Madam Chair, members of the committee, thank you for inviting us to discuss the health care challenge of the growing number of cases of chronic diseases we are seeing in Canada today and, particularly, the link between chronic diseases and our aging population and the even larger aging population we'll have in the years to come.
Canada is an aging country and is already among the oldest in terms of its population.
Life expectancy at birth in Canada is about 81 years old now, a little bit less for males than for females. Our life expectancy in Canada is greater than in the United States by nearly two years. It's greater than in the United Kingdom by a year, more or less similar to Germany and France, but still nearly two years less than in Japan.
At 65 years old, our life expectancy is approximately another 20 years. The most dramatic change is seen among the oldest old. The real achievement, however, will be to transform all these extra years into healthy extra years.
This is not yet the case. The current figures indicate that the proportion of healthy life is about 86.3 and 88.8 respectively for women and men in their lives. Transforming longer life expectancy into healthy life expectancy is one of the contributions of Canadian researchers in the field of aging, supported through the Canadian Institutes of Health Research. In 2009-10 alone, the federal investment in research and aging was $122 million through the CIHR.
The CIHR president, Dr. Alain Beaudet, appeared before you earlier this month and outlined CIHR's strategic plan. I'll remind you that this plan includes a commitment to concentrate efforts in five specific health research priority areas, including the priority areas to promote health and reduce the burden of chronic disease and mental illness, as was said.
CIHR has identified a series of so-called signature initiatives--that's how we call them--that are linked to the five commitment priority areas, many of which relate to chronic diseases and aging. These are large targeted research programs that will leverage several-fold resources from partners in the public and private sectors. They include, for example, inflammation and chronic disease, community-based primary health care--as we heard, it's a challenge--as well as the international collaborative research strategy on Alzheimer's disease.
Above and beyond the CIHR signature initiatives, there's a unique research platform that is supported by CIHR and the government that will contribute to the better understanding of chronic disease and aging. The Canadian longitudinal study on aging, or CLSA, will follow a cohort of Canadians aged 45 and older over the next 25 years. CLSA will advance aging research in Canada and enable researchers to move beyond providing a snapshot of the adult Canadian population towards observing and understanding the evolution of diseases, psychological attributes, function, disabilities, and psychosocial processes that frequently accompany the trajectory of aging. To date a total of $38 million in federal investment in the study is matched by $15 million from the provinces and other partners.
This demographic change has induced profound modifications of the types and patterns of diseases that Canadians have to live with. One of the main characteristics of this change is the increase in the proportion of chronic diseases such as, as we heard, diabetes or pulmonary conditions. Why is it so? Mainly because more acute diseases--infectious diseases, for instance--occurring younger in life have been largely controlled.
The result is that very few seniors in this country do not live with a chronic disease. Over two-thirds of seniors live with one or more chronic diseases. We heard some other figures earlier. If in most cases these conditions are controlled by medication or other health solutions, such as little bit of lifestyle change, it will have a major impact on the health of the aging population.
Let me share with you two dimensions of this new challenge for which research supported by CIHR is ongoing, to provide the necessary knowledge to help you in your decisions. These two dimensions illustrate the complex dynamics between chronic disease and aging. The first has to do with the fact that the presence of chronic disease induces an overall condition of frailty in the elderly, which is highly associated with the loss of autonomy, and which, in turn, can favour the appearance of other health conditions. Frail seniors, as many as 20% of Canadian seniors, are at greater risk for acute and chronic diseases, disability, and death.
Being unable to measure frailty in seniors delays our efforts to prevent these outcomes. A CIHR-funded researcher, Dr. Kenneth Rockwood of Dalhousie University, has developed and tested the seven-point clinical frailty scale as an easy-to-use predictive tool to estimate frailty in seniors. That's only an example.
At the same time, we're beginning to understand as well that some barely detectable chronic health conditions could play a major role in the series of physiological events that can cause other diseases. For example, research is beginning to reveal the role that low-level chronic inflammations could have in the cascade of events that induce Alzheimer's disease.
Again, due to the effort of Canadian basic researchers, whether the process by which our body accumulates amyloid deposits, which is the basis of Alzheimer's disease, could be initiated and sustained by the presence of chronic low-grade inflammation is the subject of a lot of research.
CIHR has a road-map signature initiative that will bring together researchers to build on significant Canadian strengths recognized throughout the world, with the global objective of bridging the silos between research groups working in particular on the chronic disease area, so as to recognize in advance the common pathways and interventions.
The second agent I mentioned of the chronic disease and aging dynamic challenge has to do with the way health services are provided and how health professionals are trained. Health professionals and the health system have largely been constructed on the basis of the acute disease model, as was said before. Of course we still need specialized professionals and acute hospitals to take care of those with acute conditions, but we need to complement this model with professionals who will be able to understand the complexities of the interactions between different chronic conditions. We certainly need a health system that will adapt to better care for those chronic diseases.
According to Dr. Howard Bergman, the Canadian leader in this area, the shift from mainly acute disease to mainly chronic disease means that first we have to increase our emphasis on primary care. Attaining this goal could be helped by the availability of new technologies and information systems allowing all the community health providers to have access to the information regarding the chronic condition of a given individual. Secondly, it also means that our health system should definitely evolve from being institution-based to being a network of health care. We need research on this, including hospitals and nursing homes, but also assisted living, community hospitals, physicians' offices, and so on, research currently being supported by CIHR.
Thirdly, it means as well that health services to individuals with chronic diseases will require physicians who will be better trained to cope with highly complex and intricate health conditions. These physicians will work more and more with the other health professionals to support individuals with chronic conditions to diminish the possible deleterious impact of these conditions on overall frailty—not to mention the impact of the declaration of other diseases like Alzheimer's disease, which I mentioned earlier.
This challenge has to be addressed, because currently seniors with chronic diseases are responsible for an important proportion of our health care. The decisions we have to make about adapting our health services to the elderly with chronic conditions have to rely on evidence coming from research on health services. This is why CIHR is also supporting this type of research, as well as basic clinical and social research. The Institute of Aging has already identified this topic as a priority, and is launching a special program that will support health services and systems for an aging population, a priority for research on aging identified by the seniors themselves across the country through the regional seniors workshop that we hosted some years ago.
We're convinced that research on health systems will provide evidence and knowledge that will help you with the difficult decisions about our health system.
I cannot discuss the interactions between chronic diseases and aging today without addressing the matter of prevention, as we saw.