Thank you very much for the invitation, members of the committee.
The Canadian Medical Association wishes to commend the House of Commons Standing Committee on Health for undertaking this study of the issue of chronic diseases related to aging. It is a timely issue, since the first members of the baby boom generation turn 65 this year. It's predicted that by 2031, a quarter of Canada's population will be 65 or older.
Though chronic disease is not exclusive to seniors, its prevalence does rise with age. According to Statistics Canada, about 74% of Canadians over 65 have at least one chronic condition, such as diabetes, high blood pressure, arthritis, or depression, and nearly 25% have three or more. The proportion is higher among people 85 years and over.
What are the causes of chronic disease? There are many. Some of them are rooted in unhealthy behaviour—smoking, poor nutrition, and in particular a lack of physical activity. This latter concerns physicians particularly because of the rising obesity rate in Canada. Obesity increases one's risk of developing chronic diseases later in life.
But there's more to chronic disease than simply unhealthy behaviour. It's also affected by a person's biological and genetic makeup as well as by his or her social environment. Lower income and educational levels, poor housing, and social isolation, which is a greater problem for seniors than for other populations, are each associated with poorer health status.
Now the good news. Chronic disease is not an inevitable consequence of aging. We can delay the onset of chronic disease and perhaps even reduce the risk that it will occur at all. The conditions of patients who do have existing chronic disease can often be controlled through appropriate health care and disease management, so they can continue to lead active and independent lives. Thus, the CMA supports initiatives promoting healthy aging, which the Public Health Agency of Canada defines as the process of optimizing opportunities for physical, mental, and social health as people age.
Healthy lifestyles should be encouraged at any age. For example, the Canadian physical activity guidelines, which the CMA supports, recommend that people 65 or older accumulate at least 2.5 hours per week of aerobic activity such as walking, swimming, or cycling. Experts believe that healthy aging will compress a person's period of illness and disability into a shorter period just prior to death, enabling a longer period of healthy, independent, and fulfilling life.
For those who are already affected with chronic diseases, treatment and management is long term and can be very complex. People with diabetes, for example, need a continuous, ongoing program to monitor their blood sugar levels and maintain them at an appropriate level. People with arthritis or mobility problems may require regular physical therapy. For the patient, chronic disease means long-term management that's much more complicated than simply taking antibiotics for an infection. People with two or more chronic conditions may be consulting a different specialist for each as well as seeking support from nurse counsellors, dieticians, pharmacists, occupational therapists, social workers, or other health professionals.
Often, management requires medication. The majority of Canadians over 65 take at least one prescription drug, and nearly 15% are on five drugs or more, which increases the possibility, for example, that two of these drugs could interact negatively with each other to produce unpleasant and possibly serious side effects.
Long-term complex chronic disease care is in fact the new paradigm in our health care system. About 80% of the care now provided in the United States is for chronic diseases, and there's no reason to believe Canada is greatly different. Hence, it's worth considering what form, ideally, a comprehensive program of chronic disease management should take for patients of any age. The CMA believes it should include the four following elements.
First is access to a primary care provider who has responsibility for the overall care of the patient. For more than 30 million Canadians, that primary care provider is a family physician. Family physicians who have established long-standing professional relationships with their patients can better understand their needs and preferences. They can build a relationship of trust so that patients are comfortable in discussing frankly how they want to treat their condition—for example, whether to take medications for depression or to seek counselling with a therapist. The family physician can also serve as a coordinator of the care delivered by other providers.
This leads to our second recommended element, which is that of collaborative and coordinated care. The CMA believes that given the number of providers who may be involved in the care of chronic diseases, the health care system should encourage the creation of interdisciplinary teams, or at a minimum enable a high level of communication and coordination among and between individual practitioners and providers. We believe that all governments should support interdisciplinary primary care practices, such as the family health networks in Ontario, or the primary care networks in Alberta, which bring a variety of different health professionals and their expertise into one practice setting--a medical home, if you like.
Widespread use of electronic health records can facilitate information sharing and communication among providers. There should be a smooth process for referral, for example, from family physician to specialist, or from family physician to physiotherapist. The CMA is working with other medical stakeholders to create a referral process toolkit that governments, health care organizations, and practitioners can use to support the development of more effective and efficient referral systems.
The patient may also need non-medical support services to help cope with disability related to chronic disease. For example, a person with arthritis who wants to remain at home may need to have grab bars, ramps, or stairs installed there. Ideally, a coordinated system of chronic disease management would also include referral to those who could provide these services.
The third necessary element is support for informal caregivers. These people are the unsung heroes of elder care. An estimated four million Canadians are providing informal, uncompensated, unpaid care to family members or friends. About one quarter of these caregivers are themselves over 65 years of age. Their burden can be a heavy one in terms of time and expense. Stress and isolation are very common among caregivers.
The federal government has taken steps to provide much-needed support to informal caregivers. The most recent federal budget, for example, increased the amount of its caregiver tax credit. We recommend that government build on these actions to provide a solid network of support, financial and otherwise, to informal caregivers.
The fourth and final element is improving access to necessary services. Only physician and hospital services are covered through the Canada Health Act, and many other services are not. All provinces have a pharmacare program for people over 65, but coverage varies widely between provinces, and many--particularly those with lower incomes--find it difficult to pay for their necessary medication. Seniors who do not have post-retirement benefit plans--and these are the majority--also need to pay out of pocket for dental care, physiotherapy, mental health care, and other needed supports.
We recommend that all levels of government explore adjusting the basket of services provided through public funding to make sure that it reflects the needs of the growing number of Canadians burdened by chronic disease. In particular, we recommend that the federal government negotiate a cost-shared program of comprehensive prescription drug coverage with the provincial and territorial governments.
In conclusion, the CMA believes that the committee is wise to consider how we might reduce the impact, on individual patients, the health care system, and society, of chronic disease related to aging. Chronic disease management is a complex problem that warrants close attention, as it is now the dominant form of health care in Canada. We look forward to the committee's deliberations.
Thank you for this opportunity.