Preventative Medicine 101

You know the old proverb, an ounce of prevention is worth a pound of cure. If that's good advice for your own health, might it also be worthwhile as a prescription for the health care system as a whole? Pegene Walsh is Executive Director of the Ontario Public Health Association and Chair of the Ontario Chronic Disease Prevention Alliance, which approached us to put together an election debate among the parties about how to get the most from our health care dollars. We're doing just that tonight, and we're going to get started by welcoming Pegene Walsh to our studio. It's nice to meet you. Likewise, thank you. Thanks for being here. Brass tacks right off the top. Your mission at your organization is what, essentially? Well, we have 19 organizations that have come together because we're calling for a comprehensive chronic disease prevention strategy. So we believe that a lot of diseases can be prevented, and that's what united us is that call for a strategy to help us tackle chronic diseases. When you talk about preventing diseases, this is very distinctive from most of what our health care system does, which is treat sickness as opposed to prevent diseases. Have I got that right? Yes. Well, of course, treatment and management of disease is really important, but we want to see more emphasis on prevention. And we know things like misuse of alcohol, tobacco use, promoting healthy eating, physical activity, and mental health are all important aspects of keeping people well and out of the health care system. We also know that there's other factors that affect people's health as well, so where you live, your income, your education, those also need to be kept in mind. So there's a range of things that we can do to keep people healthy and out of our health care system. If we invested more in disease prevention, would we be able to invest less in sickness treatment? Well, it's going to take some time. It's not something that right away we're going to see that impact, and I think that's a challenge, why we're not seeing more investment in prevention, because the results can take some time. Are there any policies in particular that you would like to see whoever forms the next government of Ontario pursue? Well, I think the most obvious one that probably is very familiar to a lot of people is tobacco control. So for over 30 years, we've really changed our culture. We're not seeing the rates of smoking that we used to see. Young people, we have a generation now, the majority of whom are not smoking. So I think that's a good example of what we could see happen. If we turn to healthy eating, there's a range of things we could be doing in our schools, in our workplaces, in our communities. The same thing around alcohol in terms of pricing and issues of taxation and distribution, and also when we look at physical activity, if we think of our school system and having people be active throughout high school rather than just limiting that to grade 9. Let me pick some of these apart here, because, you know, every time the taxes go up on smoking in hopes of inhibiting people from buying more and getting into it, you know, it goes underground. And the underground economy takes off in cigarette purchases. So I guess the question is, are you sure that a tax approach works? For sure there isn't one aspect that works. And if we look at tobacco control, it wasn't about one intervention. It's a range of interventions. So it's public education awareness. It's taxation, and taxation is very effective, we know, for young people, because that price point is going to affect whether or not they start smoking. And if we can keep young people from not smoking up to the age of 21, it's very unlikely that they will start. So, as I mentioned, taxation is one aspect. Legislation, regulation, public awareness, and building that capacity within the community to raise awareness and mobilize people for change. You know, of course, in our parents' days, trying to get access to alcohol was very problematic. Nowadays, it is much more liberalized in sales. The current government of Ontario has put it in certain supermarkets and so on. The Progressive Conservative Party has said it's time to put beer and wine in corner stores. Do you have a view on, in terms of disease prevention and health promotion, do you have a view on what model is best for distribution of alcohol? Well, we draw a lot of our research from the Canadian, from the Centre for Addiction and Mental Health. And that research will show you that the more widespread distribution, the more consumption, the more consumption, the more harms. So, for most people, we're not seeing that range of harms, but there are a significant number that are affected by alcohol. And it has a significant cost. For example, our healthcare system and other aspects of society, we're paying more in the harms from alcohol than is being made through the sale of alcohol. The only thing that troubles me about that argument is that the inverse of that argument is, okay, then, the best thing to do is make alcohol a prohibited substance, as they did back, you know, during Prohibition. And that way, everybody stays healthy. Except we know that's not true. So, in, you know, in the year 2018, is this still a decent argument in terms of health promotion? It is a tough argument. And a lot of people are not even aware that there's a link between alcohol and cancer. So, I think what our association is aiming to do is to raise awareness about those harms, because, again, there's limited knowledge about the harms. And, obviously, for most people, there's an issue of moderate use. But we are seeing increase in binge drinking among young people. So, we do need to be concerned and think about what evidence-based measures will make a difference. That is a new thing, isn't it? Binge drinking in young... A new thing in as much as I now hear that before kids go to parties, they liquor up before they go to party because they want to be half-hammered by the time they get there. That can't be good for your health. Well, if you think about tobacco, the big change there really was our cultural awareness and attitude. So, as much as we had regulation and legislation, there was also a societal change. So, again, I think the thing with alcohol is how do we make a culture of moderation the norm? Let's just then, in our last couple of minutes here, talk about how you are going to measure, presumably, the success of what you do. If you are successful, we will know because how? If we're successful, what we'll see is across government, every ministry would be using a health lens to say, okay, are our interventions promoting health? Or are they contributing to chronic disease? We'll know we're successful because we'll see different sectors intervening. So, we'll see the implementation of a health curriculum that embraces issues of chronic disease prevention. We'll see workplaces that have workplace wellness policies. And we see municipalities looking at how do we design our communities to make sure they can promote health and well-being and be walkable and support transit and cycling. And in recreation centres, we can see no longer the sale of unhealthy foods. Let me just jump in there. That's going to be a tough one. If you want to stop selling soda pop and chocolate bars at schools or in fitness centres, that's going to be a tough one, isn't it? Well, there are already municipalities that have embraced that, and we're already seeing some recreation centres that have done that. So, I think the point is raising awareness, understanding about the importance of healthy eating, and then providing those choices and creating an environment that makes it easy. So, this is the secret with tobacco control is we made the environment easy. We denormalized tobacco use. So, we want to do the same thing around those other risk factors to make it easy for people to make a healthy choice. Since we have high taxes on cigarettes and alcohol, would you go a step further and recommend that the next government of Ontario put in an extra tax on, for example, soda pop or fruit juices that are all basically sugar and nothing else anyway? Well, a number of our members are calling for the use of taxation as a way to influence behaviour change. Are you calling for that as well? Well, a number of members on our alliance. Yes. Got it. Okay. So, clearly, this is not something that just the Ministry of Health ought to be seized with. This is something that goes across government departments and throughout society, in fact. Well, leadership is really important. So, government can play a strong role in providing that leadership, but as can other sectors. Gotcha. And we welcome that chance as an alliance of 19 non-profit health-related organizations. We are looking for that chance to work with others so that we can align our resources, our volunteers and our activities so that we've got a master plan, we have a shared vision, and together we can bring about that change. We shall stay tuned and keep watching. Peggy Walsh, thanks so much for joining us tonight on TVO. Well, thanks for having me. The Agenda with Steve Bacon is brought to you by the Chartered Professional Accountants of Ontario. Helping businesses stay on the right side of change with strategic thinking, insightful decisions and business leadership. Are you on the right side of change? Ask an Ontario CPA.