A New Global Health Crisis
• Chronic disease replacing communicable disease
• By 2020, chronic disease (heart and lung disease, diabetes and
cancer) will
account for 75% of all deaths
worldwide
• Obesity, inactivity and poor diet
have reached epidemic levels
A New Environment
Choice or response?
• Many people believe that we simply need to make better
choices (it’s about ‘will power’)
• Individual choices are important – we all need to take more
responsibility for our health
• Choices we make are shaped by
the choices we have
• To have an impact, we must change the environment in
which choices are made
(it’s about ‘collective will’)
How does Nova Scotia Measure
Up?
Our health
by the
numbers…
Breastfeeding
Breastfeeding is recommended exclusively for the
first 6 months of life.
Infants in Nova Scotia are breastfed less frequently and for shorter
periods of time than the rest of Canada.
Data Source: CCHS 2007-08 and 2009-10
Nutrition
Not enough vegetables and
fruit
4-6 servings a day
of “other” foods
(fats, oils, sugars, candy, etc.)
Too much sodium
93-96% below
minimum fibre intake
Date Source: Keeping Pace 2009-10
Food Security
• Being “food insecure” means not always being able to
afford safe, healthy food.
Nova Scotians consistently report rates higher than average.
Data Source: CCHS, 2009-10
Physical Activity
% Meeting Minimum Guideline
15-45%
attend an after
school program with physical
activity 3 times a week.
Less than 20% walk
or bike to school in good
weather.
Data Source: Keeping Pace 2009-10
Physical Activity Trends
% Meeting Minimum Guideline
2001-02
2005-06
2009-10*
*2009-10 results
cannot be directly
compared to previous
years because the data
is weighted to be
provincially
representative
Data Source: Keeping Pace 2001-02, 2005-06, 2009-10
Sedentary Behaviour
Screen Time
Screen time was higher
on weekend days.
% Exceeding Recommended Maximum of 2 hours/day
Data Source: Keeping Pace 2009-10
Overweight and Obesity
% Overweight or Obese
Data Source: Keeping Pace, 2009-10
Looking ahead…
“Looking at the increasing
rate of childhood obesity is
like looking into the future
health of Nova Scotians.”
Dr. Keith McCormick
Doctors Nova Scotia
Health Promotion Section Chair
How Do Adults Compare?
Less Vegetables and Fruit
% Eating Less Than 5 Servings/Day
Data Source: CCHS 2009-10 (self-report)
More Overweight and Obese
% Overweight or Obese (BMI>25)
Poor Adult Health Outcomes
• Nova Scotia currently has the highest incidence of
chronic disease in Canada
– 1st for heart and lung disease
– 2nd highest diabetes and hypertension
– 1st for multiple chronic diseases (co-morbidity)
Much of this is preventable!
• Overweight and obesity cost the province
$452 million in 2010.
• Based on current rates of increase, costs are
estimated to total $9.5 billion over the next
10 years.
Developing a Strategy
• Evidence review
• Discussion Framework and web site
• Engagement (June - Nov. 2011)
– Government (forum June 2nd)
– Task Teams (Healthy Eating and Physical
Activity)
– Stakeholders (100+ groups)
– Online (900+ online submissions)
– Scientific Advisory Panel
• What We Heard released
on April 19th
What We Heard
• This is still seen as a “healthcare” issue
• Evidence is clear that it must be whole of
government and multi-sector, but we’re not there
yet (barriers and silos)
• Prevention is still not a priority – it’s seen as a
“nice to do”. We need to value it more.
• We’re doing many of the right things – we need to
celebrate, support, and expand
• “Right medicine, wrong dose”
Our Approach
• Address obesity by focusing broadly on health
• 40% of chronic disease can be prevented by focusing on
common modifiable risk factors:
–
–
–
–
–
Poor diet
Inactivity/sedentary behaviour
Mental health/stress
Tobacco use
Alcohol use
• Thrive! is part of a broad prevention platform:
– Tobacco, alcohol and mental health strategies; early years
learning and care; public health renewal; sustainable
transportation and other initiatives
Foundation – Social Policy
• 75% of the factors affecting our health are outside
the health-care system (e.g. education, income,
housing)
• Health improves at every step up the socioeconomic
ladder
• Countries with the smallest gap between rich and
poor have better health outcomes – the gap is
widening in Canada
• Strategy makes one recommendation:
– Introduce a Health Impact Assessment (“health in all policies”)
in public health legislation
What will we do?
"No ONE thing
will ever prevent
childhood obesity…
or any obesity for
that matter.”
Dr. Yoni Freedhoff
Obesity Expert
Weighty Matters
The “sandbag phenomenon”
"No ONE thing
will ever prevent
childhood obesity…
or any obesity for
that matter.”
Dr. Yoni Freedhoff
Obesity Expert
Weighty Matters
The “sandbag phenomenon”
• Support parents and families in the early years
– Best practice and clinical standards (e.g. WHO growth charts,
maternal weight gain)
– Accessible health information (e.g. Loving Care)
• Strengthen prevention in primary health care
• Encourage and support breastfeeding
– Baby-Friendly Initiative ™
– Community grants
– first6weeks online peer support
2. Skills and Knowledge
• Increase food knowledge and skills
– Curricula in schools
– Programs that build knowledge and skills (e.g. cooking, school
gardens)
– Provincial food literacy plan
• Increase physical education and physical literacy
– Professional development in regulated child care
– Physical education in schools (QDPE)
– Sport and recreation (swim and bike)
• Educate leaders
– Training opportunities for new professionals
3. Opportunities
• Make healthy food more accessible and affordable
– Cross-government committee to develop policy options (food security,
financial incentives and disincentives, food policy councils and local
food)
– Fat, sugar, sodium content of prepared foods (F-P/T)
• Support food policies in public institutions
– Policies in schools, child care, DHAs, sport and recreation facilities,
colleges and universities
– Breakfast Program transition
(Nourish Nova Scotia)
– New facility funding to require healthy
eating policy
3. Opportunities (con’t)
• Decrease the influence of marketing to children and
youth
– National approach (voluntary) and provincial approach (policies in
child care and schools)
• Increase physical activity and decrease sedentary time
in child care and schools
– Guidelines, resources, active learning
• Increase participation in after-school programs
– New program for junior high (rural and remote)
– Committee to coordinate provincial efforts
– F-P/T funding and standards
4. Healthier Communities
Leadership and Engagement
Measuring and Reporting
Outcomes
Budget
What Will Be Different?