Chronic Disease and Aging: A Public Health Perspective
Speaker: David Butler-Jones, MD, MHSc, LLD(h), FRCPC, FACPM, CCFP, Chief Public Health Officer of Canada.
While the challenges posed by chronic disease to Canada’s aging adults justly occupied the attention of the conference’s participants, Chief Public Health Officer of Canada Dr. Butler-Jones urged participants to refocus attention on the value of aging. While rising rates of chronic disease are a formidable problem, he observed that aging adults remain key contributors to society and that aging with chronic disease is preferable to dying young. He noted that aging is not the problem; how we live makes a difference—it is not just a matter of length of life.
Public health comprises a set of programs and services but is also a way of “understanding the causes of the causes.” According to Dr. Butler-Jones, public health efforts facilitate better understanding of the interrelationship of physical health and the social environment. Public health is uniquely positioned to advise other sectors, provides leadership in promoting healthy aging, and is capable of engaging valued partners across society to build healthy, enabling environments.
Public health acknowledges the importance of supporting health throughout the life course, and that health outcomes are an end stage of a lifelong trajectory. For example, poverty in infancy is associated with a doubled stroke risk in later life. He also noted that public health research has produced insights on the interaction of forces that serve as determinants of health, such as the relationship between social markers, chronic conditions, and health vulnerabilities. Dr. Butler-Jones discussed his 2008 Chief Public Health Officer’s Report on the State of Public Health in Canada, stressing that understanding the determinants of health is essential as they provide the context and direction for prevention and interventions. He also noted that mortality in the recent SARS and listeria infection outbreaks in Canada were associated with underlying chronic conditions. An aging population elevates vulnerability.
Other important factors in aging and chronic disease vulnerability include poor self-rated health and lack of social connectivity. Those without close social networks (family, friends, colleagues, etc.) have twice the risk of dying of those not socially isolated.
Regarding the prevalence of chronic disease among aging adults, Dr. Butler-Jones noted that approximately 85% of those aged 65-79 and more than 90% of those 80 years and over reported at least one chronic disease in 2005.
Dr. Butler-Jones emphasized that the approach to chronic illness should not pose preventive care against clinical care but focus on their coordination and improvement. He discussed disease-specific interventions, and noted that healthy living should not be seen in opposition but as an opportunity for interaction and cross over, for example, in terms of interventions and risk factors. The broader perspective appreciates contextual factors that improve health and build healthy environments, such as promoting those community features and infrastructures that support healthy aging (e.g., more liveable, safer communities that enhance social support and connectedness, illustrated by the example of the Age Friendly Communities Model).
Key examples of where aging and chronic disease intersect and where there are public health opportunities for healthy aging include the domains of fall prevention (involving design and infrastructure at the community level, plus awareness, education, assessment, exercise, hazard reduction, etc.), mental health, better caregiver support (one in 12 Canadian seniors provides care to another senior with a long-term health problem), emergency preparedness, elder abuse, and promoting age-friendly communities. Finally, he noted that seniors are not merely a vulnerable population but represent a key resource in the community, and are essential partners in public health efforts promoting effective healthcare improvements and safety planning.
