Diabetes epidemic finds Health Canada more worried about fragile economic recovery

Apparently regulating fast food companies to improve population health is not an option for Health Canada, who recently told CBC News that the “fragile economic recovery” is an important consideration.

Health Canada was responding to a report by the Canadian Medical Association Journal which noted sodium levels were higher in Canada’s fast food outlets than their counterparts in other countries.

The Chicken McNuggets you eat in Canada have more than twice as much salt as the McNuggets in Britain. While Canadian fast food outlets brought in salads in response to growing health concerns, these salads have higher levels of salt than any other nation. Combined with high fat levels in the dressing, you might as well have had the fries.

This week ICES – the Institute for Clinical Evaluative Sciences — issued what is effectively a wake-up call on Ontario’s spiralling diabetes epidemic. Hint: there may be a connection between these two stories.

Looking at changes between 2006/07 and 2010/11, the incidence of adults living with diabetes was up 13 per cent in the Greater Toronto Area and in Northern and First Nations communities by as much as 32 per cent. One half of all cases live in the Greater Toronto Area.

It also notes that Ontario’s response is very uneven. Whereas urban areas were more likely to experience higher levels of diabetes, they were also more likely to get support than rural areas or the north. While amputations are preventable with this kind of support, the two northern LHINs reported the highest level of lower extremity amputation in Ontario – 3.5 times greater than some of the southern LHINs. Northern communities were about three times as likely to experience chronic complications from diabetes.

In 2008 Ontario launched its diabetes strategy, although the numbers would indicate that it is not nearly enough.

If we want to “bend the cost curve,” as the Ontario Hospital Association likes to say, then here is where the rubber should really hit the road.

According to the ICES report, “diabetes is an extremely complex and costly condition to manage.”

No kidding. Many of these lead to hospitalization. Cardiovascular disease (heart attack, stroke) is the leading cause of death for individuals with diabetes. It is the leading cause of kidney failure in Canada. Foot complications are major. Without prevention, amputation is a very real possibility.

ICES also notes that people with diabetes are at increased risk for cancer, arthritis, liver disease, depression and anxiety disorders. Curiously, diabetes-related mental health visits were more likely to take place in the GTA than any other part of the province.

If we want to look at why our health care costs are as high as they are, this may be the answer.

One of the criticisms of the McGuinty spring budget is it only escalates the rate of inequality within society. Yet research shows that low-income families have a much higher risk of diabetes and worse outcomes once they develop it.

ICES notes that complications from diabetes have fallen considerably in the past two decades, but not the rate of diabetes.

This would strongly suggest that we are doing better on the downstream aspects of this disease (although studies indicate a significant percentage of Ontarians with diabetes are not receiving recommended monitoring tests), but not the upstream prevention – healthy diet, increased physical activity and smoking cessation.

One of the recommendations of the Drummond Commission was to triple spending on public health prevention. This was completely ignored in the spring budget.

Clearly, as indicated by Health Canada, we can’t see the forest for the trees when it comes to meaningful and sensible actions that would reduce our health costs.

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