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Improving the Health of Manitobans: Economic Analysis and Business Case

Improving the Health of Manitobans: Economic Analysis and Business Case. Heart and Stroke Foundation of Manitoba October 14, 2009. Overview of Presentation. Understanding the Manitoba Context Prevalence and Historical Trends in the Risk Factors Risk Factors and the Burden of Disease

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Improving the Health of Manitobans: Economic Analysis and Business Case

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  1. Improving the Health of Manitobans:Economic Analysis and Business Case Heart and Stroke Foundation of Manitoba October 14, 2009

  2. Overview of Presentation • Understanding the Manitoba Context • Prevalence and Historical Trends in the Risk Factors • Risk Factors and the Burden of Disease • The Economic Burden of the Risk Factors in Manitoba • The Benefits of Reducing Risk Factors

  3. Overview of Presentation • Identify ‘Best Practices’ for Reducing the Risk Factors • Estimating the Cost of Implementing ‘Best Practices’ • Cost-Benefit Analysis

  4. Caveats • Research Project(s)? • Each step could be it’s own research project • Business Case? • Need to convince decision-makers • Business Plan? • Detailed plan for moving forward in a certain direction • Focus on • Tobacco consumption • Unhealthy eating / Obesity • Physical inactivity

  5. Understanding the Manitoba Context • Relevant policies/legislation/regulations in Manitoba • Manitoba’s partners in healthy living • Current programs with a focus on the risk factors in Manitoba

  6. Understanding the Manitoba Context • Process • Review websites, grey literature, etc. E.g. CPAC PPAG review of policy and legislation as it relates to food, physical activity, etc. in Canada • Input from Steering Committee and Reference Group • Interviews – personal and telephone

  7. Prevalence and Historical Trends in the Risk Factors (or, What’s the Problem?) • Recent study completed for CPAC – “An Overview of Selected Cancers and Modifiable Cancer Risk Factors in Canada” • Covers the current risk factors as well as a few others (alcohol, breastfeeding) • Full report available at www.krueger.ca

  8. Risk Factors and the Burden of Disease • What evidence is there for the relationship between the risk factors and the burden of disease? • Review from “The Health Impact of Smoking & Obesity and What to Do About It”(2007) by Krueger, Williams, Kaminsky and McLean

  9. The Economic Burden of the Risk Factors (in Manitoba) • Excess cost per individual with the risk factors • Direct and indirect costs • Annual cost to the province

  10. The Benefits of Reducing Risk Factors • What evidence is there that a change in risk factors is associated with a change in health? • Research complicated by the fact that changes in behavior (e.g. quitting smoking) often associated with diagnosis of a disease (e.g. cancer) • Health improvements not always immediate

  11. The Benefits of Reducing Risk Factors (cont’d) • Weight loss – intentional (24% mortality rate) vs. unintentional (31% mortality rate) (Greg et al. Ann Int Med (2003) • Smoking cessation associated with a spike in costs • Early death of smokers spares them from poor health during their later years (if they had not smoked)

  12. Identify ‘Best Practices’ for Reducing the Risk Factors • Review of the available literature • Much more research on effective interventions for smoking cessation • Identify ‘best’ and ‘promising’ interventions, particularly for other risk factors

  13. Identify ‘Best Practices’ (cont’d) What can we learn from the ‘Tobacco Wars’ about effective interventions? • Increasing Prices • Reducing Opportunities to Promote the Product • Smoke-free Public Places • Counter Advertising • Primary Care Based Cessation Programs

  14. Identify ‘Best Practices’ (cont’d) What can we learn from the ‘Tobacco Wars’? • No single intervention can account for the successes seen since the 1960s • Each intervention is enhanced synergistically by other components • Required systemic changes (ban on advertising, price increases, legislated smoke-free places) and social ‘denormalization’ • Governments and communities must work together with adequate financial and organizational resources over the long haul • Interventions must be available for individuals who seek to make a lifestyle change

  15. Identify ‘Best Practices’ (cont’d) • Overweight: What Can we Learn from the ‘Tobacco Wars’ - Differences • Food and activity are essential; tobacco is not • Possible negative consequences (disordered eating) • Underlying genetic/disease conditions • Limited research on effective interventions

  16. Identify ‘Best Practices’ (cont’d) Overweight: What Can we Learn from the ‘Tobacco Wars’ - Similarities • Social influences and advertising pressures influence what we eat • Environmental constraints can lead to limitations on physical activity • ‘Obesogenic environment’

  17. Identify ‘Best Practices’ (cont’d) • Regulatory and Economic Interventions(cont’d) • Consider restrictions on food advertising aimed at children • Consider a focused trial of taxation measures for specific unhealthy foods • Continue to protect against creative attempts by the tobacco industry to market their product, e.g., retail “power walls,” product placements, smoking in movies & magazines • Improve compliance with restrictions on tobacco sales to minors

  18. Identify ‘Best Practices’ (cont’d) • Community-Based Interventions • Establish Community Action Coordinators (2 per electoral riding) to mobilize strategies for risk factor reduction • Provide modest funding for up to 1,200 community groups throughout the province with ideas on how to address risk factors • Develop a strategic media plan with clear, common messages for different at-risk populations with well-conceived short and long term advocacy goals • Consider subsidizing pedometers as a source of instant feedback to individuals who are attempting to become more physically active • Implement “point-of-decision” prompts to encourage healthy behaviours • Encourage and support walking groups and physical activity events • Enhance access to places of physical activity; both indoor and outdoor

  19. Identify ‘Best Practices’ (cont’d) • School-Based Interventions • Expand Action Schools! BC program and encourage a more rapid implementation of some of its recommendations, plus coordination with anti-smoking resources, to move towards significant levels of primordial prevention among young people • Focus on environmental approaches to risk factor interventions, including options for promoting healthy foods, curtailing access to unhealthy foods, creating opportunities for physical activity and tobacco free sites. • Workplace-Based Interventions • In partnership with WCB, unions, business and others, offer funding to assist employers and employees to create a healthier work environment, from stairway walking campaigns to exercise facilities and healthy food choices

  20. Identify ‘Best Practices’ (cont’d) • Clinical Interventions and Management • Implement a program of ‘prevention detailing’ to provide education and feedback to enable primary health care providers to more fully address risk factors • Cover out-of-pocket expenses for nicotine replacement therapy initiated within a recognized clinical program • Provide reimbursement for lifestyle counselling around physical activity, healthy eating and living smoke free • Provide compensation to primary health care providers for lifestyle counselling around physical activity, healthy eating and living smoke free

  21. Estimating the Cost of Implementing ‘Best Practices’ • High level costing of implementing the major interventions • E.g. from increased taxation to community-based action co-ordinators to prevention detailing, etc.

  22. Cost-Benefit Analysis • Combining information on • Potential Targets • Cost of interventions required to achieve targets • Potential costs avoided if the targets are achieved

  23. Logical Pathway

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