Shifting the Focus: Preventative Healthcare vs. Disease Care in Canada

For several years now, I’ve had the honour and privilege to see multiple hospital reports daily across most specialties, with patients ranging from children to seniors, and one thing has become apparent to me: In Canada, we have a disease-care system, not a health-care system. Please don’t get me wrong: Our medical professionals are exceptionally talented and caring, are doing their very best, but are stretched thin to their maximum capacity. Just that sentence alone is a sad statement on the state of our health system in Canada. Add to it that our doctor visits now are generally 15 minutes long and limited to one “complaint” unless it’s a full physical, and it’s obvious that a visit is a stopgap measure, not a stepping stone to education and prevention.

So, what do I mean when I say disease care versus health care? In my mind, from a holistic viewpoint, and based on observation, there is a fundamental distinction that often emerges between healthcare and disease care. While disease care primarily revolves around managing and treating existing medical conditions only, including imaging and lab tests, health care would take a proactive approach, focusing on prevention, holistic well-being, and the maintenance of healthy lifestyles, with disease care coming in only when needed. Unfortunately, health care takes time, and an ability to get to know your whole patient, in order to be able to create a joint preventative healthcare plan and have ongoing followup when a health glitch occurs. With our physician shortage and the pharmacological viewpoint pushing medication for everything, it’s tough for anyone to have healthcare in Canada, unless they take care of their own health plan, pay for alternative healthcare practitioners, or pay privately.

Current Landscape of Disease Care in Canada

I want to make is clear that disease care is absolutely critical, but we really need to start focussing on prevention in our healthcare system. Using AI to help pull some stats, a sobering picture emerges: Based on the latest available data, the rate of chronic disease prevalence in Canada has been showing an increasing trend over time. According to a report on the health of Canadians, the age-standardized prevalence of chronic diseases has been on the rise, indicating a growing burden of disease within the population. Specifically, the number of patients with chronic disease increased by 11.0% over a 10-year study period to 9.8 million in 2017/18. No doubt this is continuing into the 2020’s, and this upward trajectory is concerning, especially when considering the financial and capacity impact on public health and healthcare systems.

Furthermore, a study on chronic disease multi-morbidity revealed that 12.9% of Canadians report having two or more chronic diseases, while 3.9% report three or more chronic diseases. This underscores the complex nature of the disease burden faced by a significant portion of the Canadian population. As our population ages and lives longer, these numbers will likely increase.

I can’t cover all disease in one blog post, but one of the more prevalent chronic diseases of our time is diabetes. There are 2 well-known types: Type 1 diabetes, which is a chronic condition where the pancreas makes an insufficient amount or no insulin, and insulin injections are required. Diabetes mellitus, or type 2 diabetes, develops over time when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin to maintain normal blood sugar levels. This condition is influenced by a combination of genetic, environmental, and lifestyle factors. There’s also type 3 diabetes — Alzheimer’s disease — which is potentially insulin resistance in the brain.

Unfortunately, the prevalence of diabetes in Canada has increased over time. Again using AI to pull some statistics, according to the most up-to-date surveillance information, currently 8.8% of Canadians are affected by diabetes, with the prevalence being 9.4% among males and 8.1% among females (Source: NCBI). Additionally, it’s reported that there are more than 5.7 million Canadians living with diabetes, including both diagnosed and undiagnosed cases (Source: Diabetes Canada).

Just a few more quick stats:

• Chronic diseases among Canadian adults includes hypertension at 25%, osteoarthritis at 14%, and mood and/or anxiety disorders at 13% (Source: Canada.ca).

• For Canadians aged 65 years and older, the prevalence of chronic diseases and risk factors includes 65.7% for hypertension and 52.0% for periodontal disease (Source: Canada.ca).

• Canadian adults aged 20–79, 12.4% had prediabetes and 7.5% had diabetes, with 37.3% of all diabetes cases being undiagnosed (Source: PubMed). These statistics indicate a concerning trend of increasing diabetes prevalence in Canada, suggesting a need for proactive measures to address this public health issue.

