March 22, 2012 - From the Patients’ Association of Canada (PAC) we can do little but applaud yesterday’s publication by Cancer Care Ontario and Public Health Ontario of Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario. They have recognized that the great killers today are no longer the acute infectious diseases of yesteryear which were caused by identifiable microorganisms, but the slowly progressing chronic conditions which are affected by social and environmental factors.
In the past the efforts of public health contributed to the reduction and virtual eradication of acute infectious diseases like small pox, tuberculosis, and polio. A shift of focus to the current reality of chronic disease is now needed. This paper also marks a substantial change of emphasis for Cancer Care Ontario. Cancer is not “conquerable†like acute infectious diseases – it must be understood as many different chronic diseases, some of which are preventable, and some that are treatable - and so our way of responding to cancer must change. At PAC we have recognized that the prevention and treatment of acute infectious disease is properly expert driven.
Patients cannot design protocols for treating acute episodes of small pox or tuberculosis, nor can they develop vaccines for polio or anthrax. But when it comes to most non-acute chronic conditions, patient and family engagement is critical to their prevention and treatment. Unfortunately, the methodology and the recommendations of Taking Action to Prevent Chronic Disease have no patient and family contribution – it seems that no patients or patient organizations are listed among the contributors nor the project teams as far as we can tell. This absence is worth noting.
One result is that the document assigns the entire responsibility for prevention of chronic disease to government and its “non-governmental partners.†It is as if those who are at risk of chronic diseases or already suffer from them can have no thoughts or useful ideas about prevention of the diseases that affect them and their lives. This seems to be a hangover from the expert based response to acute infectious diseases. It is quite inappropriate for chronic conditions.
What difference would it have made to involve patients? Patients and families would reprioritize the recommendations, add to some of them and reduce the emphasis on others. They might also add new recommendations not considered by the “experts.†For example, the most critical recommendation for patients and families with regard to smoking and alcohol is to provide much more smoking and alcohol cessation support. In our current system these kinds of programs are underfunded and the first to be targeted by spending cuts. Raising taxes on addicted cigarette smokers who have no possible help in stopping is hardly humane.
As another example, a food policy for Ontario has already been proposed by the industry, and this one looks remarkably similar. It is a policy that emphasizes contributions from the industry itself and researchers; it makes little or no mention of consumers who actually eat the stuff and have a great deal to say about everything from labelling to distribution. Unfortunately, this aspect of the document is a remnant of the older expert and researcher driven way of thinking about health which leaves no room for patient, consumer, or citizen involvement. This will, I am sure, be remedied in the future so that we can effectively reduce the impact of chronic disease with the active participation of patients and their families.