heart disease and stroke and gastrointestinal disease.
- Limit your alcohol consumption to no more than 2 drinks per 3 hours and no more than 10 drinks per week if you are a women and 15 per week for men.
- Inactivity impacts both your physical and mental well-being and is the number one risk factor for obesity
- Aim for a minimum of 150 minutes of moderate to vigorous activity per week and muscle strengthening activities twice a week.
- Obesity is linked to heart disease, diabetes, cancer and arthritis. Over the last 25 years the prevalence of obesity has double in Canadian adults and triple in children.
- Track your Body Mass Index; if you fall in the overweight or obese category pay extra attention to your diet and the amount of exercise you are getting.
If you need help in achieving these goals, seek professional advice. Depending on your area of greatest need, a naturopathic doctor, family physician or nutritionist.
Dr. Ludovic Brunel is an exceptional physician with strong clinical skills grounded in scientific knowledge. He has helped design and formulated several dietary supplements for some of the most advanced nutraceutical companies in Canada. Dr. Ludo has also helped develop and implement wellness strategies for corporations and businesses looking to improve the health and happiness of their employees.
[i] Mikkonen J, Raphael D. Social Determinants of Health: The Canadian Facts. May 2010.Toronto: York University School of Health Policy and Management.
[ii] Jacobs P et al. Chronic Diseases in Alberta: Cost of Treatment and Investment in Prevention. Institute of Health Economics Working Paper 04-09. National Library of Canada. 2004.
[iii] Alberta Health Services. The Cost of Obesity in Alberta Summary Report, January 2010. Research and Evaluation Unit.