I think you get the picture here. What we have here is a healthcare system with a shortage of medical professionals in most fields, an increasing burden of people becoming chronically ill, care wait times skyrocketing at every doctor’s office and hospital, and insufficient financial resources, government or otherwise, to fund the system.

I think it’s time we shifted the current healthcare paradigm into something more accessible and proactive: Enter preventative or maintenance healthcare.

So What Do I Mean by Preventative Health Care?

At it’s most basic definition, to me, preventative healthcare is a broad term that encompasses measures and practices aimed at preventing illness, promoting wellness, and identifying health issues early on. This proactive approach to healthcare emphasizes regular screenings, vaccinations, lifestyle modifications, and health education to minimize the risk of developing chronic conditions and address potential health concerns before they escalate. By prioritizing preventative healthcare, individuals can work towards maintaining overall well-being and reducing the burden of disease, ultimately leading to improved long-term health outcomes.

Those things sound good for individuals for sure, but the impact on the Canadian healthcare system could be even more important.

Before I get into that though, I want to clarify that healthcare in Canada isn’t a centralized system addressed at the national level, which means that every province’s healthcare offerings may be different. Provinces have the responsibility of the financing, administration, and regulation of public health care. In other words, each province sets budgets for healthcare spending and manages its own healthcare system and related services, which directly impact the provision of healthcare to its residents. The criteria is that the system must be universal, publicly administered, have comprehensive coverage and be accessible, and offer access to physician and hospital services through tax-funded public insurance plans.

The Future View

Having set the background understanding of our Canadian “healthcare” system and how poorly the overall infrastructure is equipped to handle the current trend of increasing disease care that will be required, I think it’s basically it’s up to our provinces to start future-thinking and to see that our current healthcare isn’t sustainable. Our system is broken, and breaking down even further. Preventative healthcare is a way to bypass the old system, and set the future of our healthcare for success. I’m not saying it’s a perfect fix, or even that we’ll get it right out of the box. What I am saying is that preventative health care can save money and free up medical resources for the inevitable illnesses and acute injuries/illness that will happen as part of our human condition.

It’s pretty obvious that our medical professionals don’t have time to give health education or lifestyle advice, but there are many others who are very qualified to do this, though most aren’t recognized by provincial insurance plans, such as OHIP. For example, medical herbalists are trained in the art of physical exams, and if in a good school, the same health sciences as medical students. They’re educated on how to make/administer herbal medicine, have nutritional training and are well able to suggest positive lifestyle modifications. This is the path that I’m on. Naturopathic doctors are trained in the same basic health sciences as a medical doctors, needing a pre-med degree, then a 4-year program in naturopathic medicine, and must be licensed in many provinces, the same as medical doctors. The difference is that they also learn holistic and nontoxic approaches to health care, with a strong emphasis on disease prevention and optimizing well-being. Traditional Chinese medicine is another perfect example of practitioners who well understand the human body and can offer preventative health care. There are many other type of practitioners you can add to the list — massage therapists, physiotherapists, acupuncturists, foot care professionals, mental health counsellors — the list goes on. If you’re lucky, you or your spouse may have a “wellness” account with limited dollars to spend, but otherwise, access to these preventative measures are often prohibitive, due to cost of paying out of pocket in addition to the soaring cost of living and tax burden in this country.

The provinces need to start weighing the benefits and potential cost savings of covering actual healthcare — the educational and preventative kind — in order to ease the crunch of constantly putting out fires by treating diseases instead. Imagine a world where mental health care was prioritized, massages were a monthly option for everyone, and people had the option of visiting a doctor or alternative professional, and having it covered. We need to stop thinking that doctors/nurse practitioners, etc., are our only first avenue to good health. They are swamped, stressed and burning out trying to manage it all. The provinces need to recognize that there are perfectly qualified, knowledgeable and dedicated individuals who can contribute to medicine and healthcare as a whole, as well. It sounds like the “rose-coloured glassess” view of health care, but I believe it would make an overall difference in our view of health to what it actually should be — that we work on preventing illness until we can’t, and then we seek more specialized help. I also think this would provide significant relief to the financial burden, resource shortage and lack of access to healthcare for most that is the current climate in Canada overall.