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…

BreastfeedingBreastfeeding 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

NutritionNot 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

Data Source: Keeping Pace 2009-10

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.

Physical Activity Trends% Meeting Minimum Guideline

*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

2001-02 2005-06 2009-10*

Sedentary BehaviourScreen Time

% Exceeding Recommended Maximum of 2 hours/day

Data Source: Keeping Pace 2009-10

Screen time was higher on weekend days.

Overweight and Obesity

% Overweight or Obese

Data Source: Keeping Pace, 2009-10

“Looking at the increasing rate of childhood obesity is like looking into the future health of Nova Scotians.”

Dr. Keith McCormickDoctors Nova Scotia

Health Promotion Section Chair

Looking ahead…

How Do Adults Compare?

More Overweight and ObeseLess Vegetables and Fruit

% Eating Less Than 5 Servings/Day % Overweight or Obese (BMI>25)

Data Source: CCHS 2009-10 (self-report)

• 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.

Poor Adult Health Outcomes

• 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

Developing a Strategy

• 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”

What We Heard

• 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

Our Approach

• 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

Foundation – Social Policy

"No ONE thing will ever prevent childhood obesity… or any obesity for that matter.”

Dr. Yoni FreedhoffObesity Expert

Weighty Matters

The “sandbag phenomenon”

What will we do?

"No ONE thing will ever prevent childhood obesity… or any obesity for that matter.”

Dr. Yoni FreedhoffObesity 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?