2011 APTEI Acupuncture & Dry Needling (ADN) Program

presIdent’s address
Health promotion: the only long-term solution
to the healthcare crisis
By Christopher Winn
My previous article in Physiotherapy
Today touched on something which I feel
more strongly about with each passing
year: Primary Health Care. We’re all acutely
aware of the rising costs associated with the
delivery of health care and while the rate
of increase is abating, costs continue to rise
unsustainably. Currently, over 40% of all
Ontario government revenue is spent on
healthcare. More disturbing is the prediction
that should costs continue to rise at
their current rate, this number will increase
to 70% in the next 10 years! 1
I submit that the health care system
in which we function is not so much
“health care” as it is “disease care”. I’m of
this opinion because the vast majority of
encounters that health care providers have
with patients occur after the individual has
become unwell. From the beginning of
treatment, we are behind the eight ball and
in the case of costly chronic diseases such as
heart disease and diabetes, by the time the
patient enters the health care system, he or
she likely has a myriad of unhealthy behaviours
and other risk factors that should have
been addressed years before.
Our health care system is at an inter-
Number 132
June/July 2011
Ontario Physiotherapy Association
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Physiotherapy Today is published
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office no later than August 15, 2011.
esting juncture. Advances in medical care
have allowed individuals to live longer
with chronic illness and while this is commendable,
it comes at a cost. Individuals
receiving care for longer periods of time
place increased financial pressure on the
health care system. In fact, the direct
and indirect costs associated with disease
morbidity now exceed those of disease mortality.
2 According to the Ontario Ministry of
Health and Long-Term Care (MOHLTC),
“the economic burden of chronic disease in
Ontario is estimated to be 55% of total direct
and indirect health costs which includes… lost
productivity from disability.” 3
In that same document, the MOHLTC
goes on to state “the good news is that there
is great potential to improve health outcomes
and reduce the burden of chronic disease.”
To me, that’s an interesting spin on what
is basically saying that the situation is so
dreadful, we don’t have anywhere to go
but up!
So how do we effect change? I’ve personally
read report after report whose
conclusions are similar: we need to tackle
the rising rates of chronic disease by taking
a preventative approach. The Ontario
government for their part seems to understand
this and has even published their
“Framework for Preventing and Managing
Chronic Disease”. 4
The problem, in my opinion, lies in the
lack of funding commitment to address the
issue. Ontario has two separate ministries
responsible for health care and disease prevention:
the MOHLTC and the Ministry
of Health Promotion and Sport. Setting
aside for the moment the strange logic
of creating a separate ministry for health
promotion than for health care, the budget
numbers don’t lie. Health promotion/disease
prevention initiatives require financial
commitment, yet the Ontario Ministry of
Health Promotion and Sport has an annual
budget that is less than 10% of the annual
budget of the MOHLTC. 5,6
Thinking bigger picture for the moment,
we should never forget that being “healthy”
is a much more complex state of being than
simply being free of disease. An individual’s
health status is the product of a complex
assortment of factors, known collectively
as the Determinants of Health. The Public
Health Agency of Canada currently lists
2
twelve such determinants, ranging from
income and social support networks to
education level and culture. In other words,
improving the health status of a population
means more than just good quality health
care. It means equal opportunity for education,
ensuring access to clean drinking
water, breaking down stigmas associated
with gender and cultural inequality and
much more.
Overwhelmed? It’s not an easy task and
simple solutions are hard to come by. So
how can we as a profession help? I believe
it starts first and foremost when we as physiotherapists
work with individual patients
to empower them with the means by which
they can not only recover from injury but
ensure they maintain a healthy lifestyle.
Patient education is central to this and it’s
incumbent upon all of us to recognize, for
example, that educating a patient we’re
seeing for a neck strain about the risks
inherent with his obesity is entirely within
our scope of practice. Taking it to the next
level, I feel it is absolutely our responsibility
to approach each and every one of our
patient interactions with this broader perspective
in mind.
More formally, Ontario has several service
models for primary health care already
in place, including Community Health
Centres. Although originally envisioned as
another model of primary health care, the
extent to which Family Health Teams have
achieved this component of their mandate
is debatable. Regardless, the Ontario
Physiotherapy Association is committed to
ensuring physiotherapists are included as
a valued member of the team in primary
health care roles. As individuals, we must
also take every opportunity to show our
value as primary health care practitioners
in both the way we treat our patients and
in our communications with our partners.
There is no doubt in my mind that
the only long-term solution to the crisis
of our health care system is preventing
people from becoming ill in the first place.
Physiotherapists can and must be a leader in
these initiatives and I encourage all of us to
apply that in our day to day practice.
Continued on page 5