Thank you.
Honourable chairperson, members of Parliament, colleagues, and other attendees, thank you for the privilege of addressing you on this very important topic, which is very close to my heart.
I've been asked to address how innovative technologies can be used to support the prevention and management of chronic diseases. It is very difficult to follow my colleagues, who have spoken very eloquently about various aspects. I hope to add a little bit more to these. I have made a submission as a brief and trust it will be useful to you as you deliberate.
There are two key messages that I have for you today. One is that our health behaviour—what we do—is determined by a variety of interacting and competing factors between our environments, whether social, geographical, economic, or family environments, and our biology, whether that be our genetics or what the environment has done to our genetics—what is known as “epigenetics”.
So how we act today is best understood from a developmental context of our brains, from before we were born until what we do now. It determines how we think about things, how we feel about things, and how we act. This means that the actions—especially the habits—of what we do today are shaped by our early experiences and by the current opportunities and constraints of our environment, which help us to act in a healthful way or not.
That's one message. The second is that the technological advances in the products, practices, policies, and communications through such means as social media are double-edged swords. They can promote ill health by exposing us to harmful messaging or making us more sedentary, or they can play a major role in empowering us to take action, whether at an individual level, a family level, or a community level. However, the use of these technologies needs to be promoted, and they need to be situated within the broader context of health behaviour change interventions, rather than in isolation.
Never before has society faced such a radical shift in how we live. Think about it: in the last 50 years, we have seen a huge shift, from most of us being paid to expend our energy to now, in this knowledge economy, having to pay to expend energy. I find it ironic that I drive to a gym, pay a membership, and then pedal a stationary bicycle for no purpose at all other than to get my heart going. Then I sit back in my car and drive home. That's the change. Our ancestors never did that, and I'm sure, when they look down on us, they must be wondering what on earth we are up to. That's it.
We've also tamed the production and distribution of food so that it is low-cost and packed with calories that we can consume ad lib, no problems, in ways that go far beyond what we need. What does that lead to?
Moreover, the use of tobacco and alcohol is endemic and accounts for significant ill health and premature death. Moreover, the pressures of modern living, despite everything we have, are leaving us more stressed, with less time to sleep. Taken together, our successive advancements are also making us more prone to develop such chronic diseases as cancer, heart disease, depression, etc.
Now we are closing in on a health care cliff whereby most chronic diseases will take up most of our health care resources—approximately $83 billion in 2005, and I think much more now, as you mentioned, Kim.
The good news is that as our health care system matures into its forties, it's starting to develop a little less myopia and starting to look into the future, so that we begin paying attention a bit more to prevention. We need to do that.
Moreover, we have a population ever increasingly informed about health and health behaviours, but clearly not in numbers sufficient to prevent the tsunami of chronic disease that's going to come exponentially, as Kim was just saying in talking about diabetes.
I and many others before me have identified the core modifiable behaviours that account for about 200 chronic diseases that are estimated to account for seven years of lost life, at least in Ontario. Often these behaviours cluster in the same individual and often in the same community. We can also understand them as being socially infectious. Many good researchers have found that these behaviours don't just occur in isolation; they tend to occur in communities and they tend to be infectious.
If we as a society collectively address the problems of tobacco use, excessive and risky use of alcohol, poor nutrition, including excess salt intake, physical inactivity, stress, and poor sleep, we can reduce illness and approximately prolong healthy years of life—not life on a respirator—by about three and a half years. Taken together, I call this a health promotion six-pack. If we all strengthened and implemented this broadly across the country, it could help address things like obesity, heart disease, cancer, lung disease, Alzheimer's, and diabetes, just to name a few that we are now trying to address separately.
So how do we reach everybody across Canada? Clearly, we are aware of the geographical variations in health status in the urban versus rural divide, the spread across various sectors of society, maldistribution of health care resources across the country, and that we'll never have the health human resources necessary for that one-to-one promotion of health. Clearly, policy-level interventions are necessary to promote health, such as taxation on certain products, reducing the access and attractiveness of unhealthy behaviours, and, as I said, the promotion of the health promotion six-pack. These make it easier for all of us to do the right thing for our health.
In addition, there are other ways to increase health literacy in our society and empower us. Here's where I see technology has that role in potentially scaling up what we know needs to be done.
Roughly, if you take a look at these risk behaviours, you can step back and ask what are the core, the dominance, of these behaviours and this is what we can modify. Clearly, we can modify it at the individual level, but we can sometimes modify it at the product level. For example, there are product innovations that may be able to help us reduce the harm from certain of these products—medications and medication reminders to help people stop unhealthy behaviours, or create safer products that might have less salt or less sugar. Good examples that are emerging now that need to be paid close attention to are things like electronic cigarettes. Suddenly, most of the carcinogens or cancer-causing chemicals are being eliminated from that. We need to be able to study that. We need to be able to develop that. That's technology really taking out the harm from cigarettes that we need to focus on, and it needs to be proven. It needs to be studied scientifically. We need to invest in those kinds of scientific studies to make sure they come in and don't cause more harm than good. Moreover, we may need to look at design innovations that get us to move more or get us to pick healthier choices when we eat food. However, the biggest developments that have been published and that I'll speak about are communication technologies to promote and assist with behaviour change, and these are typically reminders.
What's very interesting is that our brain is the only organ that outsources its functions. Your heart doesn't say “I've had a bit too much beating and I'm going to get a machine to help me do that”; that's called sickness. But our brain constantly writes it down and puts it on a BlackBerry, or what have you, to help us remember. So we outsource a lot to remind us of one thing that can help us. It helps us check on weight, blood sugar, track calories, reduce the amount one drinks, or even help quit smoking. These can be done through websites, social media pages, web-based tools, video games, and apps that can be downloaded on to your phone and therefore don't need an active Internet connection that you can take with you to make it mobile.
This explosion of interest has been due to the development, reach, and adoption of the Internet and mobile technologies, and it has enhanced connectiveness among society, even among people who don't know each other. These online communities are powerful networks that are constantly forming, reforming, dissolving, and often mirror real-world networks, except that the geographic and socio-economic divide is being bridged. In other words, we have networked intelligence potentially among these members in these communities. This flow of information can be fairly rapid, but we need to figure out ways in which this information can flow. For example, we've had this broadband initiative in Canada that has increased access in remote areas of this country. This increases the possibility of mitigating the inequity of access of evidence-based information to empower health.
At least 80% of Canadian households had access to the Internet in 2010, according to StatsCan. Two-thirds use it to search for health information, and the numbers are growing exponentially, especially in rural areas and by women.
There are over 20 million mobile phone users in Canada, with over six and a half million of these with smart phones, with half of them accessing the Internet using that smart phone. Using downloaded apps is the top monthly Internet activity; 85% of smart phone subscribers download an app. According to Quinn Street, the number of mobile health apps has nearly doubled worldwide, from 124 million in 2011 to 247 million in 2012.
We know that although younger people are most likely to use their mobile phones, older individuals have begun to use them as well, and we shouldn't make any assumptions about age. The trend is only going to go up. As I age, I don't see myself giving up my own smart phone.
