Conseil Communauté en santé du Manitoba

BY DR. MICHAEL ROUTLEDGE
Winnipeg Health Region
Wave Magazine, Nov. / Dec. 2011

Nineteen.

As I sat down to write this column for Wave - the first in a series that will look at health issues in our community - this number kept popping into my head.

Let me explain why.

The past century has seen an incredible increase in life expectancy in Western society. In 1900, a woman in Canada could expect to live 50 years, while a man could expect to live to be 47. Today, these numbers are 83 years and 79 years respectively.

Some of this increase in life expectancy can be credited to advances in medical science and our ability to better diagnose and treat diseases. But most of it is due to something outside the scope of our healthcare systems: advances in public healthrelated policies and practices.

In fact, of the 30 years of average lifespan gained in the 20th century - an incredible advance given that prior to 1900 there had been minimal change in life expectancy through several thousand years of human existence - 25 years of it can be attributed to advances related to public health.

In 1999, the U.S.-based Centers for Disease Control identified a list of 10 great public health achievements based on the opportunity for prevention and the impact on death, illness, and disability. This list includes vaccination; motor-vehicle safety; control of infectious diseases from clean water and improved sanitation; healthier mothers and babies; and recognition of tobacco as a health hazard. The most striking conclusion from this list is that it’s not high-tech tests that most effectively improve life expectancy. Rather, it is other societal and environmental changes that prevent disease and result in improved health, well-being and safety.

Yet despite the overall increases in life expectancy, there is reason to believe that we can do better.

Which brings us to 19.

Within Winnipeg, recent data has shown a 19-year difference between the neighbourhoods with the highest and lowest life expectancy. To put this enormous gap into perspective, it has been estimated that if all cancers were eliminated, we would see an increase in life expectancy in the range of only three to five years.

Clearly, the 19 year gap suggests that there is something systemic at work that is negatively affecting the health of some in our community much more than others. And the impacts are significant. People are dying before their time from chronic diseases and suffering from mental illness, while the health-care system strains to meet the demands of caring for the ill.

What can be done to close this gap? To be sure, we need to continue efforts to help individuals make good personal choices. But we also need to make changes at the societal and environmental level.

The effort to reduce smoking rates provides an excellent example of how we can create positive health behaviour change at a population level. Increased education about the harmful effects of tobacco helped convince people that smoking was bad for them. But the biggest factors in driving down smoking rates were environmental changes, such as making cigarettes more expensive through taxation and introducing smoke-free public spaces. And while this reduction in smoking rates has been a success, many teens and young adults continue to take up smoking, indicating that there is still much to do.

The lesson here is clear. Individuals make choices, but the environment society creates around a person can dramatically affect the choices he or she makes. Our goal as a society should be to create environments that foster good decision-making.

The opportunities for improvement are many, but here are a few to consider:

Nutrition

We know that a balanced diet is important to good health. But are we doing enough to ensure all members of society have access to affordable and nutritious food?

Healthy families

We know that the health of our children depends on them being raised in a supportive and stimulating home. But are we doing everything we can to ensure that mothers and fathers have the tools and skills required to be good parents?

Active living

Health experts often talk about the need for people to exercise more. But is there more we can do to make sure we have communities that make an active lifestyle convenient and safe?

These are just some of the public health issues we face today. My own education on these gaps and challenges began as a medical student, and continues to this day in my role as a medical officer of health and as a family physician. Many of the patients I see suffer from conditions that could have been prevented. This constantly reminds me that promoting health and preventing avoidable disease is better for individuals, and is more efficient for a sustainable health-care system as well.

In the months ahead, I will use this column to explore the impacts of these and other challenges, as well as potential solutions. The focus will be a combination of advice directed at both the individual and the societal level to improve health by examining the factors that make some healthy and others sick. In doing so, I hope we can start a discussion about ways to build a healthier community. Perhaps we can even come up with a few ideas to shrink the 19-year gap.

Dr. Michael Routledge is a Medical Officer of Health with the Winnipeg Health Region.