The Cost of Chronic Disease in Nova Scotia. 2002.

A research report that looks at the financial impact of seven chronic conditions, as well as the province's performance relating to the major modifiable risk factors for these diseases and the underlying social determinants of health.
By Ron Coleman, Ph.D., GPI Atlantic
135 pages

The Cost of Chronic Disease in Nova Scotia

Description

The Cost of Chronic Disease in Nova Scotia is the report of a study undertaken to estimate the financial cost of chronic illness, and to assess both the proportion of chronic illness that is preventable and the cost-effectiveness of prevention. The study uses 1998 figures to examine the costs of selected chronic diseases of the circulatory, respiratory, musculoskeletal, endocrine and nervous systems, as well as cancer and mental illness. Costs and performance associated with the major risk factors for these conditions and the underlying socio-economic determinants of health are also examined. In addition, the report provides a review of current research on the value of health promotion in reducing chronic disease.

Compared to other Canadians, Nova Scotians have particularly high rates of chronic illness. The province ranks first in the country for people with arthritis and rheumatism and for deaths from cancer and respiratory disease. Nova Scotia ranks second in Canada for psychiatric hospitalization and for deaths due to diabetes and circulatory problems. Cardiovascular disease (heart disease, stroke and atherosclerosis) claims the lives of 2,800 Nova Scotians each year, and accounts for 36% of all deaths in the province. An estimated 2,400 Nova Scotians will die of cancer every year, accounting for 30% of all deaths in the province.

Medical care costs for people with these chronic conditions account for 60% of total medical care expenditures in Nova Scotia, or $1.2 billion a year. Because of the debilitating nature of these illnesses, and because cancer and heart disease kill so many at an early age, the indirect costs of chronic illness due to productivity losses are particularly high. If the direct medical cost and indirect productivity losses ($1.79 billion) are combined, the total economic burden of seven types of chronic illness (cardiovascular diseases, cancer, respiratory ailments, diabetes, musculoskeletal disorders, conditions of the nervous system and sense organs, and mental illness), exceeds $3 billion a year.

The report estimates that 40% of chronic illness can be prevented. Epidemiological studies indicate that 25% of all medical costs (or nearly half a billion dollars a year in Nova Scotia) are attributable to a small number of excess risk factors like smoking, obesity, physical inactivity and poor nutrition.

Socio-economic causes of chronic illness, such as poverty, inequality and poor education, and environmental causes such as exposure to toxic pollutants, are also modifiable. Low-income women under the age of 40 are 62% more likely to be hospitalized than higher-income women; over the age of 40, they are 92% more likely to be hospitalized. In Nova Scotia, those without a high school diploma use 49% more physician services than those with a B.A., while low income groups use 43% more physician services than higher-income groups. The report estimates that excess physician use due to educational inequality costs the Nova Scotia health care system $42.2 million a year; excess physician use due to income inequality costs $27.5 million a year.

Low-income groups have higher rates of smoking, obesity, physical inactivity and cardiovascular risk. The report suggests that Nova Scotia could avoid an estimated 200 deaths and save $214 million per year if all Nova Scotians were as heart healthy as higher-income groups.

The report concludes that Nova Scotia's high rates of chronic illness can be reduced through concerted health promotion initiatives that reduce risk behaviours and conditions. It suggests that the province's escalating health care costs can be significantly lowered by improving the health of the population and thereby reducing the need and demand for medical care.

Credits

The Cost of Chronic Disease in Nova Scotia was produced by Ron Coleman, Ph.D. of GPI Atlantic. The report was commissioned and funded jointly by the Nova Scotia Department of Health and the Atlantic Regional Office of the Population and Public Health Branch, Health Canada.

Availability

This report is available in English only on the web site of the Nova Scotia Department of Health.

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